Publication Details

Title :

Similarities and differences in the associations between patient safety culture dimensions and self-reported outcomes in two different cultural settings: a national cross-sectional study in Palestinian and Belgian hospitals


BMJ Open

Impact Factor:



Shahenaz Najjar1,2, Elfi Baillien3, Kris Vanhaecht4, Motasem Hamdan5, Martin Euwema6, Arthur Vleugels2, Walter Sermeus2, Ward Schrooten7, Johan Hellings7, Annemie Vlayen7


1 Population Health Department, Hospital – MNG-HA, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

2 Leuven Institute for Healthcare Policy, School of Public Health & Primary Care, KU Leuven, Leuven, Belgium

3 Department of Work and Organisation Studies, KU Leuven, Brussels, Belgium

4 Leuven Institute for Healthcare Policy, School of Public Health & Primary Care, Department of Quality Management, UZ Leuven, KU Leuven, Leuven, Belgium

5 Department of Health Policy & Management, Faculty of Public Health, Al-Quds University, Jerusalem, Palestine

6 OrganizationalPsychology, research group Work, Organizational and PersonnelPsychology, KU Leuven, Leuven, Belgium

7 Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium

Year of Publication:





To investigate the relationships between patient safety culture (PSC) dimensions and PSC self-reported outcomes across different cultures and to gain insights in cultural differences regarding PSC.

Design :
Observational, cross-sectional study.

Ninety Belgian hospitals and 13 Palestinian hospitals.

Participants :
A total of 2836 healthcare professionals matched for profession, tenure and working hours.

Primary and secondary outcome measures:
The validated versions of the Belgian and Palestinian Hospital Survey on Patient Safety Culture were used. An exploratory factor analysis was conducted. Reliability was tested using Cronbach’s alpha (α). In this study, we examined the specific predictive value of the PSC dimensions and its self-reported outcome measures across different cultures and countries. Hierarchical regression and bivariate analyses were performed.

Eight PSC dimensions and four PSC self-reported outcomes were distinguished in both countries. Cronbach’s α was α≥0.60. Significant correlations were found between PSC dimensions and its self-reported outcome (p value range <0.05 to <0.001). Hierarchical regression analyses showed overall perception of safety was highly predicted by hospital management support in Palestine (β=0.16, p<0.001) and staffing in Belgium (β=0.24, p<0.001). The frequency of events was largely predicted by feedback and communication in both countries (Palestine: β=0.24, p<0.001; Belgium: β=0.35, p<0.001). Overall grade for patient safety was predicted by organisational learning in Palestine (β=0.19, p<0.001) and staffing in Belgium (β=0.19, p<0.001). Number of events reported was predicted by staffing in Palestine (β=−0.20, p<0.001) and feedback and communication in Belgium (β=0.11, p<0.01).

To promote patient safety in Palestine and Belgium, staffing and communication regarding errors should be improved in both countries. Initiatives to improve hospital management support and establish constructive learning systems would be especially beneficial for patient safety in Palestine. Future research should address the association between safety culture and hard patient safety measures such as patient outcomes.