Effect of Accreditation on Patient Safety Culture: Insights from a Brazilian Multicenter Cross-Sectional Study

As healthcare organizations strive to improve the quality and safety of their services, there is growing recognition of the importance of fostering a patient safety culture to enhance patient safety and improve patient care outcomes. This study aims to evaluate healthcare professionals' perceptions of patient safety culture in accredited vs nonaccredited hospitals within a network of 68 hospitals in Brazil.

This cross-sectional, multicenter study included 68 hospitals from a private network. The Hospital Survey on Patient Safety Culture (HSOPSC) was administered across all participating hospitals in September 2022. Hospitals that had been formally recognized for their quality and safety standards were compared with nonaccredited hospitals. Scores for various dimensions of patient safety culture were compared between groups. A logistic regression model was applied to assess the association between the frequency of event reporting in the past 12 months and participant characteristics.

A total of 31,919 healthcare professionals responded to the survey. Compared with nonaccredited hospitals, accredited hospitals reported higher scores in communication openness (3% higher, p = 0.04), frequency of events reported (4% higher, p = 0.02), and overall perception of patient safety (4% higher, p = 0.02). Accreditation was associated with a reduced likelihood of event underreporting (odds ratio = 0.80; 95% CI, 0.74-0.87), and physicians were more likely to underreport compared with nursing staff.

Although accreditation enhances patient safety culture, its effect may be more limited in healthcare networks with robust quality management systems already in place. To drive meaningful improvements, policymakers should go beyond accreditation and prioritize the reinforcement of ongoing institutional safety initiatives. Particular attention should be given to persistent challenges, such as fostering a nonpunitive approach to errors and addressing underreporting of adverse events. A graphical abstract is provided in the supplemental material.