The Relationship Between Barriers to Medical Error Disclosure and Patient Safety Culture: A Cross-Sectional Study

Changes in the patient safety culture in hospitals can increase error disclosure, but the relationship between these factors remains unclear.

To explore nurses' perceptions of barriers to the disclosure of medical errors in the context of a patient safety culture and to identify relevant influencing factors.

Cross-sectional study.

Two tertiary and two secondary comprehensive hospitals in southwestern China.

Chinese registered nurses who were employed in secondary or tertiary comprehensive hospitals.

In May 2023, electronic questionnaires were distributed to all nurses in the selected hospitals. The survey included nurses' characteristics, a hospital survey on patient safety culture, and the Chinese version of the barriers to error disclosure assessment (C-BEDA) tool. The data thus collected were subjected to descriptive and multiple linear regression analyses.

The effective recovery rate was 96.23% (792/823). Nurses reported that financial concerns represented the greatest barrier to medical error disclosure, followed by psychological barriers and knowledge barriers. A multiple linear regression analysis revealed that working departments, communication openness, feedback and communication about errors, nonpunitive responses to errors, teamwork across units, and hand-offs and transitions collectively accounted for 27.2% of the variation in nurses' confidence and knowledge barriers. Age, title, managerial position, tenure, marital status, and continuous improvement in organizational learning explained 28.7% of the variation in the institutional barriers faced by nurses. Gender, title, tenure, supervisor/manager expectations, actions taken to promote patient safety, and openness to communication explained 10.2% of the variation in the psychological barriers faced by nurses.

To encourage nurses to disclose medical errors effectively, hospitals must first address nurses' concerns regarding economic issues and provide them with comprehensive training in error disclosure alongside psychological support. Hospitals should prioritize the establishment of a patient safety culture at the unit level, particularly with respect to organizational learning, continuous improvement, and openness to communication.