Assessing Patient Safety Culture in Hospital at Home Services Across Spain Through a National Survey

Patient Safety Culture (PSC) is key to healthcare quality. While widely studied in hospitals, evidence on PSC in Hospital at Home (HaH)-a growing model delivering hospital-level care at home-remains scarce. This study evaluated PSC among professionals in Spanish public HaH units. A descriptive, cross-sectional survey was conducted using the Spanish-validated Hospital Survey on Patient Safety Culture 2.0. Participants were physicians, nurses, and other HaH professionals with ≥ 3 months' experience. A total of 199 responses were analyzed using non-parametric tests. Positive response rates identified strengths (≥ 75%) and improvement areas (≤ 50%). Teamwork Within Units achieved the highest positive responses, indicating strong collaboration, while Staffing and Work Pace scored lowest, reflecting workload concerns. Most rated unit safety as "good" or "very good," though few as "excellent." Nurses reported more favorable perceptions than other professionals. Significant differences appeared in teamwork, communication, and leadership support. Comments highlighted commitment despite workforce shortages and limited institutional recognition. HaH services demonstrate a generally positive PSC. Addressing staffing and workload challenges through stronger institutional support and safety protocols is crucial for sustainable, safe home-based care.