Organizational Culture Patterns and Safety-Relevant Dimensions in Teaching Hospitals: A Cross-Sectional Study

Organizational culture is widely recognized as an important determinant of patient safety, yet it remains unclear which cultural dimensions genuinely drive safety-related outcomes in teaching hospitals, particularly in low- and middle-income country (LMIC) contexts. This study aimed to move beyond organizational ideals by identifying dominant cultural patterns and their potential operational relevance for safety outcomes in Iranian teaching hospitals.

This cross-sectional analytical study was conducted among healthcare staff working in teaching hospitals affiliated with Mashhad University of Medical Sciences, Iran. Organizational culture was assessed using a validated multilevel questionnaire measuring teamwork, responsibility, risk-taking, and accountability across beliefs, values, behaviors, and symbols. Descriptive statistics, group comparisons, correlation analyses, and regression models were used to examine cultural patterns and identify factors associated with accountability and responsibility.

A total of 108 hospital staff participated in the study. Among the four organizational culture dimensions, responsibility showed the highest overall mean score, followed by accountability, while teamwork and risk-taking had comparatively lower mean scores. Female participants reported significantly higher responsibility scores than male participants (4.17 ± 0.69 vs. 3.85 ± 0.54; p = 0.014). Significant differences were observed across staff categories, with managerial staff reporting higher accountability scores (4.20 ± 0.61; p = 0.019). Clinical staff reported higher responsibility scores (4.18 ± 0.66; p = 0.047), indicating a modest but statistically significant difference compared to other staff groups. Teamwork was strongly correlated with accountability (r = 0.696, p < 0.01), suggesting a robust positive relationship between collaborative culture and accountability-related organizational behaviors.

Teaching hospitals in Iran exhibit a predominantly conservative organizational culture that prioritizes stability and compliance over adaptability and innovation. While responsibility and accountability represent important strengths, strengthening teamwork and collaborative practices may enhance the practical translation of organizational values into safety-related outcomes. These findings offer relevant insights for teaching hospitals in Iran and other LMIC settings seeking to balance accountability with adaptability in pursuit of safer and more resilient health systems.