Patient safety culture in Chinese nursing homes: a mixed-methods study

To evaluate patient safety culture (PSC) and its associated factors and staff perceptions of adverse event reporting in Chinese nursing homes.

A mixed-methods study based on a secondary analysis of a multisite research program, integrating a 2021-2022 cross-sectional survey with a secondary thematic analysis of focus group interviews.

Eleven nursing homes in South China, including 674 frontline staff (quantitative phase) and 35 managers, nurses, and caregivers (qualitative phase).

PSC was assessed using the Nursing Home Survey on Patient Safety Culture. Quantitative data were analyzed using descriptive statistics, univariate analysis, and multiple linear regression. Interview data were analyzed using Braun and Clarke's thematic analysis.

The overall positive response rate (PRR) for PSC was 86.5%, with lower PRRs for Adherence to Workflow (72.7%) and Staffing (67.0%). PSC was statistically associated with income satisfaction (B = 0.174, β = 0.189, p = 0.020), job satisfaction (B = 0.176, β = 0.208, p = 0.046), and years of work experience in nursing home care (B = -0.098, β = -0.113, p = 0.014). The model explained 35.0% of the variance (R ² = 0.350, adjusted R ² = 0.345). Thematic analysis identified four themes: workforce shortages and safety anxiety, non-standardized workflows and interprofessional role conflicts, cultural barriers to adverse event reporting, and staff-driven improvement strategies.

Despite positive overall PSC, structural deficiencies were observed in staffing and adherence to workflow. Cultural factors and organizational pressures may be associated with the underreporting of adverse events. The findings suggest priorities for future intervention development, including resource optimization, workflow standardization, and non-punitive reporting systems. However, these findings require testing in longitudinal or interventional studies.