Measures of patient safety culture from the perspective of health workers can be used – along with patient-reported experiences of safety and traditional patient safety indicators (see section on “Safe acute care – surgical complications and handling of errors”) – to give a holistic perspective of the state of safety in health systems.
A positive patient safety culture for health workers results in shared perceptions of the importance of safety, increased transparency and trust, and higher levels of shared responsibility, along with improved confidence in organisational and national safety initiatives. A growing body of research has found that a positive patient safety culture is associated with better health outcomes and patient experiences, as well as improved organisational productivity and staff satisfaction. Improved models of patient safety governance and investment in improving the patient safety culture have a substantial and lasting impact on outcomes (G20 Health & Development Partnership, 2021[1]).
Figure 6.18 and Figure 6.19 illustrate two domains of the Hospital Survey on Patient Safety Culture (HSPSC), which asks hospital staff to provide information on aspects of their work environment and whether they are conducive to good patient safety. Figure 6.18 shows staff perceptions of whether important patient care information is transferred across hospital units and during shift changes. Positive perceptions from staff on safety of handoffs and information exchange range widely across countries, with a difference of 25% p.p. (78% to 53%) for countries using HSPSC version 2.0. Countries using HSPSC version 1.0 typically observe lower levels of positive perceptions of handoffs and transitions due to the format of the survey questions – with values ranging from 53% to 36% of staff having a positive perception of patient safety in their hospital. Figure 6.19 shows that most hospital workers feel that staffing levels and the pace of work are not adequate for providing safe patient care. Across all staff types, positive perceptions on staffing and work pace are highest in Poland, Israel, Colombia, the United States and Latvia (50% or more with positive perceptions across different types). There is a clear disconnect between perceptions among management and frontline staff in most countries. On average, for OECD countries using HSPSC 2.0, only 44% of physicians and nurses in hospitals perceived staff levels and work pace to be safe, compared to 53% of management staff.
Patient perspectives are also critical to make health systems safer and more people‑centred. According to data from the OECD PaRIS initiative, 25% of primary care users aged 45 and over reported having experienced an event or circumstance that could have resulted, or did result, in unnecessary harm to themselves, such as not getting an appointment when needed; receiving a wrong or delayed diagnosis or treatment; or experiencing problems with communications between healthcare professionals. Rates ranged from over 50% in Greece and Saudi Arabia, to under 10% in Czechia and Switzerland (Figure 6.20). The experience of an adverse event has a strong impact on deteriorating trust in both the professional and the healthcare system more broadly. Analysis of PaRIS data shows that people who have experienced an event or circumstance that could potentially cause them harm in healthcare are 1.6 times less likely to trust the healthcare system compared to those who have not experienced such an adverse event (45% compared to 70%). Likewise, trust in the person’s last care professional is 1.4 times lower among people who have experienced an adverse event compared to those who have not (59% compared to 85%) (OECD, 2025[2]).
