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Patient Safety Climate in General Public Hospitals in China: A Multiregion Study

Zhou Ping PhD; Li, Minqi MPA; Wei, Xuefeng MPA; Zhu, Hongbo MS Med; Xue, Di PhD
doi: 10.1097/PTS.0000000000000427
Original Article: PDF Only


This study aimed to analyze the potential difference in patient safety climate by region (Shanghai vs Hubei Province vs Gansu Province) and general public hospital level (tertiary vs secondary) in China.


Using a stratified sampling method, employees from 54 public general hospitals in Shanghai, Hubei Province, and Gansu Province in China were surveyed in 2015. The Patient Safety Climate in Health Care Organizations tool and the percentage of “problematic responses” (PPRs) were used to measure and analyze the patient safety climate. A χ2 test and hierarchical linear modeling were applied for the analysis.


In the study, 4121 valid questionnaires were collected. The psychometric analysis supported the validity and reliability of our Chinese version of the Patient Safety Climate in Health Care Organizations. The overall patient safety climate was relatively good and exhibited no significant differences among the surveyed hospitals by various regions (Shanghai vs Hubei Province vs Gansu Province) and diverse hospital levels (tertiary vs secondary) using hierarchical linear models. “Fear of blame and punishment” and “fear of shame” had the highest PPRs and were prevalent in various types of hospitals. “Provision of safe care” and “organizational resources for safety” also had notably high PPRs. There were 4 dimensions varied by region and hospital level in this survey.


Fear of shame and fear of blame are the most important barriers to the improvement of patient safety in the hospitals of China. Facility characteristics contributed somewhat to hospital patient safety climate in some dimensions. The initiatives to improve hospital patient safety climate are necessary and its implementation strategies needs to be shared.

Correspondence: Di Xue, PhD, PO Box 197,138 Yi Xue Yuan Rd, Shanghai, 200032, PR China (e-mail:

The authors disclose no conflict of interest.

This study was supported by National Natural Science Foundation of China (Grant Number 71473047).

Di Xue conceived and designed the study. Di Xue, Minqi Li, Xuefeng Wei, Hongbo Zhu, and Ping Zhou performed the investigation. Ping Zhou and Minqi Li analyzed the data. Ping Zhou and Di Xue wrote the article.

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