Abstract
Background Enhancing security and dependability of health systems necessitates resource allocation, a well-defined infrastructure, and a steadfast commitment to ensuring its safety and stability over time. The aim of this study was to analyse the temporal trend of patient safety culture within a network of private hospitals in Brazil, while also evaluating the relationship between the safety culture and the hospital accreditation process.Methods We retrospectively analysed the temporal trend of patient safety culture within a network of Brazilian private hospitals, while also evaluating the relationship between safety culture and the hospital accreditation process/status. The Hospital Survey on Patient Safety Culture questionnaire was distributed to 71 hospitals between 2014–2022 with 259,268 responders. Hospitals were classified as accredited (AH) or non-accredited (NAH). A linear mixed-effects regression model was applied to fit the trend for the dimension score over time.Results Out of 12 dimensions analysed, 11 significantly improved, and one (“frequency of reported events”) remained unchanged over time (p = 0.84). Two dimensions had < 50% positive responses: “communication openness” (47.13% [38.19–58.73]) and “nonpunitive response to errors” (41.24% [34.13–51.98]). Safety culture improved among AHs across all, but “frequency of reported events” (p = 0.12), dimensions. Among NAHs, “frequency of reported events” decreased over time (p = 0.008) while other dimensions remained unchanged.Conclusion Overall, patient safety culture improved between 2014–2022. While accreditation has seemingly fostered a culture of safety over time, underreporting of adverse events among NAHs indicate missed opportunities for healthcare system improvement through adverse event analysis.