Patient Safety Culture in Sierra Leonean Hospitals: A Mixed-Methods Study

Abstract

This study assessed patient safety culture across selected public hospitals in Sierra Leone and explored how perceptions vary by hospital characteristics, including size, location and resource availability, with the aim of identifying practical strategies to strengthen safety culture and improve care quality. A sequential cross-sectional mixed-methods design was employed. Quantitative data were collected from 404 healthcare workers using the Hospital Survey on Patient Safety Culture and analysed using descriptive statistics and logistic regression. Qualitative data from ten key informant interviews were thematically analysed in NVivo-14 to provide contextual insights. The overall patient safety culture score was low at 40.5% (95% CI: 37.4-43.6). Teamwork within units and organizational learning emerged as relative strengths, while incident reporting and management support were identified as major weakness. Most respondents rated patient safety as acceptable, although underreporting of incidents was widely acknowledged, driven by fear of blame, time constraints and unclear reporting procedures. Qualitative findings highlighted leadership gaps, staffing shortages, resource limitations and marked disparities between urban and rural hospitals. Overall, patient safety culture in Sierra Leone hospitals remains underdeveloped, highlighting the need for strengthened leadership accountability, non-punitive reporting systems, improved communication, training, and broader systemic investments to enhance safe and high-quality care.