Evolution and national benchmarking of patient safety culture in a newly established hospital: a two-year repeated cross-sectional study.

Abstract

Background: Patient safety culture is a fundamental component of healthcare quality, yet empirical evidence on how it evolves during the early life cycle of newly established hospitals remains limited. This study aimed to examine changes in patient safety culture over the first two years of operation of a newly established hospital and to benchmark its performance against national reference data.

Methods: A repeated cross-sectional study was conducted in a newly established regional hospital in Taiwan. Hospital-wide surveys using the Safety Attitudes Questionnaire (SAQ-Taiwan) were administered during the first year (2024, n = 361) and second year (2025, n = 781) of operation. Differences in eight safety culture dimensions were analysed using independent-samples t-tests and Cohen's d effect sizes. Multivariable linear regression analyses were additionally conducted to estimate the adjusted year effect after controlling for sex, professional role, hospital tenure, work unit, and supervisory role. Results from the second year were benchmarked against national norms published by the Joint Commission of Taiwan.

Results: Mixed trends were observed across the two years. Significant improvements occurred in working conditions (d = 0.18) and work-life balance (d = 0.17). Conversely, job satisfaction (d = -0.14), perception of management (d = -0.13), and stress recognition (d = -0.20) declined significantly. After adjusting for workforce composition differences, improvements in working conditions and work-life balance remained statistically significant, while the decline in perception of management was attenuated, suggesting partial confounding by changes in staff composition. Despite these declines, Year 2 performance remained broadly within the national interquartile range across most dimensions.

Conclusion: Safety culture in a new hospital evolves dynamically. While infrastructure maturation may improve working conditions, rapid expansion was associated with an unadjusted decline in job satisfaction and stress recognition, though only the latter remained significant after adjustment. Early investment in systems may mitigate the "liability of newness," but sustained cultural reinforcement is essential for long-term resilience.