Beyond Psychological Safety: Organizational Infrastructure and Knowledge Drive Patient Safety Reporting in a Developing Country Hospital

Abstract

Patient safety incident reporting is crucial for identifying issues within patient safety programs, yet underreporting remains a significant challenge in many hospitals. Understanding the factors influencing reporting behavior is essential for developing strategies that enhance a culture of patient safety. This study examines the impact of organizational and individual factors on incident reporting behavior among nurses in an Indonesian public hospital, using a robust regression analysis approach. A cross-sectional study was conducted with 143 nurses at Tenriawaru Public Hospital in Bone, Indonesia. Data were collected through validated questionnaires assessing seven enabling factors: leadership, policies and resources, group cohesiveness, psychological safety, knowledge, sense of control, and commitment. To ensure reliable estimates amid potential outliers and heteroscedasticity, robust regression with Huber’s M-estimation was applied. The analysis identified policies and resources as the most influential factor in incident reporting (β=0.3357, t=12.0238), followed by knowledge (β=0.1226, t=2.8175), commitment (β=0.0855, t=4.2705), and leadership (β=0.0577, t=2.2421). All factors showed t-values exceeding the critical threshold of 1.656, indicating statistical significance. The model exhibited a Root Mean Squared Error (RMSE) of 3.94915, indicating relatively low prediction error. Group cohesiveness, psychological safety, and sense of control were not found to significantly impact reporting behavior. This study underscores the complex interaction of factors shaping incident reporting behavior. The findings highlight the importance of robust policies, resource allocation, staff commitment, and knowledge in fostering a safety culture. These insights provide practical guidance for hospital administrators and policymakers, especially in developing countries, on improving incident reporting practices. Future research could employ longitudinal designs to observe changes over time and investigate the potential of digital tools and reporting systems to further enhance reporting behaviors.