Patient Safety Environment and Its Associated Factors among Health Care Providers in Primary and Comprehensive Health Centers in Al-Mafraq Governorate: A Cross-Sectional St

Abstract

Background: Patient Safety Environment (PSE)—defined as the structural, organizational, and procedural conditions that support the implementation of patient safety standards— remains underexplored in primary healthcare settings in Jordan, Al-Mafraq Governorate. Purpose: This study aimed to assess the level of PSE implementation, defined as the extent to which WHO patient safety structural and process standards are operationalized, among healthcare providers in 30 primary and comprehensive health centers. Methods: A descriptive cross-sectional design was used. Data was collected between March and June 2024. A total of 430 healthcare providers participated (response rate: 86.0%; 430/500 invited). Data was collected using a validated WHO-based PSE tool. Because providers were nested within 30 centers, multilevel linear regression modeling with random intercepts for health centers was performed to adjust for clustering. Analyses included descriptive statistics and cluster-adjusted regression estimates with 95% confidence intervals (CIs). Results: Overall PSE score was M = 57.24 (SD = 5.49) out of a possible 150 (30 items × 5 points), corresponding to a mean item score of 1.91. On the 5-point Likert scale (1 = strongly disagree to 5 = strongly agree), this suggests general disagreement that patient safety standards are fully implemented. Using norm-referenced percentile categories (sample-based quartiles), 27.4% were classified as low, 53.0% as moderate, and 19.5% as high implementation. Thus, “moderate” reflects relative positioning within the sample distribution rather than adequate absolute implementation. Conclusion: Although most participants fell within the interquartile (“moderate”) range, absolute item means indicate low overall implementation of WHO-aligned patient safety standards. Implications for Nursing: Findings highlight the need for nursing leadership actions, including advocacy for adequate staffing, structured patient safety training, emergency preparedness drills, fatigue management strategies, and strengthening of non-punitive incident reporting systems. Keywords: Patient safety, Primary healthcare, Predictors, Staffing, Quality of care, Comprehensive healthcare