Safety culture among healthcare professionals in psychiatric clinics: a study from a psychiatric hospital in Türkiye

Abstract

Background

The perceptions of safety culture in psychiatric clinics are critically important for both patient safety and the sustainability of high-quality care delivery. This study aims to assess the levels of safety culture among mental health professionals working in psychiatric clinics.

Methods

This descriptive and cross-sectional study was conducted with 205 healthcare professionals, including 103 nurses and 102 psychiatrists, employed in a psychiatric hospital in Türkiye. Data were collected between 24 June and 27 November 2024, using a demographic information form and the Patient Safety Culture Scale. The scale consists of items rated on a four-point Likert scale (1 = Strongly disagree to 4 = Strongly agree).

Results

The mean overall safety culture score of the participants was 2.73 ± 0.46. The highest mean score was found in the “employee behaviour” subdimension (2.78 ± 0.51), while the lowest was in the “management and leadership” subdimension (2.68 ± 0.47). Unmarried participants had significantly lower scores in the management and leadership dimension compared to their married counterparts (p < 0.05). Participants who were unhappy with working in the psychiatric clinic and those who had not received patient safety training scored significantly lower (p < 0.05). Professionals with ≤ 5 years of experience in psychiatry scored higher in some subdimensions compared to those with > 5 years of experience (p < 0.05).

Conclusions

The perception of the safety culture among healthcare professionals in psychiatric clinics is generally positive, but still needs improvement. Factors such as educational status, job satisfaction, and participation in patient safety training significantly influence perceptions of the safety culture.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-025-13359-4.

Introduction

The patient safety culture is defined by transparency in error reporting, a systematic approach to prevent medical errors, and a commitment to honesty [1]. This culture represents a multidisciplinary structure that integrates information and communication technologies. The safety culture is primarily shaped by managerial support, teamwork, compliance with regulations, systematic reporting, education, staff participation, sensitivity, diligence, and the establishment of a secure healthcare system [2]. It also includes the values, beliefs, and norms of both management and staff on what is considered important within the healthcare organisation, as well as how processes and procedures are rewarded or sanctioned [1, 3, 4].

Patient safety culture is a vital component of high-quality healthcare delivery. It is a matter of global concern due to its impact on both healthcare professionals and patients [5]. Research has shown that patient safety culture is associated with a variety of outcomes, including medical errors, length of hospital stay, readmission rates, patient mortality, staff perceptions of safety, the rate of incident reporting, and the frequency and number of reported events [6, 7]. Furthermore, the patient’s safety culture can be influenced by the participant and the hospital, the setting of work, the professional role, the level of participation in safety programmes, communication practices, the management of safety, and the available resources [3, 7]. The values, beliefs, and norms that healthcare professionals hold about patient safety significantly affect their actions and behaviours [7]. Therefore, establishing a shared attitude and culture towards patient safety is essential to recognise safety-related errors and implement preventive and corrective measures within healthcare institutions.

Promoting a culture of safety within healthcare systems is an international necessity [8]. Healthcare institutions with a positive safety culture are characterised by communication based on mutual trust-based communication, awareness of the importance of safety, and the implementation of effective preventive measures. Additionally, it plays a critical role in enhancing the quality of care and promoting patient safety. Therefore, assessing patient safety is essential to improve safety outcomes.

In Türkiye, the concept of patient safety culture has gained increasing importance with the implementation of national quality and accreditation standards by the Ministry of Health. The Ministry of Health has mandated the establishment of patient safety committees in hospitals, the adoption of incident reporting systems, and the provision of regular training programmes on patient safety [4, 9]. One of the most significant regulatory efforts in this area was the publication of the Communiqué on Procedures and Principles Regarding the Ensuring and Protection of Patient and Employee Safety in Health Institutions and Organisations in 2009. This was followed by the Regulation on Ensuring Patient and Employee Safety, which came into effect in 2011 [10]. Research indicates that Turkish healthcare professionals often report moderate levels of patient safety culture, with notable deficiencies in areas such as open communication, incident reporting, and managerial support [11].

In psychiatric clinics, as in other clinical settings, there are various risks in terms of patient safety, including medication errors, falls, and prolonged hospital stays. In addition to these, there are more unique and serious safety threats, such as the risk that patients harm themselves or others, which require customised and rigorous safety measures. However, interventions aimed at managing these risks, such as the use of physical restrictions, can sometimes introduce new safety concerns [12, 13].

Establishing a safe environment in psychiatric clinics is of paramount importance to protect patients and ensuring the continuity of high-quality care. In the care of hospitalised psychiatric patients, safety strategies often focus predominantly on the prevention of physical harm, particularly through the use of isolation and restraint. However, patient safety should not be limited to physical harm alone; it must also include emotional harm and other potentially hazardous situations, adopting a holistic and integrated approach [12, 14, 15].

In psychiatric hospitals, which serve a particularly vulnerable patient population, investigating the culture of patient safety can help make the current state of affairs more visible and contribute to raising awareness in this critical area. The findings obtained may provide guidance for the development and dissemination of systems aimed at strengthening patient safety culture. Therefore, the objective of this study is to determine the levels of patient safety culture in healthcare healthcare working in psychiatric clinics.

Methods

Study design, sample, and setting

This descriptive and correlational study was conducted between June 24 and November 27, 2024. The study was carried out at a psychiatric specialty hospital in Türkiye that provides both inpatient and outpatient services with a capacity of 260 beds. The hospital includes acute psychiatric wards for male and female patients, a Community Mental Health Centre (CMHC), an Alcohol and Substance Addiction Treatment Centre (AMATEM), and a neurology clinic. The study population consisted of a total of 256 psychiatrists and nurses working in the hospital who have the most direct contact with patients. These two professional groups will be referred to as ‘healthcare professionals’ throughout the manuscript. In this study, a complete enumeration method was preferred covering the entire population. This method provided the same opportunity for participation to all individuals in the population. The study was designed to reach the entire population and was completed with 205 participants who volunteered to participate. This number represents approximately 80% of the population. The high participation rate increases the generalisability of the study findings to the population.

Inclusion Criteria

• Voluntary participation with signed informed consent.

• Employment at the XXX Hospital for Mental and Neurological Disorders.

Exclusion criteria

• Incomplete or incorrectly filled questionnaire responses.

Data collection

The researchers collected data through both face-to-face and online surveys. The study used a demographic information form and the Patient Safety Culture Scale (PSCS). Of the total of 205 surveys, 143 were completed online through a secure web-based platform, while 62 were administered face-to-face during scheduled staff gatherings. Face-to-face surveys were distributed and collected by one of the researchers. To minimise the risk of administrator bias and ensure participant autonomy, surveys were conducted in settings without the presence of managerial staff. Participants were encouraged to complete the questionnaires independently and in a setting that ensured confidentiality and comfort.

Demographic information form

This form was developed by researchers based on a review of the relevant literature and previous studies in the field [16–18]. It consisted of 11 items designed to gather information on sociodemographic (e.g., age, sex, marital status, educational level) and professional characteristics (e.g., years in the profession, years working in a psychiatric clinic, willingness to work in a psychiatric clinic, current assignment, job position, work schedule, and whether the participant had received specific training on patient safety). The English version of the form is provided in Supplementary File 1.

Patient Safety Culture Scale (PSCS)

Developed by Türkmen et al. This scale includes 51 items across five subdimensions: management and leadership, employee behaviour, reporting of unexpected incidents and errors, staff training, and care environment. It assesses the perception of patient safety culture using a four-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree). A higher mean score approaching 4 indicates a more positive perception of patient safety culture, while a lower score approaching 1 suggests a more negative perception [19]. The subdimensions are defined as follows: The management and leadership subdimension assesses the support, transparency, and direction of management with regard to patient safety. The employee behaviour subdimension assesses the adherence of staff members to safety protocols, their awareness of safety issues, and the degree of collaboration within the team. The reporting of unexpected events the and error subdimension measures the level of trust in reporting systems and the effectiveness of incident and error reporting practices. The subdimension of staff training evaluates the adequacy, frequency, and quality of education and training received on patient safety practices. Lastly, the care and technology subdimension assesses the suitability of physical infrastructure, medical equipment, and systemic safeguards to support safe patient care [11, 19, 20]. The overall Cronbach alpha coefficient for the original scale was 0.97, with subdimension coefficients ranging from 0.83 to 0.92. In the current study, the overall Cronbach alpha was found to be 0.96, with subdimension reliability coefficients ranging between 0.82 and 0.92.

Data analysis

Data were analysed using IBM SPSS version 22. The assumption of multivariate normality was tested to assess the suitability of the data for parametric analyses. Independent sample t tests and one-way analysis of variance (ANOVA) were performed to examine differences between groups. Descriptive statistics, including means, standard deviations, and frequency distributions, were used to summarise the demographic and professional characteristics. A significance level of p < 0.05 was adopted for all statistical analyses. Only fully completed questionnaires were included in the analysis. Incomplete or incorrectly filled responses were excluded based on predefined exclusion criteria. Data were analysed using complete case analysis and no imputation or additional data cleaning or imputation procedures were applied.

Results

Among the 205 participants, 103 were nurses (50.2%) and 102 were psychiatrists (49.8%). The mean age of the participants was 31.37 ± 6.14 years. Of the participants, 67.8% were women, 60.0% were single, 52.7% had a postgraduate degree, and 56.6% were employed in community mental health centres, addiction units or therapy centres. Furthermore, 54.6% had five years or less of professional experience and 72.2% had worked in psychiatric clinics for five years or less. Most of the participants (91.2%) reported being satisfied working in a psychiatric clinic and 57.1% had received training on patient safety.

The overall mean score on the Patient Safety Culture Scale was 2.73 ± 0.46, indicating a moderately positive perception of patient safety culture among participants. The subdimension scores were as follows: management and leadership 2.68 ± 0.47, employee behaviour 2.78 ± 0.51, reporting unexpected incidents and errors 2.71 ± 0.59, staff training 2.72 ± 0.58, and care and technology 2.74 ± 0.57 (Table 1). The scale is scored on a four-point Likert scale (1 = strongly disagree, 4 = strongly agree). Higher scores indicate more favourable perceptions of patient safety culture, while lower scores suggest less supportive or negative perceptions in the respective subdimensions.

Table 1.

Evaluation of the reliability and mean scores of the patient safety culture scale and its subdimensions (N = 205)

SCALE		Cronbach’s Alfa	Mean ± SD
PSCS		0.96	2.73 ± 0.46
Sub dimensions	Management and Leadership	0.86	2.68 ± 0.47
	Employee Behavior	0.92	2.78 ± 0.51
	Reporting of Unexpected Events and Errors	0.82	2.71 ± 0.59
	Training	0.89	2.72 ± 0.58
	Care and Technology	0.85	2.74 ± 0.57

According to group comparisons (Table 2), single participants had lower mean scores in the Management and Leadership subdimension compared to married participants (2.62 ± 0.46 vs. 2.76 ± 0.47; p = 0.046), suggesting that single individuals perceived the support of leadership and management for patient safety less favourably. Participants who reported dissatisfaction with working in psychiatric clinics scored significantly lower overall PSCS (2.43 ± 0.32) than those who were satisfied (2.76 ± 0.46; p = 0.004). In particular, the differences were also statistically significant in all subdimensions (p < 0.05), except for care and technology. This indicates that job satisfaction may be related to more positive perceptions of patient safety practices.

Table 2.

Mean total and subdimension scores of the patient safety culture scale by participants’ descriptive characteristics

Characteristic			PSCS		Management and Leadership		Employee Behavior		Reporting of Unexpected Events and Errors		Training		Care and Technology
	Min	Max	X ± SD	Test	X ± SD	Test	X ± SD	Test	X ± SD	Test	X ± SD	Test	X ± SD	Test
Age	23	57	31.37 ± 6.14	F = 1.200, p = 0.239	2.73 ± 0.46	F = 1.151, p = 0.288	2.68 ± 0.47	F = 0.867, p = 0.658	2.71 ± 0.59	F = 1.119, p = 0.323	2.72 ± 0.58	F = 1.040, p = 0.418	2.74 ± 0.57	F = 1.637, p = 0.052
Gender	n	%
Female	139	67.8	2.73 ± 0.45	t = 1.195, p = 0.233	2.70 ± 0.47	t = 0.807, p = 0.421	2.81 ± 0.48	t = 1.242, p = 0.217	2.73 ± 0.53	t = 0.350, p = 0.727	2.75 ± 0.58	t = 1.070, p = 0.286	2.78 ± 0.54	t = 1.341, p = 0.181
Male	66	32.2	2.67 ± 0.48		2.64 ± 0.46		2.71 ± 0.56		2.70 ± 0.70		2.66 ± 0.59		2.66 ± 0.61
Marital Status
Single	123	60.0	2.69 ± 0.46	t=−1.520, p = 0.130	2.62 ± 0.46	t=−2.011,p = 0.046	2.75 ± 0.50	t=−0.980, p = 0.328	2.70 ± 0.61	t=−0.339, p = 0.735	2.69 ± 0.58	t=−1.083, p = 0.280	2.70 ± 0.57	t=−1.314, p = 0.190
Married	82	40.0	2.79 ± 0.46		2.76 ± 0.47		2.82 ± 0.51		2.73 ± 0.56		2.78 ± 0.58		2.80 ± 0.56
Education
Undergraduate down	11	5.4	2.88 ± 0.41	F = 0.686, p = 0.505	2.95 ± 0.31	F = 2.053, p = 0.131	2.71 ± 0.53	F = 0.888, p = 0.413	2.64 ± 0.77	F = 0.117, p = 0.889	2.74 ± 0.57	F = 1.032, p = 0.358	2.86 ± 0.59	F = 0.446, p = 0.641
Bachelor and education	86	42.0	2.73 ± 0.48		2.65 ± 0.50		2.74 ± 0.55		2.73 ± 0.60		2.79 ± 0.61		2.76 ± 0.60
Master’s	108	52.7	2.71 ± 0.45		2.67 ± 0.44		2.71 ± 0.47		2.72 ± 0.52		2.67 ± 0.56		2.71 ± 0.53
Profession
Psychiatrist	102	49.8	2.71 ± 0.41	t=−0.475, p = 0.635	2.68 ± 0.41	t=−0.039, p = 0.969	2.78 ± 0.45	t=−0.109, p = 0.913	2.70 ± 0.53	t=−0.461, p = 0.645	2.64 ± 0.51	t=−1.823, p = 0.070	2.72 ± 0.51	t=−0.556, p = 0.579
Nurse	103	50.2	2.74 ± 0.51		2.69 ± 0.52		2.78 ± 0.56		2.74 ± 0.64		2.80 ± 0.64		2.76 ± 0.62
Unit
Inpatient Service	89	43.4	2.74 ± 0.47	t = 0.353, p = 0.274	2.70 ± 0.46	t = 0.700, p = 0.485	2.84 ± 0.54	t = 1.423, p = 0.156	2.72 ± 0.61	t = 0.091, p = 0.928	2.65 ± 0.58	t=−1.466, p = 0.144	2.71 ± 0.57	t=−0.651, p = 0.516
Other	116	56.6	2.72 ± 0.45		2.66 ± 0.48		2.74 ± 0.48		2.71 ± 0.57		2.77 ± 0.58		2.76 ± 0.57
Years in Profession
5 years and below	112	54.6	2.76 ± 0.43	t = 1.068, p = 0.287	2.72 ± 0.42	t = 1.282, p = 0.201	2.84 ± 0.47	t = 1.840, p = 0.067	2.77 ± 0.58	t = 1.500, p = 0.135	2.69 ± 0.56	t=−0.704, p = 0.482	2.75 ± 0.55	t = 0.405, p = 0.686
6 years and above	93	45.4	2.67 ± 0.50		2.63 ± 0.52		2.71 ± 0.54		2.64 ± 0.60		2.75 ± 0.61		2.72 ± 0.59
Years of working in psychiatry
5 years and below	148	72.2	2.76 ± 0.45	t = 1.615, p = 0.108	2.71 ± 0.46	t = 2.035,p = 0.043	2.83 ± 0.49	t = 2.558,p = 0.011	2.74 ± 0.58	t = 0.767, p = 0.444	2.70 ± 0.57	t=−0.759, p = 0.449	2.76 ± 0.55	t = 0.886, p = 0.377
6 years and above	57	27.8	2.64 ± 0.48		2.57 ± 0.47		2.63 ± 0.52		2.66 ± 0.61		2.77 ± 0.63		2.68 ± 0.60
Satisfaction with working in psychiatry
Satisfied	187	91.2	2.76 ± 0.46	t = 2.948, p = 0.004	2.70 ± 0.46	t = 2.726, p = 0.007	2.81 ± 0.50	t = 3.075, p = 0.002	2.75 ± 0.58	t = 2.956, p = 0.003	2.75 ± 0.57	t = 2.189, p = 0.030	2.76 ± 0.57	t = 1.687, p = 0.093
Not Satisfied	18	8.8	2.43 ± 0.32		2.40 ± 0.49		2.44 ± 0.38		2.33 ± 0.59		2.43 ± 0.64		2.52 ± 0.48
Patient Safety Training
Received	117	57.1	2.82 ± 0.50	t = 3.306, p = 0.001	2.77 ± 0.50	t = 3.377, p = 0.001	2.84 ± 0.54	t = 2.048, p = 0.042	2.77 ± 0.63	t = 1.568, p = 0.119	2.86 ± 0.62	t = 3.985, p˂0.001	2.85 ± 0.62	t = 3.155, p = 0.002
Did Not Receive	88	42.9	2.61 ± 0.38		2.55 ± 0.39		2.70 ± 0.45		2.64 ± 0.52		2.54 ± 0.49		2.60 ± 0.45

X Descriptive statistics are given as mean, SD Standard deviation , Min Minimum, Max Maximum, N Number, % Percentage, F = One way ANOVA, t = Independent Samples Test

Furthermore, participants who had not received patient safety training reported significantly lower scores in overall PSCS (2.61 ± 0.38) compared to those who had received training (2.82 ± 0.50; p = 0.001). This trend was consistent in all subdimensions, and trained participants reported more favourable perceptions (p < 0.05 for each). In terms of work experience in psychiatry, those with five years or less experience reported significantly higher scores in management and Leadership (2.71 ± 0.46 vs. 2.57 ± 0.47; p = 0.043) and Employee Behaviour (2.83 ± 0.49 vs. 2.63 ± 0.52; p = 0.011), indicating that less experienced staff may perceive safety leadership and behaviour norms more positively.

On the contrary, no statistically significant differences were found in PSCS scores based on gender, age, educational status or professional role (nurse and psychiatrist) (p > 0.05).

Discussion

Patient safety culture plays an essential role in ensuring quality healthcare outcomes, particularly in high-risk settings such as psychiatric units. Previous studies have shown that a strong safety culture is associated with reduced adverse events, improved communication, and better team coordination in mental health settings [21, 22]. However, the literature indicates that psychiatric institutions often face unique challenges in cultivating safety-orientated environments, including stigma, underreporting, and lack of specialised training [5].

In this study, the overall and subdimension scores of the Patient Safety Culture Scale suggest that participants possess a generally positive, yet improvable, perception of patient safety culture. Studies conducted in various countries have reported that healthcare professionals have positive attitudes towards patient safety, while also highlighting that it remains an area that needs further development [5, 8, 17, 18]. However, patient safety culture continues to be an underexplored topic, particularly in psychiatric clinical settings [10, 19]. In particular, similar findings were observed in the subdimensions of employee behaviour and ‘reporting of unexpected incidents, which have also been highlighted in international studies such as those by Sammer et al. and Park and An. These findings highlight the need for a comprehensive approach to all dimensions of patient safety culture in psychiatric clinics, especially considering its potential role in improving the overall quality of care [22, 23].

In our study, the mean score on the subscale ‘management and leadership’ was found to be lower among single healthcare professionals compared to their married colleagues (2.59 ± 0.47 vs. 2.70 ± 0.46, p = 0.046). This finding is consistent with the literature, suggesting that married individuals tend to exhibit a greater sense of responsibility and greater organisational commitment in the workplace due to their increased personal responsibilities [24, 25]. The more structured lifestyle of married employees and their tendency to view their professional roles as an extension of their family responsibilities can positively influence their perceptions of management. Abdou and Saber noted in their study that the majority of the participants were married and older and that this group demonstrated more positive perceptions of management, which may be associated with a heightened sense of professional responsibility [25]. Similarly, Asegid et al. stated that married individuals tend to have higher levels of long-term commitment and responsibility [24].

The finding that participants dissatisfied with working in a psychiatric clinic had significantly lower overall Patient Safety Culture scores, as well as lower scores in all subdimensions except for ‘care and technology’, is both notable and expected. The mean overall PSCS score for those satisfied with working in psychiatry was 2.76 ± 0.46, while it was 2.43 ± 0.32 for those dissatisfied (p = 0.004). In the subdimension of ‘Employee behaviour’, the satisfied group scored 2.81 ± 0.50 compared to 2.44 ± 0.38 for dissatisfied (p = 0.002). Although causality cannot be inferred due to the cross-sectional nature of the study, this result suggests a possible association between job satisfaction and perceptions of safety culture. Healthcare professionals who are dissatisfied with their work environment may be less willing to adopt organisational policies and engage in safety practices, which could be linked to reduced motivation to participate in safety procedures. These findings imply that improving employee satisfaction could contribute to more favourable perceptions of patient safety. To support this, Wang et al. emphasised that job satisfaction plays a key role in patient safety, particularly by fostering effective team performance [26]. Similarly, a study conducted in Iran reported a significant relationship between employee job satisfaction and patient safety culture [27, 28]. Syahrir et al. and Ooshaksaraie et al. also reported a significant and positive correlation between job satisfaction and safety culture. Furthermore, Hayashi also emphasised that effective management of working conditions, including hours, night shifts and rest days, improves job satisfaction and, in turn, improves the safety culture [29].

The finding that participants who did not receive patient safety training had significantly lower scores in both the overall Patient Safety Culture and all subdimension scores is consistent with previous literature and underscores the potential importance of training. In our study, the mean overall PSCS score for trained participants was 2.82 ± 0.50, compared to 2.61 ± 0.38 for those untrained (t = 3.306, p = 0.001). The ‘Care and Technology’ subdimension showed a notable difference (2.86 ± 0.62 vs. 2.54 ± 0.49, p < 0.001).Albalawi et al. emphasised the necessity of continuous training to improve patient safety [30]. Park and An also reported that regular training programmes and in-clinic awareness activities positively influenced employees’ perceptions of safety culture [23]. Hamaideh suggested that, in addition to training, creating an open communication environment and reporting incidents without a culture of blame, individuals, are crucial for promoting improvements in overall patient safety [5]. Training not only improves knowledge, but also fosters trust within teams, open communication, and a shared sense of responsibility. In this regard, the interaction between training and experience plays a critical role in ensuring the sustainability of safe care. A study by Alyousef et al. in Saudi Arabia emphasised the need for psychiatric nurses to receive peer-led training, team-based learning, multidisciplinary collaboration, and regular feedback to ensure safe care practices [31]. Therefore, maintaining continuity in safety training and practical experience is critical in psychiatric services.

The finding that participants with five years or less of work experience scored higher in the subdimensions “management and leadership” (2.71 ± 0.46 vs. 2.57 ± 0.47, p = 0.043) and “employee behaviour” (2.83 ± 0.49 vs. 2.63 ± 0.52, p = 0.011) subdimensions may suggest a relationship between the duration of professional experience and perceptions of the safety culture. In a study by Rızalar et al. which examined factors influencing the safety culture of nurses, it was found that nurses with 0–5 years of experience had higher scores than those with 6–10 years of experience in terms of patient safety [16].Similarly, a study by Molloy et al. revealed that less experienced employees felt safer in their work environments and had higher perceptions of safety culture [32].

Long-term employees become more accustomed to institutional safety practices, which can result in a decreased sensitivity to issues to which they may have been more attuned earlier in their career. On the contrary, healthcare professionals with less experience can adhere more strictly to the safety principles they learnt in training and can more genuinely embrace the patient’s safety culture. Although no statistically significant differences were observed between psychiatrists and nurses in any of the safety culture subdimensions, nurses reported slightly higher scores in the training subdimension which may indicate a trend worth exploring in future studies. This result might reflect differences in educational exposure or expectations for the institutional role. This finding suggests that experienced employees remain a hypothesis that could be examined in future longitudinal studies.

Finally, the findings should also be evaluated within a cultural context. In Türkiye, the culture of patient safety is an important issue according to the Quality Control Criteria of the Ministry of Health and institutions are audited on this matter. However, the patient safety culture, particularly in terms of open communication and event reporting, is still in a development phase. Employees’ reluctance to report adverse events due to concerns about blame or lack of managerial support can negatively impact the perception of patient safety. It is well known that regular provision of patient safety training and the establishment of event reporting systems positively influence perception of safety culture [33]. Therefore, creating safe communication environments and demonstrating supportive attitudes from managers are of great importance for cultural transformation.

Strengths and limitations of the study

One of the most significant aspects of this study is its focus on psychiatric clinics, which are associated with unique risks in terms of patient safety. Furthermore, the inclusion of psychiatrists and nurses in the study allowed an evaluation of perceptions of the patient’s safety culture in different professional disciplines. This study contributes to the limited body of research on the patient safety culture specific to psychiatric clinics in Türkiye. However, as a single-centre study, the findings should be interpreted with caution regarding their applicability to other psychiatric settings or broader healthcare systems.

Furthermore, the voluntary nature of participation may have introduced selection bias, since individuals with a greater interest or opinion on patient safety culture may have been more likely to participate.

Finally, because the data were collected through both in person and online methods, the potential for mode-of-response bias should also be acknowledged. Although researchers provided standardised instructions, differences in how participants interacted with the survey across modalities may have affected their responses.

Conclusion

This study found that healthcare professionals working in psychiatric settings in Türkiye generally had moderately positive perceptions of the patient’s safety culture. Key factors such as marital status, job satisfaction, participation in patient safety training, and years of experience in psychiatry were identified as significant influences on these perceptions.

In clinical practice, establishing a more supportive and transparent safety environment is essential. Rather than adopting punitive approaches, it is recommended to implement supportive strategies through targeted training programmes for both managers and staff. From a managerial point of view, increasing leadership visibility and strengthening accountability are considered critical to improve staff engagement and improving safety-related behaviours.

Future research should focus on evaluating the impact of organisational improvements on the development of a healthy patient safety culture in psychiatric clinics, particularly through intervention-based study designs.

Authors’ contributions

Study design: SP, BC; Data collection: SG; Data analysis: BC, SP; Manuscript writing: SP, BC.

Funding

This research did not receive any specific grants from funding agencies in the public, commercial or not-for-profit sectors.

Data availability

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. The data are not publicly available due to restrictions that contain information that could compromise the privacy of research participants.

Declarations

Ethics approval and consent to participate

Ethical approval for this study was obtained from the Scientific Research Ethics Committee of the Erenköy Mental and Nervous Diseases Training and Research Hospital (Date: 13.06.2024, Approval No: 2024/35). All participating mental health professionals were informed according to the principles of the Declaration of Helsinki and both written and verbal informed consent was obtained. Participants were informed of the purpose of the study prior to enrolment.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.