Impact of the COVID-19 Pandemic Peak and Post-pandemic Period on Healthcare Professionals’ Attitudes Toward Patient Safety Culture: A Comparative Study

Abstract

Background

The COVID-19 pandemic placed unprecedented pressure on healthcare systems, affecting frontline staff through long hours, psychological stress, and resource disparities. In Taiwan, the pandemic’s peak in 2021 and subsequent easing in 2022 brought changes in clinical operations and organizational dynamics. This study explores how these shifts influenced healthcare workers’ perceptions of patient safety culture (PSC) over time.

Methods

A cross-sectional survey was administered at a medical center in central Taiwan using the New Chinese version of the Safety Attitudes Questionnaire (New-SAQ). Valid responses were collected from 3,709 healthcare workers across two periods: 2021 (pandemic peak) and 2022 (post-peak). Data were analyzed using SPSS 22.0 (IBM Corp., Armonk, NY, USA) for descriptive statistics, independent t-tests, analysis of variance, Pearson correlation, and two-way analysis of variance to assess differences and interactions across roles, time periods, and demographic variables.

Results

PSC scores showed significant improvement in 2022 compared to 2021. The highest-rated dimensions were teamwork climate, job satisfaction, and perceptions of management, reflecting enhanced collaboration and leadership support. However, stress recognition and resilience (measured via reverse-coded emotional exhaustion) remained low, highlighting ongoing emotional burden. Nurses reported significantly lower scores in job satisfaction and safety climate compared to other professional groups. Strong interrelations were found among dimensions, particularly between teamwork and safety climate (r = .781).

Conclusion

While PSC improved post-peak pandemic, specific groups—particularly nurses, women, and mid-career professionals—continue to face elevated stress and burnout risks. Healthcare organizations should prioritize leadership engagement, implement flexible work arrangements, and provide targeted resilience training to promote a safer and more supportive work environment.

1. Introduction

The COVID-19 pandemic has significantly disrupted healthcare systems and patient safety. Rapid viral transmission, asymptomatic cases, shortages of resources and protective equipment, and rapidly changing policies led to overloaded operations and high-stress environments. In the early stages, limited knowledge about the virus contributed to severe psychological distress among healthcare workers. As hospitalizations and mortality rose, staff experienced increased burnout and, in some cases, post-traumatic stress disorder. A positive patient safety culture (PSC) has been shown to enhance job satisfaction, reduce turnover and burnout, and decrease medical errors and adverse events. Teamwork climate plays a stabilizing role under pressure and promotes mental well-being. International organizations regard PSC as central to improving healthcare safety. This study explores the changes in PSC at a medical center in Taichung during the pandemic peak and post-peak periods, and assesses the influence of work stress and life balance on safety attitudes.

1.1. PSC, resilience, and emotional exhaustion

PSC, resilience, and emotional exhaustion are closely linked. PSC enhances care quality by fostering teamwork and safety awareness in high-stress settings [1]. Resilience helps reduce stress and burnout and mediates their effects on PSC [2]. It also mitigates anxiety and depression-related exhaustion, improving attitudes toward PSC [3]. Work-life balance policies can further buffer the effects of stress on PSC [1].

1.2. Impact of COVID-19 on PSC

Globally, the pandemic weakened PSC by increasing stress and operational challenges. Scores for teamwork and safety climate declined [4], while emotional exhaustion, anxiety, and post-traumatic stress disorder reduced clinical performance and engagement with PSC [5,6]. To address these challenges, healthcare institutions have implemented various strategies, including the establishment of psychological support services, enhanced infection control, and strengthened PSC training programs [7]. Flexible scheduling has also been promoted to alleviate staff fatigue and overwork [1]. Moreover, the stable supply of policies and resources is critical for sustaining PSC. Studies have shown that reliable access to protective materials and adaptable policy frameworks help reduce healthcare workers’ anxiety and perceived risk [8].

1.3. Assessment of PSC

PSC is essential for improving healthcare quality and reducing medical errors. Standardized tools are often used to systematically measure safety attitudes and behaviors across different staff levels. Since 2009, Taiwan has employed the Safety Attitudes Questionnaire (SAQ) to assess safety climate, with a focus on teamwork and unit-level culture. In response to rising burnout and workforce shortages, Dr. Sexton introduced the New-SAQ, which includes new dimensions such as resilience and work-life balance. The tool was translated and authorized for use in Taiwan by Dr. Wei-Chiang Lee and has been promoted by the Joint Commission of Taiwan since 2014 [9].

Research Hypotheses.

• H1: Significant differences in attitudes toward PSC dimensions between 2021 and 2022.

• H2: PSC attitudes between 2021 and 2022 differ significantly across healthcare roles.

• H3: Significant differences exist in PSC scores across demographic variables (e.g., gender).

• H4: Attitudes across PSC dimensions are significantly and positively correlated.

2. Method

This study employed a cross-sectional design using data from PSC surveys conducted in the past two years at a medical center in Taiwan. The hospital comprises multiple departments, including outpatient clinics, emergency services, operating rooms, inpatient wards, ICUs, rehabilitation, and dialysis units. Surveys were distributed annually to staff with at least three months of service. Participation was voluntary and anonymous, announced hospital-wide in advance, and promoted through internal emails and departmental meetings. Staff completed the questionnaire via personalized email links, with no identifiable information—such as email addresses or account names—collected. All responses were fully anonymized to protect confidentiality. The dataset, provided in a Microsoft Excel format, included only de-identified data suitable for research analysis.

2.1. Research framework

The research framework is built upon a comparative predictive model designed to assess the influence of organizational context and workforce characteristics on the eight dimensions of PSC measured by the New-SAQ. The model is structured around three key relationships that capture the full scope of our objectives.

• 1.Primary independent variable (time effect): We compared the total PSC score and all eight individual PSC dimensions between the two distinct time points: the 2021 Pandemic Peak and the 2022 Post-Peak Period.
• 2.Secondary independent variables (demographic effects): Demographic variables were assessed as predictors. The framework uses two-way analysis of variance (ANOVA) to specifically capture the interaction effect between the time period and demographic variables, determining how the change in PSC scores between 2021 and 2022 was moderated by specific job roles.
• 3.Dependent variables (comprehensive PSC dimensions): The framework integrates the eight dimensions of the New-SAQ—including the crucial additions of resilience and work-life balance—as dependent variables. We also examined the internal consistency and interrelationships among these eight dimensions (via Pearson correlation). The research framework is illustrated in Fig. 1.

Fig. 1.

The research framework.

2.2. Participants and setting

The study population included healthcare professionals employed at a medical center in Taiwan between 2021 and 2022. The hospital participates in the national PSC survey system, established by the Joint Commission of Taiwan (JCT) in 2009. Staff were categorized into six groups based on the JCT's 2014 New-SAQ classification: physicians, nurses, medical technologists, pharmacists, rehabilitation personnel, and other healthcare workers. Data were collected through anonymous, web-based surveys conducted internally in 2021 and 2022. Participation was voluntary, with responses submitted via the hospital’s online system.

2.3. Procedure

Since 2009, the Joint Commission of Taiwan has promoted regular PSC surveys to foster a positive safety environment. The studied medical center conducts an annual hospital-wide PSC survey each fourth quarter, using a census approach without monetary incentives. Participation is encouraged through communication by the quality management center, which assigns unique login credentials to staff. Prior to the survey, briefing sessions explain its importance and procedures. Healthcare workers complete the questionnaire online via the JCT’s PSC survey system [10].

2.4. Materials

This study utilized the PSC survey system, based on the SAQ developed by Dr. Sexton and adapted for Taiwan. The core SAQ includes 30 items across six dimensions: teamwork, safety climate, job satisfaction, stress recognition, perceptions of management, and working conditions. In 2014, two additional dimensions—resilience (9 items) and work-life balance (7 items)—were incorporated. Resilience items, primarily reverse-scored, assess emotional exhaustion, while work-life balance uses a 4-point Likert scale to evaluate rest and personal time, with higher scores indicating better balance. These measures support early identification of burnout risks and safety concerns (Taiwan, 2024). The New-SAQ demonstrates good reliability (Cronbach α = 0.65–0.87) [11]. Annual hospital-wide surveys help monitor trends as higher PSC scores correlate with fewer medical errors, improved teamwork, and greater job satisfaction. Prior research in northern Taiwan shows that education, seniority, and managerial roles are linked to more positive PSC perceptions [12].

2.5. Statistical approach

Valid questionnaires were coded and entered into a database by the researchers. Data analysis was performed using SPSS 22.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics—means, standard deviations, medians, frequencies, and percentages—summarized the demographics of healthcare personnel and PSC dimension scores. Independent samples t-tests and one-way ANOVA compared PSC scores between 2021 and 2022 to examine attitude changes over time (Hypothesis 1). The 2022 data were further analyzed to assess demographic influences, such as gender, on safety attitudes (Hypothesis 3). Two-way ANOVA evaluated interaction effects between job category and year on PSC dimensions (Hypothesis 2); if interactions were not significant, main effects were assessed. Pearson’s correlation examined linear relationships among PSC dimensions in 2022, assessing their consistency and interrelations (Hypothesis 4).

3. Results

3.1. Distribution of healthcare personnel demographic variables

This study included healthcare personnel who participated in the PSC questionnaire surveys in 2021 and 2022. After excluding those with an education level below high school and administrative staff, the final valid sample consisted of 3,709 individuals (1,796 in 2021 and 1,913 in 2022). The overall sample characteristics are presented in Table 1.

Table 1.

Basic demographic characteristics

	2021(n = 1,796)	2022(n = 1,913)
	n (%)	n (%)
Gender
Male	267 (14.9)	312 (16.3)
Female	1529 (85.1)	1601 (83.7)
Age
21 to 30 y	689 (38.4)	690 (36.1)
31 to 40 y	593 (33.0)	642 (33.6)
41 to 50 y	377 (21.0)	408 (21.3)
51 to 60 y	121 (6.7)	155 (8.1)
61 y and above	16 (0.9)	18 (0.9)
Job categories
Physician	148 (8.2)	162 (8.5)
Nursing staff	1281 (71.3)	1334 (69.7)
Medical technologists	208 (11.6)	228 (11.9)
Pharmacists	70 (3.9)	81 (4.2)
Rehabilitation staff	24 (1.3)	28 (1.5)
Other∗	65 (3.6)	80 (4.2)
Education level	n (%)	n (%)
College/university	1591 (88.6)	1689 (88.3)
Graduate school	205 (11.4)	224 (11.7)
Years of service at the hospital
Less than 6 mo	4 (0.2)	10 (0.5)
6 to 11 mo	16 (0.9)	6 (0.3)
1 to 2 y	98 (5.5)	41 (2.1)
3 to 4 y	360 (20.0)	394 (20.6)
5 to 10 y	671 (37.4)	734 (38.4)
11 to 20 y	417 (23.2)	473 (24.7)
Over 21 y	230 (12.8)	255 (13.3)
Supervisory position (including deputy roles)
Yes	168 (9.4)	173 (9.0)
No	1628 (90.6)	1740 (91.0)

^∗Other professions include dietitians, psychologists, physical therapists, and others.

3.2. Comparison of PSC scores across dimensions among healthcare personnel

3.2.1. Overall PSC score comparison

The overall PSC score in 2022 (M = 166.33, standard deviation [SD] = 15.92) was significantly higher than in 2021 (M = 164.48, SD = 13.57), t(3673.09) = -3.81, p < 0.001, indicating a more positive attitude toward PSC among healthcare personnel in the post-pandemic period. This finding is consistent with Chen et al. (2022), who found that ongoing patient safety education and strengthened management systems enhance staff engagement with safety culture [8]. Additionally, as healthcare institutions gradually returned to normal operations after the pandemic peak, staff may have had more capacity to focus on safety issues, improving awareness and participation (see Table 2).

Table 2.

Differences in total scores of PSC dimensions between the two years

Dimension	Y	Mean (M)	SD	t-value	df	p
Teamwork	2021	23.01	3.176	0.866	3707	0.387
	2022	22.91	3.500
Unit safety culture	2021	27.22	3.514	2.193	3707	0.028∗
	2022	26.95	3.944
Job satisfaction	2021	15.66	3.408	3.708	3707	<0.001∗∗
	2022	15.54	3.380
Perception of stress	2021	15.66	3.408	1.104	3707	0.270
	2022	15.54	3.380
Perception of management	2021	15.65	3.067	4.348	3707	<0.001∗∗
	2022	15.21	3.196
Working conditions	2021	15.02	3.041	3.948	3707	<0.001∗∗
	2022	14.62	3.043
Resilience	2021	34.28	7.690	-12.919	3707	<0.001∗∗
	2022	37.58	7.830
Work-life balance	2021	15.04	4.127	-3.045	3707	0.002∗∗
	2022	15.46	4.198
Total safety culture score	2021	164.4844	13.56586	-3.810	3673	<0.001∗∗
	2022	166.3309	15.91744

∗p < 0.05, ∗∗p < 0.01.

PSC, patient safety culture, SD, Standard deviation.

3.2.2. Dimension-specific score comparisons and literature alignment

• (1) Teamwork Climate:

Although no significant difference was found between 2021 and 2022 scores (p = 0.387), both years maintained high mean scores (M > 22). Teamwork is a fundamental component of PSC, reflecting strong interprofessional collaboration. Juvet et al. (2021) noted in their cross-sectional study that a stable team climate helped healthcare workers cope with the fluctuating stress brought on by the pandemic [13].

• (2)Job satisfaction:

The 2021 score was significantly higher than that of 2022 (t = 3.70, p < 0.001). This decline may be attributed to persistent work-related stress, increased administrative demands, or uneven resource distribution during the post-pandemic period. The finding aligns with Labrague and de Los Santos (2021), who reported that managerial instability and uncertainty during COVID-19 reduced employee satisfaction and organizational commitment [14].

• (3)Stress recognition:

No significant difference was observed between the two years (p = 0.270), suggesting a stable self-assessment of stress among healthcare workers. This may reflect the normalization of high-stress conditions throughout the pandemic. As Pankov, Lakhman et al. (2024) noted, prolonged exposure to stress can lead to emotional exhaustion and burnout regardless of pandemic status [15].

• (4)Working conditions:

Scores were significantly higher in 2021 than in 2022 (p < 0.001). This dimension includes aspects such as access to diagnostic resources, training, and supervision. The decline may relate to continued staffing fluctuations and increased clinical workload in 2022, potentially affecting the stability of training and support systems due to higher turnover among new staff.

• (5)Perception of management:

A significant decrease was also noted in this dimension (p < 0.001), indicating reduced staff perceptions of managerial support and communication transparency in 2022. While initial crisis management responses received positive evaluations, prolonged pandemic conditions may have led to weakened trust and engagement due to diminished clarity in communication and decision-making [16].

• (6)Unit safety climate:

Scores were significantly higher in 2021 compared to 2022 (p = 0.029). Although both years showed moderately high scores, the slight decline post-pandemic may indicate reduced sensitivity toward error reporting and feedback systems as routine operations resumed. Singer et al. (2013) emphasized that the absence of sustained learning and feedback mechanisms can discourage staff from reporting errors and engaging in safety improvements, thereby weakening the overall safety culture [17].

• (7)Resilience:

This dimension showed a significant increase in 2022 (t = -12.91, p < 0.001), indicating higher levels of emotional exhaustion and psychological fatigue among healthcare personnel in the later phase of the pandemic. This aligns with findings by Chen et al. (2021), who reported increased psychological trauma and adjustment difficulties among frontline workers during the prolonged outbreak [18].

• (8)Work-life balance:

Scores improved significantly in 2022 compared to 2021 (p = 0.002), suggesting modest improvements in work scheduling and personal time. This may reflect organizational adjustments in staffing and rest policies. According to Tran et al. (2021), a positive work-life balance is strongly associated with better PSC and contributes to lower burnout and staff turnover [1].

3.3. Two-way ANOVA of PSC by year and job category

A further independent samples t-test was conducted for each job category. The results showed that, except for medical technologists, there were no significant differences in the overall PSC scores between the two years across the other job categories. Physicians showed no significant difference between 2021 (M = 168.55) and 2022 (M = 169.28), with a t-value of -0.409 and a p value of 0.683, indicating that their attitudes toward safety culture remained stable. Similarly, nurses’ scores in 2021 (M = 168.66) and 2022 (M = 169.41) did not differ significantly (t = -1.230, p = 0.219). Pharmacists had slightly higher scores in 2022 (M = 180.73) compared to 2021 (M = 178.89) but this difference was not statistically significant (t = -0.855, p = 0.394). Rehabilitation staff also showed no significant difference between the two years, with scores of 179.29 in 2021 and 181.86 in 2022 (t = -0.717, p = 0.477). Other personnel similarly had no significant change, scoring 170.03 in 2021 and 168.63 in 2022 (t = 0.567, p = 0.571).

Notably, medical technologists rated PSC significantly higher in 2022 (M = 172.72) than in 2021 (M = 170.09), with a t-value of -1.982 and a p value of 0.048, indicating a statistically significant improvement. This suggests a marked enhancement in this group’s perception of organizational policies or safety culture following the pandemic (see Table 3).

Table 3.

Differences in PSC among medical technologists in 2021–2022

Medical technologists	2021	2022
Sample size (n)	208	228
Mean (M)	17.09	172.72
Standard deviation	13.93	17.11
Mean difference	–	-2.628
t-value	–	-1.982
p	–	0.048

PSC, patient safety culture.

3.4. Correlation analysis between demographic variable (gender) and PSC in 2022

This study used an independent-samples t-test to analyze the differences in scores across various dimensions of PSC among healthcare personnel of different genders in 2022. The results are shown in Table 4. Overall, with the exception of “Perception of Stress” (t = 1.572, p = 0.116) and “Total PSC Score” (t = 1.535, p = 0.125), the other seven dimensions showed statistically significant differences (p < 0.05 or p < 0.01), indicating that gender may have a significant influence on certain aspects of PSC.

Table 4.

Differences in patient safety culture dimensions by gender (2022)

Dimension	Male (M ± SD)	Female (M ± SD)	t-value	df	p
Teamwork	23.61 ± 3.474	22.78 ± 3.490	3.847	1911	0.000∗∗
Unit safety climate	27.80 ± 4.197	26.79 ± 3.873	4.189	1911	0.000∗∗
Job satisfaction	19.24 ± 4.688	17.84 ± 4.440	4.440	1911	0.000∗∗
Perception of stress	15.81 ± 3.458	15.49 ± 3.363	1.572	1911	0.116
Perception of management	15.83 ± 3.384	15.08 ± 3.145	3.764	1911	0.000∗∗
Work conditions	15.03 ± 3.378	14.54 ± 2.968	2.568	1911	0.010∗
Resilience	35.31 ± 8.839	38.02 ± 7.542	-5.642	1911	0.000∗∗
Work-life balance	14.97 ± 4.214	15.55 ± 4.190	-2.246	1911	0.025
Total safety culture score	167.596 ± 16.9841	166.084 ± 15.6948	1.535	1911	0.125

∗p < 0.05; ∗∗p < 0.01.

Specifically, male healthcare workers scored significantly higher than females in the dimensions of “Teamwork” (M = 23.61, SD = 3.47), “Unit Safety Climate” (M = 27.80, SD = 4.20), “Job Satisfaction” (M = 19.24, SD = 4.69), "“Perception of Management” (M = 15.83, SD = 3.38), and "“Work Conditions” (M = 15.03, SD = 3.38). This suggests that men are more likely than women to perceive their units as having a good cooperative atmosphere and a supportive management culture. These findings are consistent with the study by Chen (2019) of a medical center in Taipei City [12], which also reported that men had a more favorable subjective perception of communication and support within medical teams. On the other hand, female healthcare personnel scored significantly higher than males in the dimensions of “Resilience” (M = 38.02, SD = 7.54) and “Work-Life Balance” (M = 15.55, SD = 4.19) (Resilience: t = -5.642, p < 0.001; work-life balance: t = -2.246, p = 0.025). This phenomenon may relate to the self-regulation mechanisms and psychological flexibility developed by women during the pandemic. According to Schwartz et al. (2019) [19], female nurses exhibited higher levels of work-life balance behaviors during the COVID-19 pandemic, which were significantly associated with emotional exhaustion and perceptions of PSC. Additionally, Chen et al. (2022) found that female healthcare workers often adopted emotion-focused and social support strategies when coping with pandemic-related stress. This indicates a stronger level of resilience, enabling them to maintain mental health and professional stability even under high-pressure conditions.

Although the total PSC score did not show a statistically significant gender difference (t = 1.535, p = 0.125), the above analysis of specific dimensions suggests that gender still has a meaningful impact on how PSC is perceived and evaluated. Therefore, future efforts to promote safety culture in healthcare institutions should incorporate gender perspectives and differentiated intervention strategies.

3.5. Correlation analysis of PSC dimensions among healthcare personnel

This study further employed Pearson’s product-moment correlation analysis to explore the relationships among the various dimensions of PSC as perceived by healthcare personnel. The results are shown in Table 5. Overall, most dimensions of PSC showed significant positive correlations (p < 0.01). In particular, the highest correlation was observed between “Teamwork” and “Unit Safety Climate” (r = .781), indicating that in environments where teamwork is strong, staff are more likely to perceive a positive and supportive safety climate.

Table 5.

Pearson’s correlation analysis of PSC dimensions among healthcare personnel

–	Teamwork	Unit safety climate	Job satisfaction	Perception of stress	Perception of management	Work conditions	Resilience
Unit safety climate	${0.781}^{\ast \ast }$	–	–	–	–	–	–
Job satisfaction	${0.734}^{\ast \ast }$	${0.723}^{\ast \ast }$	–	–	–	–	–
Perception of stress	-0.003	0.001	-${0.095}^{\ast \ast }$	–	–	–	–
Perception of management	${0.716}^{\ast \ast }$	${0.723}^{\ast \ast }$	${0.713}^{\ast \ast }$	-0.018	–	–	–
Work conditions	${0.649}^{\ast \ast }$	${0.682}^{\ast \ast }$	${0.673}^{\ast \ast }$	-${0.082}^{\ast \ast }$	${0.725}^{\ast \ast }$	–	–
Resilience	-${0.265}^{\ast \ast }$	-${0.261}^{\ast \ast }$	-${0.468}^{\ast \ast }$	${0.420}^{\ast \ast }$	-${0.331}^{\ast \ast }$	-${0.360}^{\ast \ast }$	–
Work-life balance	${0.277}^{\ast \ast }$	${0.285}^{\ast \ast }$	${0.362}^{\ast \ast }$	-${0.167}^{\ast \ast }$	${0.329}^{\ast \ast }$	${0.379}^{\ast \ast }$	-${0.497}^{\ast \ast }$

Note: Correlations are significant at the 0.01 level (2-tailed).

PSC, patient safety culture.

4. Discussion

This study sampled healthcare personnel from a medical center in central Taiwan during 2021 and 2022 to examine differences in their perceptions and attitudes toward PSC between the peak and later stages of the COVID-19 pandemic.

4.1. Correlations among PSC dimensions among healthcare personnel

The results of Pearson’s correlation analysis showed that most dimensions of PSC were moderately to highly positively correlated . In particular, “Teamwork” had significant positive correlations with “Unit Safety Climate” and “Job Satisfaction,” indicating that establishing a good collaborative atmosphere within units can help improve overall job satisfaction and safety awareness. Conversely, “Perception of Stress” and “Resilience” showed a significant negative correlation (r = -0.420, p < 0.01), suggesting that as healthcare workers perceive higher stress levels, they experience more emotional exhaustion and lower resilience. This finding is consistent with Galanis et al. (2021) [20].

Additionally, “Work-Life Balance” was positively correlated with “Perception of Management” and “Work Conditions,” indicating that reasonable management policies and improved working conditions can effectively promote healthcare workers’ overall mental health and engagement in safety culture [21]. Overall, if healthcare institutions can systematically enhance unit support, reduce stress burden, and improve work-life balance, they can strengthen employees’ positive perceptions of safety culture, thereby advancing the achievement of patient safety goals [22].

4.2. Comparison of PSC among different job categories of healthcare personnel across years

A cross-year comparison revealed that most healthcare personnel categories showed no significant changes in overall PSC scores between 2021 and 2022 (p > 0.05), indicating relative stability. However, medical technologists demonstrated a significant increase (M = 172.82 vs. 169.95, p = 0.031), possibly due to institutional improvements in workflow and training during the pandemic’s later phase. Two-way ANOVA showed a significant main effect of job category on PSC scores (F = 20.017, p < 0.001), confirming varied perceptions across roles. The interaction between year and job category was not significant (F = 0.324, p = 0.899), suggesting consistent trends over time. Notably, nurses’ scores in “Perception of Stress” and “Resilience” remained low, reflecting persistent emotional exhaustion. This supports Sasaki et al. (2020) [23], who emphasized that stable systems without adequate emotional support contribute to burnout. Targeted interventions and cross-role learning—particularly from roles like medical technologists—may help strengthen resilience and improve PSC in vulnerable groups.

4.3. Differences in PSC dimensions by demographic variable (gender) in 2022

Regarding gender, males scored significantly higher than females on the “Work-Life Balance” dimension (M = 20.03 vs. M = 19.45, p = 0.025), possibly reflecting that female healthcare workers bear more responsibilities between family and work roles, facing greater pressure. Age analysis showed that healthcare personnel aged 51 years and above reported a higher sense of imbalance between work and life (M = 20.49–20.50, p = 0.003), suggesting that older workers may require more support in physical and psychological stress adjustment.

4.4. Correlations among patient safety culture dimensions among healthcare personnel

Hospitals often face challenges in promoting PSC, including organizational change, uneven staff participation, and cross-department collaboration, requiring strong leadership and systemic support [24]. This study found nurses’ job satisfaction significantly lower than physicians and pharmacists, linked to pandemic-related work pressure, staffing shortages, and shift work. Al Surimi et al. (2022) [25] highlighted that positive evaluations of staffing and management support correlate with higher job satisfaction, which in turn enhances PSC. Wang et al. (2019) [26] demonstrated that total quality management improves nurses’ safety culture attitudes by boosting work values and satisfaction. Together, these findings suggest that improving shift systems, feedback, and management support can raise nurses’ job satisfaction and strengthen overall PSC. The “Perception of Stress” dimension showed limited correlations with other dimensions but was moderately related to “Resilience” (r = .420), supporting Schwartz et al. (2019) [19], who emphasized resilience’s role in buffering emotional exhaustion’s impact on safety attitudes.

4.5. Limitation

This study used a cross-sectional survey design, which limits the ability to infer causal relationships as it can only explore associations between variables. Although anonymous questionnaires were used, self-report bias may still affect the accuracy of responses due to factors such as social desirability, workplace atmosphere, or personal defense mechanisms. Additionally, the data were collected from a single medical center in central Taiwan, which restricts the generalizability of the findings to other regions or healthcare institutions of different sizes. Furthermore, the study did not analyze differences in PSC across departments (e.g., internal medicine, surgery) or shifts (day versus night). Future research could address these areas for a more in-depth understanding.

This study conducted a comparative cross-sectional analysis using the New-SAQ on 3,709 healthcare professionals to examine the shifts in PSC during the COVID-19 pandemic peak (2021) and the immediate post-peak period (2022) at a central Taiwan medical center. The study’s primary significance is its resolution of a key post-crisis management problem: determining which PSC dimensions stabilize and which remain vulnerable after an acute healthcare crisis. We found that while the overall PSC score showed a modest, significant increase in 2022—largely driven by an improvement in perceived work-life balance and higher resilience scores (indicating greater emotional exhaustion)—core systemic organizational factors declined significantly, specifically job satisfaction, perception of management, and working conditions. This critical finding indicates that the long-term strain of the pandemic manifested as a persistent erosion of trust and morale, even as the immediate crisis eased. The results confirm that vulnerable groups, particularly nurses, women, and mid-career professionals, continue to bear the greatest risk of burnout. Therefore, to ensure sustained patient safety and workforce resilience, we recommend that management move beyond general initiatives to focus on targeted psychological support, transparent communication, and the implementation of flexible work arrangements that directly address the specific declines identified in organizational support and morale. Future longitudinal studies are needed to track the long-term effectiveness of these interventions.

5. Data transparency

The de-identified dataset file is available on request.

CRediT authorship contribution statement

Yun-Chen Chang: Writing – review & editing, Writing – original draft, Supervision, Funding acquisition, Formal analysis, Data curation, Conceptualization. Jung-Jung Chan: Data curation, Formal analysis, Writing – original draft. Jui-Cheng Chen: Supervision, Writing – review & editing, Investigation. Yu-Chun Wang: Data curation, Project administration, Supervision.

Ethics statement

This study was approved by the Ethics Committee of China Medical University Hospital.

Data availability statement

Data will be made available on request.

Statement on the Use of AI Tools

No AI tools were used in the preparation of this manuscript.

Funding

This work was funded by a collaborative grant from China Medical University and China Medical University Hsinchu Hospital (Grant No. CMUHCH-CMU-114-013).

Conflicts of interest

The authors declare that they have no known competing financial or personal relationships that could have appeared to influence the work reported in this paper.