Assessment of patient safety culture among nurses in Djibouti: a multicentric study

BACKGROUND: Patient safety is a cornerstone of healthcare quality, yet it persists as a critical global challenge. In Djibouti, data on safety culture are scarce. This study aimed to assess the patient safety culture among nurses in the country’s principal public referral hospitals. METHODS: A multicentre cross-sectional study was conducted in four of Djibouti’s main public hospitals using the validated French version of the Hospital Survey on Patient Safety Culture (HSOPSC). A total of 239 nurses from four hospitals participated. Data were analysed using descriptive statistics, with dimensions classified based on predefined positive response rate thresholds. RESULTS: The overall perception of patient safety was low, with only 37% of nurses rating it as “acceptable” and 38% as “poor.” Teamwork within units was a relative strength (50% positive responses). In contrast, critical weaknesses were identified in non-punitive response to error (26%), staffing (24%), communication openness (31%), and management support for patient safety (35%). These deficits manifested operationally: 87% reported no adverse events in the past year, suggesting severe under-reporting. CONCLUSION: This first multicentre assessment reveals a patient safety culture in urgent need of strengthening in Djibouti’s major hospitals. While teamwork provides a foundation, systemic interventions are required to build managerial commitment, ensure adequate staffing, and foster a just, open, and reporting-oriented culture to sustainably improve patient safety.