Assessment of patient safety culture among physicians in public hospitals in Djibouti: a cross-sectional study

BACKGROUND: Patient safety culture is a key determinant of care quality and organisational resilience, particularly in resource-limited settings. In Djibouti, evidence on physicians’ perceptions remains scarce despite their central role in incident reporting and clinical governance. This study aimed to assess the patient safety culture among physicians working in public hospitals in Djibouti. METHODOLOGY: A cross-sectional descriptive study was conducted from September 2024 to March 2025 in the four main public hospitals of Djibouti City. Physicians completed the validated French version of the Hospital Survey on Patient Safety Culture (HSOPSC) developed by the Agency for Healthcare Research and Quality (AHRQ). Negatively worded items were reverse-coded in accordance with AHRQ recommendations. Descriptive statistics were used to calculate positive response rates across the ten HSOPSC dimensions, and internal consistency was evaluated using Cronbach’s alpha. RESULTS: A total of 105 valid responses were analysed (response rate: 75.5%). Overall perception of patient safety was excellent for 43% of physicians. The lowest scores were observed for staffing adequacy (22%), non-punitive response to error (25%), frequency of event reporting (26%), and communication openness (30%). Teamwork within units showed comparatively higher positive responses (56–71%). Cronbach’s alpha values ranged from −0.27 to 0.84 across dimensions, with an overall reliability of 0.88. CONCLUSIONS: Physicians’ perceptions reveal a fragmented patient safety culture characterised by limited communication openness, inadequate staffing, and very low incident reporting. Strengthening reporting systems, promoting non-punitive approaches, and improving organisational communication are essential to fostering a safer clinical environment. These findings provide baseline evidence to support ongoing reforms in Djibouti’s public hospital system.