Shahroud University of Medical siences Shahroud Journal of Medical Sciences 2423-6594 12 3 2026 06 03 Between Leadership Expectations and Error Reporting: Contradictions in Patient Safety Culture in an Iranian Hospital eng Abolfazl Zakeri Technical Associate Degree Student in Occupational Safety and Technical Protection, Rafsanjan Branch, Islamic Azad University, Rafsanjan, Iran.. a.zakeri3040@gmail.com Mohammad Ali Zakeri PhD student, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran; PhD student, Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.. ma.zakeri115@gmail Tahereh Sadat Hosseini Rafsanjani MSc in Nursing, Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.. hosseinitahereh61@gmail.com Zahra Ryahi MSc in Nursing, Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.. zahrariahi8693@gmail.com Sayed Mortaza Hossini Rafsanjanipoor MSc of Epidemiology, Social Determinants of Health Research Centre, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.. mhosseini622@gmail.com 2025 04 24 2025 11 05 Background: A safety culture is a foundational determinant of patient safety in healthcare settings, and its deficiency has been consistently linked to increased risks of adverse events and suboptimal care delivery. This study examines the current state of patient safety culture (PSC) through the perspectives of frontline hospital staff, identifying both key strengths and critical areas for improvement within the organizational environment. Methods: In this descriptive cross-sectional study, 316 staff working in Ali Ibn-e Abitaleb hospital, Rafsanjan were selected. The study employed the Hospital Survey on Patient Safety Culture (HSOPSC) a validated instrument measuring 12 composite domains to collect data, which were subsequently analyzed using one-way ANOVA and Kruskal-Wallis tests in SPSS software. Results: Results showed a relatively strong perception of leadership support for safety (76.85%), but critically low scores in non-punitive response to errors (16.82%), staffing (18.35%), and error reporting (39.23%). Communication and feedback about errors (44.63%), communication openness (39.47%), frequency of events reported (39.23%), management support for patient safety (34.47%), teamwork across units (33.47%) were among the weaknesses of PSC. Notably, a punitive culture and staffing were strongly associated with suppressed incident reporting, revealing a critical failure in organizational level occupational health and safety (OHS) controls. The aggregate score for PSC was observed to be suboptimal (44.76%), necessitating subsequent enhancement. Conclusions: Overall PSC is poor and requires hospital manager’s attention. The punitive culture at workplace, the staffing, management support for staff and teamwork across units are the most important issues that should be considered in this hospital. Therefore, the safety culture can be promoted, the risks threating patients can be reduced, and ultimately the health care quality can be improved. These findings underscore the need for OHS interventions targeting punitive workplace norms, staffing adequacy, and inter-unit collaboration to foster a just culture and improve patient outcomes.