Patient Safety Culture, Transformational Leadership, and Employee Safety Behavior: Evidence from A Primary Healthcare Facility in Indonesia
DOI:
https://doi.org/10.58526/jsret.v5i3.1226Keywords:
Patient safety culture, transformational leadership, Dayak Culture, employee safety behavior, primary healthcare, community health center, IndonesiaAbstract
Patient safety in primary healthcare depends not only on formal safety procedures but also on the organizational environment and leadership that shape employees’ safety-related behavior. This study examined the relationship of patient safety culture and transformational leadership with employee safety behavior at UPTD Puskesmas Cipadung, Bandung, Indonesia. A quantitative cross-sectional study was conducted in 2026 using total population sampling involving all 39 employees of the health center. Data were collected using structured questionnaires measuring patient safety culture, transformational leadership, and employee safety behavior on a four-point Likert scale. Data were analyzed using descriptive statistics, Cronbach’s alpha, Spearman correlation, and multiple linear regression. The findings showed that patient safety culture was perceived as very high (mean = 3.83), transformational leadership was very high (mean = 3.84), and employee safety behavior was very high (mean = 3.86). Incident reporting had the highest mean among the patient safety culture dimensions (3.88), while intellectual stimulation was the highest transformational leadership dimension (3.87). Employee safety behavior showed similarly high levels of safety compliance (3.86) and safety participation (3.85). Multiple linear regression showed that patient safety culture had a positive and significant effect on employee safety behavior (β = 0.620; p < 0.001), while transformational leadership also had a positive and significant effect (β = 0.516; p = 0.001). The regression model was statistically significant (F = 64.828; p < 0.001) and explained 78.3% of the variance in employee safety behavior (R² = 0.783). Patient safety culture demonstrated the stronger relative contribution, although transformational leadership also made a significant independent contribution. These findings indicate that employee safety behavior in primary healthcare is associated with both a supportive patient safety culture and transformational leadership. Strengthening safety culture through open communication, incident reporting, teamwork, organizational learning, and employee participation, together with leadership that encourages motivation and problem solving, may support the sustainability of safe practices in primary healthcare.
Downloads
References
Adeyemi, C., Adegoke, B. O., & Odugbose, T. (2024). The impact of healthcare information technology on reducing medication errors: A review of recent advances. International Journal of Frontiers in Medicine and Surgery Research, 5(2), 020–029. https://doi.org/10.53294/ijfmsr.2024.5.2.0034
AHRQ. (2021). Hospital Survey on Patient Safety Culture Version 2.0: User’s Guide (J. Sorra, N. Yount, T. Famolaro, & L. Gray (eds.); 2.0, Vol. 19, Issue (21)-0076). AHRQ Publication.
Alsobou, N., Rayan, A. H., Baqeas, M. H., ALBashtawy, M. S., Oweidat, I. A., Al-Mugheed, K., & Abdelaliem, S. M. F. (2025). The relationship between patient safety culture and attitudes toward incident reporting among registered nurses. BMC Health Services Research, 25(1). https://doi.org/10.1186/s12913-025-12763-0
Althobaiti, F. M. (2026). The effects of leadership on patient safety culture in health care: a systematic review. BMC Nursing, 25(125), 1–20. https://doi.org/10.1186/s12912-025-04263-7
Amallia, R. D., Pramesona, B. A., Setiawan, G., & Saftarina, F. (2024). Gambaran Budaya Keselamatan Pasien di Rumah Sakit : Tinjauan Pustaka Overview of Patient Safety Culture in Hospitals : Literature Review. Journal Medula, 14(10), 1946–1952.
Ana, K., Yetti, K., Suhendri, A., & Maryunani, A. (2023). Budaya Pelaporan Insiden Keselamatan Pasien Terintegrasi Melalui SIMRS. Journal of Telenursing (JOTING), 5(1), 1083–1092. https://doi.org/10.31539/joting.v5i1.4905
Astriyani, S., Suryoputro, A., & Budiyanti, R. T. (2021). Pelaksanaan Keselamatan Pasien di Puskesmas X Ditinjau dari Tujuh Langkah Menuju Keselamatan Pasien. Media Kesehatan Masyarakat Indonesia, 20(3), 150–158. https://doi.org/10.14710/mkmi.20.3.150-158
Azyabi, A., Karwowski, W., & Davahli, M. R. (2021). Assessing patient safety culture in hospital settings. International Journal of Environmental Research and Public Health, 18(5), 1–36. https://doi.org/10.3390/ijerph18052466
Bass, B. M., & Riggio, R. E. (2006). Transformational Leadership. Psychology Press. https://doi.org/10.4324/9781410617095
Camacho-Rodríguez, D. E., Carrasquilla-Baza, D. A., Dominguez-Cancino, K. A., & Palmieri, P. A. (2022). Patient Safety Culture in Latin American Hospitals: A Systematic Review with Meta-Analysis. International Journal of Environmental Research and Public Health, 19(21). https://doi.org/10.3390/ijerph192114380
Churruca, K., Ellis, L. A., Pomare, C., Hogden, A., Bierbaum, M., Long, J. C., Olekalns, A., & Braithwaite, J. (2021). Dimensions of safety culture: A systematic review of quantitative, qualitative and mixed methods for assessing safety culture in hospitals. BMJ Open, 11(7), 1–13. https://doi.org/10.1136/bmjopen-2020-043982
Dhamanti, I., Leggat, S., Barraclough, S., & Rachman, T. (2022). Factors contributing to under-reporting of patient safety incidents in Indonesia: Leaders’ perspectives. F1000Research, 10, 1–23. https://doi.org/10.12688/f1000research.51912.2
Grech, V., & Eldawlatly, A. A. (2023). STROBE, CONSORT, PRISMA, MOOSE, STARD, SPIRIT, and other guidelines – Overview and application. Saudi Journal of Anesthesia, 18, 137–141. https://doi.org/10.4103/sja.sja
Guspianto, Amir, A., Justitia, B., Elisma, & Ningsih, V. R. (2025). Upaya peningkatan keselamatan pasien di pelayanan kesehatan primer. Jurnal Salam Sehat Masyarakat, 7(1), 57–67.
Hamdan, M., Jaaffar, A. H., Khraisat, O., Issa, M. R., & Jarrar, M. (2024). The Association of Transformational Leadership on Safety Practices Among Nurses: The Mediating Role of Patient Safety Culture. Risk Management and Healthcare Policy, 17, 1687–1700. https://doi.org/10.2147/RMHP.S458505
Huang, C. H., Wu, H. H., Lee, Y. C., & Li, X. (2024). The Critical Role of Leadership in Patient Safety Culture: A Mediation Analysis of Management Influence on Safety Factors. Risk Management and Healthcare Policy, 17, 513–523. https://doi.org/10.2147/RMHP.S446651
Ip, E., Srivastava, R., Lentz, L., Jasinoski, S., & Anderson, G. S. (2025). Antecedents of Workplace Psychological Safety in Public Safety and Frontline Healthcare: A Scoping Review. International Journal of Environmental Research and Public Health, 22(6). https://doi.org/10.3390/ijerph22060820
Lumbantobing, F. S. V., & Thamrin, M. H. (2025). Implementasi Tata Laksana Budaya Keselamatan Pasien dalam Pelayanan Kesehatan di Puskesmas Merek Kabupaten Karo. Jurnal Ilmiah Multidisiplin Ilmu, 2(4), 242–247. https://doi.org/10.69714/k4s4z194
Muis, I., & Isyanto, P. (2022). Pengaruh kepemimpinan transformasional terhadap komitmen organisasi, dengan Kepuasan kerja sebagai variabel intervening. E-Jurnal Manajemen, 6(1), 2548–7507.
Nasution, Y. S., Lubis, M. A., Assyfa, V. N., Hasibuan, F. A. C., Sari, W., & Suraya, R. (2025). Analisis Peran Puskesmas Medan Amplas dalam Meningkatkan Kesehatan Masyarakat di Wilayahnya. Sagita Academia Journal, 3(2), 47–51. https://doi.org/10.61579/sagita.v3i2.374
Neal, A., & Griffin, M. A. (2002). Safety Climate and Safety Behaviour. Australian Journal of Management, 27(1_suppl), 67–75. https://doi.org/10.1177/031289620202701s08
Neal, A., & Griffin, M. A. (2006). A study of the lagged relationships among safety climate, safety motivation, safety behavior, and accidents at the individual and group levels. Journal of Applied Psychology, 91(4), 946–953. https://doi.org/10.1037/0021-9010.91.4.946
Noor Arzahan, I. S., Ismail, Z., & Yasin, S. M. (2022). Safety culture, safety climate, and safety performance in healthcare facilities: A systematic review. Safety Science, 147, 105624. https://doi.org/10.1016/j.ssci.2021.105624
Nuria, S., & Dhamanti, I. (2023). Types of Patient Safety Incidents in Public Health Centers. Media Gizi Kesmas, 12(2), 795–801. https://doi.org/10.20473/mgk.v12i2.2023.795-801
Palendeng, F. O., & Bernarto, I. (2022). Pengaruh Iklim Keselamatan, Sistem Manajemen Keselamatan, Dan Perilaku Keselamatan Terhadap Budaya Keselamatan Staf Klinis Di RS Gunung Maria. Jurnal Ilmiah Manajemen Bisnis Dan Inovasi Universitas Sam Ratulangi (JMBI Unsrat), 9(3), 1599–1616.
Paputungan, A., Muchlis, N., Sididi, M., Administrasi, P., Kesehatan, K., Masyarakat, K., Muslim Indonesia, U., & Epidemiologi, P. (2022). Penerapan Patient Safety Pada Ruang Rawat Inap Puskesmas Minasa Upa Kota Makassar. Window of Public Health Journal, 3(5), 860–867.
Patarru’, F., Nursalam, N., & Mar’ah HAS, E. M. (2020). Efektivitas Kepemimpinan Transformasional Terhadap Peningkatan Kinerja Perawat. Jurnal Penelitian Kesehatan “SUARA FORIKES” (Journal of Health Research “Forikes Voice”), 11(4), 381. https://doi.org/10.33846/sf11411
Peraturan Menteri Kesehatan Republik Indonesia Nomor 19 Tahun 2024 Tentang Penyelenggaraan Pusat Kesehatan Masyarakat, 90 (2024).
Roghani, M., Haroon, Z. H., Munir, M. U., Kirmani, S. I., Anwar, M., & Younas, M. (2023). Laboratory Safety Climate Assessment and its Correlation with Safety Procedures Amongst Staff of a Reference Clinical Laboratory. Journal of the College of Physicians and Surgeons Pakistan, 33(11), 1259–1263. https://doi.org/10.29271/jcpsp.2023.11.1259
Sabirin, N. A., Bur, N., & Yuliaty. (2022). Hubungan Beban Kerja Mental Tenaga Kesehatan Dengan Patient Safety di Puskesmas Padongko Kabupaten Barru. Window of Public Health Journal, 3(1), 189–197. https://doi.org/10.33096/woph.v3i1.359
Salsabila, A. N., & Dhamanti, I. (2023). Faktor-Faktor Yang Mempengaruhi Perawat Dalam Penerapan Keselamatan Pasien Di Rumah Sakit: Literature Review. Jurnal Ners, 7(1), 524–530. http://journal.stkiptam.ac.id/index.php/ners
Suryani, L., Letchmi, S., & Binti Moch Said, F. (2022). Cross-culture adaptation and validation of the Indonesian version of the Hospital Survey on Patient Safety Culture (HSOPSC 2.0). Belitung Nursing Journal, 8(2), 169–175. https://doi.org/10.33546/bnj.1928
Sutanto, H., Utami, Y., & Diantoro, A. K. (2021). The Effect of Idealized Influence, Inspirational Motivation, Intellectual Stimulation, and Individual Consideration on HR Performance. RSF Conference Series: Business, Management and Social Sciences, 1(3), 100–109. https://doi.org/10.31098/bmss.v1i3.293
Syabanasyah, I., Rachmawati, E., & Hartono, B. (2023). The Influence of Transformational Leadership on Patient Safety Efforts. Jurnal Ilmu Dan Teknologi Kesehatan, 10(2), 150–161. https://doi.org/10.32668/jitek.v10i2.1008
Wahyuda, O., Putu, G., Ketut, A., & Putu, A. (2024). Analisis Faktor-Faktor yang Berhubungan dengan Budaya Keselamatan Pasien di Rumah Sakit. Jurnal Keperawatan, 16(1), 27–36.
Waruwu, E. C., Pertiwi, A. S. P., & Andikarya, R. O. (2026). Pengaruh Patient Safety Leadership Walkrounds terhadap Budaya Keselamatan dan Implikasinya pada Pelaporan. Jurnal Pengabdian Nasional (JPN) Indonesia, 7(2), 353–363.
Wijayanti, K., & Aini, Q. (2022). The Influence of Transformational Leadership Style to Nurse Job Satisfaction and Performance in Hospital. Journal of World Science, 1(7), 485–499. https://doi.org/10.36418/jws.v1i7.69
World Health Organization. (2019). Global action on patient safety. In Report to the Seventy-second World Health Assembly (WHA72). https://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_R6-en.pdf
World Health Organization. (2023). Patient safety. https://doi.org/10.1007/978-3-319-58868-1_1
World Health Organization (WHO). (2021). Global Strategy on Digital Health 2020-2025.
Yulianti, N., & Susanti. (2025). Pengaruh Manajemen Kepemimpinan terhadap Jalur Karier Keperawatan di Rumah Sakit. Detector: Jurnal Inovasi Riset Ilmu Kesehatan, 3(4), 155–168. https://doi.org/10.55606/detector.v3i4.5826
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Sessika Yunisa, Nurdin Nurdin, Titik Respati
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Copyright @2022. This is an open-access article distributed under the terms of the Creative Commons Attribution-ShareAlike 4.0 International License (https://creativecommons.org/licenses/by-sa/4.0/) which permits unrestricted commercial used, distribution and reproduction in any medium
JRSET is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
