Association between patient safety culture, adverse events, and essential practices during childbirth in six Brazilian maternity hospitals.

OBJECTIVE

This study examines whether hospitals with stronger patient safety culture more consistently follow essential birth practices and have fewer adverse outcomes for mothers and newborns and whether this evidence can guide maternity care priorities in patient safety policy.

METHODS

We conducted a multicenter cross-sectional study in six public maternity hospitals in Brazil (November 2022 to February 2024). In each hospital, we measured patient safety culture using the Brazilian version of the Hospital Survey on Patient Safety Culture. From a systematic sample of 2183 births (approximately 360 per hospital), we reviewed charts to record eight essential obstetric and neonatal practices and 10 adverse outcomes. We created hospital-level composites for the practice bundle and adverse outcomes and correlated them with culture scores using Spearman coefficients (one-sided exact P-values).

RESULTS

A total of 686 professionals responded to the survey, with a mean overall culture score of 43.6% (range: 29.5%-56.4%). "Perception of safety" and "non-punitive response to errors" were consistently low, while "management expectations," "organizational learning," and "teamwork within units" were relative strengths. Adherence was high for postpartum oxytocin (93.4%), vitamin K (95.9%), and newborn identification (91.1%), and low for partogram initiation (36.4%), birth companion (48.1%), and breastfeeding within the first hour (47.5%). Culture scores aligned positively with the practice bundle (ρ = 0.77; P = 0.072) and inversely with adverse outcomes-maternal (ρ = -0.77; P = 0.072), neonatal (ρ = -0.89; P = 0.019), and total (ρ = -0.94; P = 0.005).

CONCLUSION

Findings support pairing culture-strengthening actions with clinical bundles to promote safer childbirth and prioritize maternity services in safety policy.