Open Access Highly Accessed Research article

The characteristics of patient safety culture in Japan, Taiwan and the United States

Shigeru Fujita1, Kanako Seto1, Shinya Ito1, Yinghui Wu1, Chiu-Chin Huang2 and Tomonori Hasegawa1*

Author Affiliations

1 Department of Social medicine, Faculty of Medicine, Toho University, Tokyo, Japan

2 Department of Senior Citizen Service Management, Ming-Hsin University of Science and Technology, Hsinchu, Taiwan

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BMC Health Services Research 2013, 13:20  doi:10.1186/1472-6963-13-20

Published: 14 January 2013



Quality and safety issues are receiving growing attention. Patient safety culture (PSC) plays an important role in patient safety. The characteristics of PSC in various countries, each with a different set of values, have not been determined sufficiently. The aim of this study is to investigate the characteristics of PSC in Japan, Taiwan and the U.S.


A cross-sectional survey was conducted in Japan and Taiwan using the Hospital Survey on PSC (HSOPS) questionnaire developed by the U.S. Agency for Healthcare Research and Quality (AHRQ). Data from Japan and Taiwan were also compared with the U.S. “2010 HSOPS Comparative Database” provided by AHRQ.


Valid response rates in Japan, Taiwan and the U.S. were 66.5% (6,963/10,466), 85.7% (10,019/11,692) and 35.2% (291,341/827,424), respectively. The proportion of respondents with some experience of event reporting during the past 12 months was highest in Japan. In general, U.S. healthcare workers were likely to evaluate their PSC higher than that in Japan or Taiwan. The attitude of continuous improvement in Japan and event reporting of near misses in Taiwan were rated as low. In the U.S., staffing was rated as high.


The results suggest that PSC varies among different countries, and the cultural setting of each country should be given special consideration in the development of effective intervention plans to improve PSC. Additional investigations with improved methodology and a common protocol are required to accurately compare PSCs among countries.

Safety; Organizational culture; Safety management; Attitude of health personnel; Patient safety culture