Analisis Faktor Blame Culture pada Perawat dalam Pelaporan Insiden Keselamatan Pasien di Rumah Sakit Umum Daerah Provinsi Nusa Tenggara Barat

Abstract

Patient safety incident reporting is a key mechanism for learning and preventing avoidable harm in healthcare organizations. A persistent blame culture continues to hinder reporting behavior despite increasing awareness of patient safety principles among nurses. This study aimed to analyze the influence of nurse-related factors, job factors, work environment factors, and organizational factors on blame culture, and to examine the effect of blame culture on patient safety incident reporting at West Nusa Tenggara Provincial General Hospital. An analytic quantitative design with deskriptif correlational approach was applied to 134 inpatient nurses selected using proportionate stratified random sampling. Data were collected through structured questionnaires and analyzed using Partial Least Squares–Structural Equation Modeling (PLS-SEM). The findings showed that blame culture remained high, particularly reflected by low psychological safety and individualized attribution of errors. Job factors had a significant effect (t = 4.115; p = 0,001), while work environment factors were the most dominant predictor (t = 5.144; p = 0,001). Blame culture had a significant negative effect on patient safety incident reporting (t = 6.664; p = 0,001) with an effect size approaching large (F² = 0.311), and explained 23.7% of reporting variation (R² = 0.237). This study concludes that the main barriers to incident reporting originate not from individual nurse capacity but from job-related pressures and psychological threats within the work environment that intensify blame culture. Strengthening just culture, enhancing psychological safety, reinforcing teamwork, and managing workload are essential to building a non-punitive and learning-oriented reporting environment.