Patient Safety Culture in Hospital Settings During the COVID-19 Pandemic: Protocol for a Scoping Review.

BACKGROUND: Patient safety culture (PSC) is a foundational component of quality health care. It is characterized by health care workers' individual attitudes, team dynamics, and organizational practices that influence clinical outcomes. During the COVID-19 pandemic, hospitals worldwide faced sudden changes and crises. In this rapidly evolving environment, organizational models were revised, established procedures were challenged, and professional roles were redefined; therefore, many aspects of safety culture may have been reshaped and redefined by the pandemic. Despite a growing body of literature examining PSC during the COVID-19 era, no comprehensive synthesis has yet mapped how PSC was conceptualized, measured, operationalized, and sustained across hospital settings during the pandemic. This gap highlights the need for an integrated synthesis that captures the multiple dimensions of PSC as they were experienced and managed during the pandemic. OBJECTIVE: This scoping review aims to map the literature on PSC in hospital settings during the COVID-19 pandemic. The specific objectives are to examine the theoretical frameworks and related constructs used to define and operationalize PSC during the pandemic; identify and categorize interventions implemented to strengthen or sustain PSC; describe monitoring activities, measurement instruments, and quality improvement approaches adopted in hospital settings; and synthesize the scope and characteristics of available evidence and identify knowledge gaps to inform future research and practice. METHODS: This scoping review will follow the methodological framework developed by Arksey and O'Malley, as updated by the JBI, and will be reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The research question was formulated using the population, concept, and context framework. Searches were conducted in the PubMed, Embase, and PsycInfo databases for records published from January 1, 2020, onward. Eligible evidence sources will include peer-reviewed empirical, interventional, measurement, review, and theoretical or conceptual publications addressing PSC or safety climate in hospital care during the COVID-19 pandemic. A total of 2 independent reviewers will conduct a 2-stage screening process, initially evaluating titles and abstracts for potential relevance, followed by a full-text assessment to determine final eligibility. RESULTS: This study commenced in April 2025 and is registered with the Open Science Framework. Database searches were completed in July 2025. Title and abstract screening commenced in July 2026. Full-text screening and data extraction are expected to be completed by September 2026, data synthesis by November 2026, and submission of the review findings in the fourth quarter of 2026. CONCLUSIONS: This scoping review will provide a structured overview of how PSC was maintained, adapted, or redefined in hospital settings during the COVID-19 pandemic. Mapping pandemic-era evidence on PSC may help hospitals translate crisis-related organizational learning into preparedness strategies, resilient safety systems, and quality improvement priorities for future public health emergencies.