Just Culture and Quality of Patient Care in Tertiary Care Hospitals: The Mediating Role of Psychological Empowerment and the Moderating Role of Perceived Organizational Support

Abstract

Background: Preventable harm remains an important patient safety concern in public tertiary hospitals in Pakistan, where fear of blame may discourage error reporting and organizational learning. This study examines whether Just Culture is associated with Quality of Patient Care through Psychological Empowerment and whether this pathway is strengthened by Perceived Organizational Support. Methods: A quantitative cross-sectional survey was conducted among 350 doctors and nurses from Mayo Hospital and Services Hospital, Lahore. A bilingual 56-item instrument incorporated the Just Culture Assessment Tool, Spreitzer’s Psychological Empowerment Scale, the Survey of Perceived Organizational Support, and WHO/AHRQ-derived indicators of Quality of Patient Care. Hypotheses were tested using regression-based path analysis, mediation and moderation analysis, and bias corrected bootstrapping with 5,000 resamples following Hayes’ conditional-process approach. Results: Just Culture had a significant positive direct association with Quality of Patient Care (β = 0.323, p < .001) and Psychological Empowerment (β = 0.583, p < .001). Psychological Empowerment positively predicted Quality of Patient Care (β = 0.342, p < .001) and partially mediated the Just Culture care quality relationship (indirect effect β = 0.199, 95% CI [0.135, 0.270]), accounting for 38.2% of the total effect. Perceived Organizational Support significantly strengthened the Psychological Empowerment–Quality of Patient Care relationship (interaction β = 0.132, p = .002). The conditional indirect effect increased from β = 0.194 at low organizational support to β = 0.347 at high organizational support. All six hypotheses were supported. Conclusion: The findings indicate that Just Culture is associated with better perceived patient care quality both directly and through Psychological Empowerment, while tangible organizational support strengthens this pathway. Hospital admintrators should therefore implement Just Culture reforms together with practical support, staff autonomy, fair incident investigation, adequate resources and protection from retaliation.