Organizational Safety Practices, Interprofessional Collaboration, and Safety Consciousness Associated with Safety Citizenship Behaviour Among Healthcare Professionals in Hospitals in Kerala, India: A Multicentre Cross-Sectional Study

Abstract

Background: Safety citizenship behaviour is important for maintaining a safe healthcare environment. However, evidence regarding the independent associations of organisational safety practices, interprofessional collaboration, and safety consciousness with this behaviour remains limited in Indian hospitals.
Objective: To examine the associations of workplace safety management practices, interprofessional collaboration, and safety consciousness with safety citizenship behaviour among healthcare professionals in Kerala, India.
Methods: This multicentre cross-sectional study was conducted in four cooperative hospitals in northern Kerala. Data were collected between June 2024 and August 2025 using self-administered questionnaires. Of 450 questionnaires distributed, 373 complete responses were analysed. Pearson correlation and multivariable linear regression were used to assess associations with safety citizenship behaviour, adjusting for demographic, professional, and hospital-related characteristics.
Results: The mean safety citizenship behaviour score was 87.72 (SD 11.36) out of 100. Safety citizenship behaviour was positively correlated with workplace safety management practices (r = 0.335, p < 0.001), interprofessional collaboration (r = 0.413, p < 0.001), and safety consciousness (r = 0.395, p < 0.001). The adjusted regression model explained 33.6% of the variance (R² = 0.336; adjusted R² = 0.305). Interprofessional collaboration (B = 0.695, 95% CI 0.205–1.185; p = 0.006) and safety consciousness (B = 0.665, 95% CI 0.141–1.189; p = 0.013) remained independently associated with safety citizenship behaviour. Workplace safety management practices were not independently associated with the outcome (B = 0.082, 95% CI −0.061 to 0.225; p = 0.260).
Conclusion: Interprofessional collaboration and safety consciousness were independently associated with safety citizenship behaviour. Strengthening collaborative working and safety awareness may support hospital safety initiatives. Longitudinal studies are required to establish temporal relationships.