Abstract
Hemodialysis is a high-risk medical procedure that requires strict adherence to patient safety protocols. Adverse events in hemodialysis units can be minimized not only through structural compliance with regulations but also through the internalization of a patient safety culture among healthcare workers. This study aimed to analyze the effect of safety protocol implementation on adverse events through patient safety culture as a mediating variable during the hemodialysis process at the Dialysis Installation of Husada Hospital, Jakarta. A quantitative approach with path analysis was employed, involving a total sample of 16 healthcare workers selected through total sampling. Data were collected using closed-ended questionnaires and analyzed using path analysis and the Sobel test. Results showed that safety protocol implementation and patient safety culture were both high (94.9% and 94.5%, respectively), while adverse events were low (85.1% on the negative-worded instrument). Safety protocol implementation significantly affected safety culture (t = 6.157; p = 0.000), and safety culture significantly affected adverse events (t = 3.409; p = 0.004). The Sobel test confirmed a significant mediating effect (z = 2.849 > 1.96) that exceeded the direct effect. Patient safety culture plays a pivotal mediating role in translating safety protocols into reduced adverse events, and hospital management should therefore foster an open, non-punitive safety climate.