Changes in Patient Safety Culture Alongside Leadership WalkRounds in Shaqra General Hospital from 2023 to 2025

Background/Objectives: This study examined changes in patient safety culture (PSC) alongside Patient Safety Leadership WalkRounds in a Saudi secondary hospital. Methods: In this retrospective repeated cross-sectional study, anonymous surveys from August 2023 and August 2025 were compared using percent-positive scores and respondent-level regression adjusted for job group, hospital tenure, working hours, and patient contact. Sensitivity analysis reweighted the 2025 role distribution to match that of 2023. National comparisons were descriptive. WalkRounds records from January–June 2025, coded follow-up actions, and annual occurrence variance report (OVR) totals described implementation context. Results: Participation increased from 180/490 (36.73%) to 349/515 (67.77%). Overall percent positive increased from 69.43% to 78.50% (difference 9.07 percentage points; bootstrap 95% confidence interval (CI) 5.45–12.85). The adjusted overall score difference was 0.243 (95% CI 0.149–0.337; p < 0.001). Nine domain differences remained significant after Holm adjustment, including hospital management and supervisor support; Staffing and Work Pace remained the lowest-scoring domain and its change was inconclusive (adjusted difference 0.109; 95% CI −0.016–0.234). The ledger documented 27 rounds, 106 staff participations, and 140 issues. Among 51 eligible follow-up actions, 12 (23.5%) were classified as strong, 32 (62.7%) as intermediate, and 7 (13.7%) as weak. Annual OVR counts increased from 1,633 to 1,954, while the proportion of survey respondents reporting no events increased from 26.7% to 35.2%. Conclusions: PSC ratings, including leadership support, were more favorable in 2025. Communication and leadership follow-up are practical priorities alongside structural workforce needs. WalkRounds’ contribution was not isolated, and reporting indicators were mixed.