Background The rate of harm resulting from unsafe care is known to be high in African health systems and there is a significant need to improve patient safety culture through the active involvement of healthcare leaders in creating an environment that enhances organizational culture around patient safety in low and middle income settings.

Methods A questionnaire developed from the Agency for Healthcare Research and Quality (AHRQ) was used to assess the organizational culture of patient safety among 120 frontline clinical staff for four health care facilities in Yaounde, Cameroon. Ethical clearance was obtained for the study.

Results Most participants (85%) responded that they clearly know the mission, vision, and goals of their institution. 97 (80.7%) of respondents agreed or strongly agreed that they receive strong emphasis from their hospital hierarchy for safe care. Participant responses varied by facility on the perceived culture of collaboration between management and frontline staff (p = 0.0374). Overall, only 43.8% of respondents felt that there was strong collaboration between management and medical staff. Overall, 47.5% of all respondents expressed that they would not feel safe being treated in their own hospital. The majority (76.7%) have no notion of patient safety and 94.2% expressed the desire for more training on the topic.

Although there is strong emphasis from leadership for safe care, the low awareness on the notion of patient safety, low collaboration between the leadership and frontline staff and the fact most frontline clinical staffs will not feel safe being treated in their own hospitals, are important indicators that reveal an unhealthy patient safety culture in the hospital.

Conclusion Hospital Leadership has a major role to play in enhancing a patient safety organizational culture. Collaboration between the leadership and frontline staff is indispensable for a successful outcome. These setbacks can be reduced with appropriate training.