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Patient safety incident reporting is central to service quality, serving as a crucial component in internal learning and improvement processes, renewal, policy revision, and updates to existing standard operating procedures (SOPs) and guidelines. Low reporting rates of safety incidents highlight the importance of investigating the factors contributing to underreporting. This study aims to analyze the influence of safety culture on patient safety incident reporting. The research design employed in this study is a literature review. The SPIDER framework was used to guide the literature review. Articles selected for the study adhered to inclusion criteria, specifically journal publications within a maximum timeframe of the past five years (2019–2024). A strong safety culture has been shown to improve patient safety incident reporting rates with the influence variable are open communication, cooperation between units, non-blaming responses, feedback on errors, organizational learning, supervisor/manager expectations and actions, and hospital management support. Patient safety culture significantly influences the reporting of patient safety incidents.

This study examines to make up this significant gap in the existing literature. Using a cross-sectional sample consisting of 240 nurses in the hospitals of Uzbekistan and a structural model, with a random sampling technique by employing explanatory, and causal design was used to test the developed framework.  Quantitative data was collected using questionnaires, the survey instruments were distributed by hand among the private and public sector, we find that nurses’ perceived safety culture (SC) and decision-making capacity (DMC) act as important mechanisms linking TL to PS. Meanwhile, nurses’ perceived locus of control (LC) moderates the effect of TL on SC and DMC in such a way that this effect is more salient for nurses with internal LC than for nurses with external LC. This paper examines the contribution, that individuals with high internal LC are more affected by TL, generate and can better develop SC and DMC. The study findings demonstrated the significant role of transformational leadership played in order to improve working conditions and the environment, which helps nurses to create good conditions, relationships with patients and increase patient safety. The theoretical and practical implications of this study are discussed