Background: Patient safety culture is critical for reducing medical errors and improving healthcare quality. In Saudi public hospitals, frontline healthcare workers often encounter organizational and systemic barriers that hinder the development of a positive safety culture. Understanding these barriers from the perspective of frontline staff is essential to inform targeted interventions.

Objective: To explore perceived barriers to patient safety culture among frontline healthcare workers in Saudi public hospitals.

Methods: A qualitative descriptive study was conducted with 11 participants, including nurses, physicians, and allied health professionals, recruited from multiple public hospital units. Semi-structured interviews were used to collect data on experiences and perceptions of patient safety culture. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis to identify key themes and subthemes.

Results: Analysis revealed five main themes: (1) limited leadership engagement and organizational commitment to patient safety, (2) fear of blame and punitive response to errors, (3) hierarchical communication and teamwork barriers, (4) workload pressure and resource constraints, and (5) limited training and patient safety awareness. Participants reported that leadership absence, punitive culture, ineffective communication, high workload, and insufficient training collectively compromised safe practice and reporting behaviours.

Conclusions: Barriers to PSC in Saudi public hospitals are predominantly organizational and systemic. Addressing these challenges requires multifaceted strategies, such as strengthening leadership engagement, and providing safety training. These findings offer practical guidance for hospital administrators and policymakers to improve patient safety culture and inform future research in similar healthcare settings.