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This study aimed to examine the mediating role of fear of negative evaluation in the relationship between power distance and attitudes toward medical error reporting among healthcare professionals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A multicenter study of physicians and nurses was conducted in five tertiary hospitals in Istanbul, Turkey. Data were collected using anonymous, paper-based questionnaires with a stratified quota-based convenience sampling approach. The survey included validated scales assessing organizational power distance, fear of negative evaluation, and attitudes toward medical errors. Mediation analysis was conducted using regression-based models with bias-corrected and accelerated (BCa) bootstrap confidence intervals based on 5,000 resamples. Statistical significance was set at\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 705 healthcare professionals participated (mean age: 32.3 [SD 8.5] years; 43.7% physicians, 56.3% nurses). More than half (51.9%) reported witnessing a medical error in the past year, whereas only 4.5% demonstrated positive attitudes toward error reporting. Internal medicine staff exhibited higher fear of negative evaluation and greater instrumental use of power compared with surgical staff (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Physicians reported higher fear of negative evaluation and greater use of instrumental power compared with nurses (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Fear of negative evaluation was positively associated with all power distance dimensions (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Mediation analysis showed that fear of negative evaluation mediates the relationship between instrumental use of power and medical error reporting attitudes (standardized \u03b2\u2009=\u20090.020,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite the high prevalence of witnessed medical errors, negative attitudes toward error reporting remained live. The findings suggest that hierarchical organizational dynamics and fear-related mechanisms may contribute to barriers to transparent reporting, highlighting the importance of psychologically safe and nonpunitive communication environments in hospital settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial number<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12913-026-14895-3","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T18:03:36Z","timestamp":1780682616000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The mediating role of power distance and fear of negative evaluation in medical error under-reporting across surgical and internal divisions: a multicenter cross-sectional survey in Turkey"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3183-3438","authenticated-orcid":false,"given":"Melike","family":"Mercan Baspinar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5095-6316","authenticated-orcid":false,"given":"Hamdiye Banu","family":"Katran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3801-4654","authenticated-orcid":false,"given":"Ali Mirza","family":"Dincer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9043-849X","authenticated-orcid":false,"given":"Feyzanur","family":"Erdem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7126-0024","authenticated-orcid":false,"given":"Beray Gelmez","family":"Tas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7926-580X","authenticated-orcid":false,"given":"Sundus","family":"Gorukmez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0200-5409","authenticated-orcid":false,"given":"Resat","family":"Dabak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0582-4570","authenticated-orcid":false,"given":"Guzin Zeren","family":"Ozturk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5222-9136","authenticated-orcid":false,"given":"Okcan","family":"Basat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0135-6909","authenticated-orcid":false,"given":"Secil","family":"Arica","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7777-8887","authenticated-orcid":false,"given":"Gokhan","family":"Adas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"14895_CR1","unstructured":"Hofstede G. 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In addition, multicenter research approval covering five hospitals was granted by the Istanbul Provincial Health Directorate (Decision No: 2022\/14, Date: 01.08.2022). Written informed consent was obtained from all participants prior to their inclusion in the study, including consent for the publication of anonymized data. The study was conducted in accordance with the Declaration of Helsinki and approved by the local institutional ethics committee.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was performed in accordance with the ethical principles specified in the Declaration of. Helsinki, the Good Clinical Practice (GCP), and regulatory requirements. No experiments have been performed including animals.","order":2,"name":"Ethics","label":"Statement of human and animal rights","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"During the preparation of this work, the authors used AI-assisted tools (Paperpal for grammar checking and language editing; ChatGPT-4 for assistance with literature search and thematic organisation of the discussion). ChatGPT was not used to generate, interpret, or analyse any study data; all quantitative analyses were performed exclusively using jamovi (version 2.7.11) and SPSS 25.0 by the study authors. ChatGPT was used solely to assist with identifying relevant literature and structuring argument flow in the discussion section. All AI-assisted content was critically reviewed, revised, and verified by the authors, who take full responsibility for the accuracy and integrity of the published work. After using this tool\/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the published work.","order":4,"name":"Ethics","label":"AI disclousure statement","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1105"}}