Literature Review of Patient Safety Culture in the Middle-East Arab Countries

Background and Purpose. The purpose of this review was to appraise the literature on patient safety culture (PSC) in in-patient healthcare settings (IPHS) in the Middle-East Arab countries (MEAC). Understanding PSC is important in MEAC due to inconsistent data being reported on PSC risk factors. The Agency for Healthcare Research and Quality (AHRQ) defined safety culture as the product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization’s health and safety management.

Theoretical Framework. Elements from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model were used to establish eligibility, identify relevant articles, and abstract data.

Methods. The search was limited to peer-reviewed studies that were conducted in MEAC and published between 2005-2015. Included were studies that measured or described PSC among IPHS. PubMed, CINAHL, and Cochrane were searched, and the key words were: patient safety, patient safety culture, and Middle-East. Out of 29 articles, 14 articles (12 cross-sectional, 1 quasi-experimental, and 1 qualitative thematic analysis) were included after screening for eligibility and overlapping. These studies were from Saudi Arabia, Egypt, Jordan, Yemen, Lebanon, Palestine, and Oman, with the majority of participants being physicians and nurses.

Results. The majority of studies used the Hospital Survey on Patient Safety Culture measure of PSC. Only IPHS were reported in the literature. No pattern could be detected regarding which factors positively contributed to PSC. Negative factors were elaborated on and included inadequate staffing, communication, reporting system, and management response to error. Additionally, no studies were found that examined PSC nor the relationship between PSC and outcomes of older adults residing in nursing homes.

Conclusion and Implications. The negligible findings among studies may be due to the healthcare system structure in MEAC. Safety issues are only beginning to be a focus in these developing countries, as agency accreditation standards gain importance. Having an understanding of factors which influence PSC is crucial in designing interventions to lower risk of harm and adverse events for patients, especially vulnerable populations such as older adults in IPHS residing in MEAC.