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Status of patient safety culture in Arab countries: a systematic review
  1. Mustafa Elmontsri,
  2. Ahmed Almashrafi,
  3. Ricky Banarsee,
  4. Azeem Majeed
  1. Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
  1. Correspondence to Mustafa Elmontsri; m.elmontsri10{at}


Objectives To explore the status of patient safety culture in Arab countries based on the findings of the Hospital Survey on Patient Safety Culture (HSPSC).

Design Systematic review.

Methods We performed electronic searches of the MEDLINE, EMBASE, CINAHL, ProQuest and PsychINFO, Google Scholar and PubMed databases, with manual searches of bibliographies of included articles and key journals. We included studies that were conducted in the Arab countries that were focused on patient safety culture. 2 reviewers independently verified that the studies met the inclusion criteria and critically assessed the quality of the studies.

Results 18 studies met our inclusion criteria. The review identified that non-punitive response to error is seen as a serious issue which needs to be improved. Healthcare professionals in the Arab countries tend to think that a ‘culture of blame’ still exists that prevents them from reporting incidents. We found an overall similarity between the reported composite score for dimension of teamwork within units in all of the reviewed studies. Teamwork within units was found to be better than teamwork across hospital units. All of the reviewed studies reported that organisational learning and continuous improvement was satisfactory as the average score of this dimension for all studies was 73.2%. Moreover, the review found that communication openness seems to be a concerning issue for healthcare professionals in the Arab countries.

Conclusions There is a need to promote patient safety culture as a strategy for improving the patient safety in the Arab world. Improving patient safety culture should include all stakeholders, like policymakers, healthcare providers and those responsible for medical education. This review was limited only to English language publications. The varied settings in which the HSPSC was used may have influenced the areas of strengths and weaknesses as healthcare workers' perception of safety culture may differ.

  • Patient Safety
  • Safety Culture
  • Arab Countries

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Contributors ME and AA prepared the study protocol. RB helped MA and AA in designing the research strategy and selecting studies for inclusion. ME and AA carried out the search, extracted the data and assessed the quality of the included studies. Data analysis was carried out under the supervision of RB and AM. ME and AA wrote the manuscript that was then revised by RB and AM. The final version of the manuscript has been approved by all authors.

  • Funding This review was part of ME's PhD research which was funded by the Government of Libya. The Department of Primary Care and Public Health at Imperial College London is grateful for support from the NW London NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC), the Imperial NIHR Biomedical Research Centre and the Imperial Centre for Patient Safety and Service Quality (CPSSQ).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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