Comparison of patient safety culture among psychiatric, general, and specialized hospitals of Tehran


  • Pouran Raeissi Iran University of Medical Sciences
  • Erfan Shakibaei Tehran University of Medical Sciences





Critical Care, General, Intensive Care, Patient Safety, Psychiatric.


Patient safety culture (PSC) has been considered less than its significance within high risk health care facilities so far. The aim of this study was to firstly compare PSC among psychiatric, general, and critical/intensive care systems then, focus on common weaknesses between Middle East countries. The study design was cross-sectional which was executed by using of a two stage sampling frame. Researchers had 298 questionnaire completed (RR=62%) among three groups comprising nurses, nurse’s aides, and laboratory personnel. The Farsi version of Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire was employed in this study. Descriptive statistics, and One Way ANOVA were used aiming to analyze collected data by using of SPSS 20. The highest percent of composite mean scores in Specialized, Psychiatric, and Generals were 61.49%, 56.67%, and 55.69% respectively. Common weakest dimensions of PSC among the three groups of hospitals included: Non-punitive response to error (24.3%), Staffing (32.18%), and Communication openness (42.44%). There were no significant differences among means and variences of the three groups of hospitals. It can be concluded that health care systems may have no differences in PSC correspond to disparities in amount of risk and job pressure. An implication of this study is the possibility that PSC is mostly local, although some weaknesses between our study and Middle East seemed to be symmetrical.


[1] LT. Kohn, JM. Corrigan, MS. Donaldson, To Err Is Human: Building a Safer Health System, National Academies Press, 2000.

[2] S. Singer, S. Lin, A. Falwell, D. Gaba, L. Baker, Relationship of safety climate and safety performance in hospitals, Health services research 44 (2009) 399-421.

[3] S. Clarke, Safety culture: underâ€specified and overrated?, International Journal of Management Reviews 2 (2000) 65-90.

[4] Mg. Milczarek, A. Najmiec, The Relationship Between Workers' Safety Culture and Accidents, Near Accidents and Health Problems, International Journal of Occupational Safety and Ergonomics 10 (2004) 25-33.

[5] R. Flin, Measuring safety culture in healthcare: A case for accurate diagnosis, Safety Science 45 (2007) 653-67.

[6] Y. Pfeiffer, T. Manser, Development of the German version of the Hospital Survey on Patient Safety Culture: Dimensionality and psychometric properties, Safety Science 48 (2010) 1452-62.

[7] D. Zohar, Thirty years of safety climate research: Reflections and future directions, Accident Analysis & Prevention 42 (2010) 1517-22.

[8] DL. Phipps, DM. Ashcroft, An investigation of occupational subgroups with respect to patient safety culture, Safety Science 50 (2012) 1290-8.

[9] S. Silva, ML. Lima, C. Baptista, OSCI: an organisational and safety climate inventory, Safety science 42 (2004) 205-20.

[10] RR. Gershon, CD. Karkashian, JW. Grosch, LR. Murphy, A. Escamilla-Cejudo, PA. Flanagan, et al., Hospital safety climate and its relationship with safe work practices and workplace exposure incidents, American journal of infection control 28 (2000) 211-21.

[11] D. McCarthy, D. Blumenthal, Stories from the sharp end: case studies in safety improvement, Milbank Quarterly 84 (2006) 165-200.

[12] HSE, Reducing error and influencing behaviour, Health and Safety Executive, 2009.

[13] MP. Aust, Establishing a Culture of Safety, American Journal of Critical Care 22 (2013) 104.

[14] R. Agarwal, S. Chaturvedi, N. Chhillar, I. Pant, S. Kaushik, CB. Tripathi, A Trend Analysis of Quality Indicators of Patient Safety in the Clinical Laboratory Over 21 Months, Lab Medicine 43 (2012) 300-6.

[15] AJ. Leendertse, AC. Egberts, LJ. Stoker, PM. van den Bemt, Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands, Archives of internal medicine 168 (2008) 1890-6.

[16] M. Zegers, M. De Bruijne, C. Wagner, L. Hoonhout, R. Waaijman, M. Smits, et al., Adverse events and potentially preventable deaths in Dutch hospitals: results of a retrospective patient record review study, Quality and Safety in Health Care 18 (2009) 297-302.

[17] AB. Haynes, TG. Weiser, WR. Berry, SR. Lipsitz, A-HS. Breizat, EP. Dellinger, et al., Changes in safety attitude and relationship to decreased postoperative morbidity and mortality following implementation of a checklist-based surgical safety intervention, BMJ quality & safety 20 (2011) 102-7.

[18] A. Okuyama, K. Martowirono, B. Bijnen, Assessing the patient safety competencies of healthcare professionals: a systematic review, BMJ quality & safety qhc (2011) 000148.

[19] RE. Mardon, K. Khanna, J. Sorra, N. Dyer, T. Famolaro, Exploring relationships between hospital patient safety culture and adverse events, Journal of patient safety 6 (2010) 226-32.

[20] PJ. Pronovost, CA. Goeschel, JA. Marsteller, JB. Sexton, JC. Pham, SM. Berenholtz, Framework for patient safety research and improvement, Circulation 119 (2009) 330-7.

[21] C. Snijders, BJ. Kollen, RA. van Lingen, WP. Fetter, H. Molendijk, NS. Group, Which aspects of safety culture predict incident reporting behavior in neonatal intensive care units? A multilevel analysis, Critical care medicine 37 (2009) 61-7.

[22] S. Kirk, D. Parker, T. Claridge, A. Esmail, M. Marshall, Patient safety culture in primary care: developing a theoretical framework for practical use, Quality and Safety in Health Care 16 (2007) 313-20.

[23] C. Wagner, R. Mannion, A. Hammer, O. Groene, O. Arah, M. Dersarkissian, et al., The associations between organizational culture, organizational structure and quality management in European hospitals, International Journal for Quality in Health Care mzu (2014) 027.

[24] S. Clarke, The relationship between safety climate and safety performance: a meta-analytic review, Journal of occupational health psychology 11 (2006) 315.

[25] E. Knebel, AC. Greiner, Health Professions Education: A Bridge to Quality, National Academies Press 2003.

[26] Nursing AaoCo, The essentials of baccalaureate education for professional nursing practice, 2008.

[27] B. Flanagan, D. Nestel, M. Joseph, Making patient safety the focus: crisis resource management in the undergraduate curriculum, Medical education 38 (2004) 56-66.

[28] D. Mayer, DL. Klamen, A. Gunderson, P. Barach, Designing a patient safety undergraduate medical curriculum: the Telluride Interdisciplinary Roundtable experience, Teaching and learning in medicine 21 (2009) 52-8.

[29] A. Wakefield, M. Attree, I. Braidman, C. Carlisle, M. Johnson, H. Cooke, Patient safety: do nursing and medical curricula address this theme?, Nurse education today 25 (2005) 333-40.

[30] DS. Debono, D. Greenfield, JF. Travaglia, JC. Long, D. Black, J. Johnson, et al., Nurses’ workarounds in acute healthcare settings: a scoping review, BMC health services research 13 (2013) 175.

[31] D. Raveendranathan, PS. Chandra, SK. Chaturvedi, Violence among psychiatric inpatients: A victim's perspective, East Asian archives of psychiatry 22 (2012) 141.

[32] H. Gilburt, D. Rose, M. Slade, The importance of relationships in mental health care: A qualitative study of service users' experiences of psychiatric hospital admission in the UK, BMC Health Services Research 8 (2008) 92.

[33] S. Berenholtz, T. Dorman, P. Pronovost, Improving quality and safety in the ICU, Contemp Crit Care 1 (2003) 1-10.

[34] LD. Scott, AE. Rogers, W-T. Hwang, Y. Zhang, Effects of critical care nurses’ work hours on vigilance and patients’ safety, American Journal of Critical Care 15 (2006) 30-7.

[35] S. Osmon, CB. Harris, WC. Dunagan, D. Prentice, VJ. Fraser, MH. Kollef, Reporting of medical errors: an intensive care unit experience, Critical care medicine 32 (2004) 727-33.

[36] AI. Glendon, NA. Stanton. Perspectives on safety culture, Safety Science 34 (2000) 193-214.

[37] FW. Guldenmund, The nature of safety culture: a review of theory and research, Safety science 34 2000) 215-57.

[38] A. Hutchinson, K. Cooper, J. Dean, A. McIntosh, M. Patterson, C. Stride, et al., Use of a safety climate questionnaire in UK health care: factor structure, reliability and usability, Quality and Safety in Health Care 15 (2006) 347-53.

[39] DL. Zwart, M. Langelaan, RC. van de Vooren, MM. Kuyvenhoven, CJ. Kalkman, TJ. Verheij, et al., Patient safety culture measurement in general practice, Clinimetric properties of'SCOPE', BMC family practice 12 (2011) 117.

[40] JR. Frank, S. Brien, The safety competencies: enhancing patient safety across the health professions, Canadian Patient Safety Institute= Institut canadien pour la sécurité 2008.

[41] M. Walton, H. Woodward, S. Van Staalduinen, C. Lemer, F. Greaves, D. Noble, et al., The WHO patient safety curriculum guide for medical schools, Quality and Safety in Health Care 19 (2010) 542-6.

[42] J. Sorra, VF. Nieva, Hospital survey on patient safety culture, Agency for Healthcare Research and Quality 2004.

[43] H. Alahmadi, Assessment of patient safety culture in Saudi Arabian hospitals, Quality and Safety in Health Care 19 (2010) 1-5.

[44] F. El-Jardali, M. Jaafar, H. Dimassi, D. Jamal, R. Hamdan, The current state of patient safety culture in Lebanese hospitals: a study at baseline, International Journal for Quality in Health Care mzq (2010) 047.

[45] J. Hellings, W. Schrooten, N. Klazinga, A. Vleugels, Challenging patient safety culture: survey results, International journal of health care quality assurance 20 (2007) 620-32.

[46] J. Kim, K. An, MK. Kim, SH. Yoon, Nurses' perception of error reporting and patient safety culture in Korea, Western Journal of Nursing Research 29 (2007) 827-44.

[47] SJ. Singer, D. Gaba, J. Geppert, A. Sinaiko, S. Howard, K. Park, The culture of safety: results of an organization-wide survey in 15 California hospitals, Quality and safety in health care 12 (2003) 112-8.

[48] MJC. Grant, AE. Donaldson, GY. Larsen, The safety culture in a children's hospital, Journal of nursing care quality 21 (2006) 223-9.

[49] J. Hellings, W. Schrooten, NS. Klazinga, A. Vleugels, Improving patient safety culture, International journal of health care quality assurance 23 (2010) 489-506.

[50] IC. Chen, HH. Li, Measuring patient safety culture in Taiwan using the Hospital Survey on Patient Safety Culture (HSOPSC), BMC Health Services Research 10 (2010) 152.

[51] D. Ausserhofer, M. Schubert, S. Engberg, M. Blegen, G. De, R. Schwendimann, Nurse-reported patient safety climate in Swiss hospitals: a descriptive-explorative substudy of the Swiss RN4CAST study, Swiss medical weekly 142 (2011) 0-.

[52] R. Ballangrud, B. Hedelin, ML. Hall-Lord, Nurses’ perceptions of patient safety climate in intensive care units: A cross-sectional study, Intensive and Critical Care Nursing 28 (2012 ) 344-54.

[53] M. Javad, G. Amin, M. Mahbobe, R. Forooshani, ASA. Abas, A. Mohammad. Validation of Farsi version of hospital survey on patient Safety culture questionnaire, using confirmatory factor analysis method, Hospital Journal 11 (2012).

[54] MA. Bahrami, R. Montazeralfaraj, M. Chalak, AD. Tafti, GA. Tehrani, SE. Ardakani, Patient Safety Culture Challenges: Survey Results of Iranian Educational Hospitals, Middle-East Journal of Scientific Research 14 (2013) 641-9.

[55] K. Henriksen, JB. Battles, MA. Keyes, ML. Grady, KJ. Jones, A. Skinner, et al., The AHRQ hospital survey on patient safety culture: a tool to plan and evaluate patient safety programs 2008.

[56] N. Hatam, V. Keshtkar, F. Forouzan, P. Bastani, Patient Safety Culture Status in Teaching Hospitals: A Case of Shiraz University of Medical Sciences, Middle-East Journal of Scientific Research 12 (2012) 970-5.

[57] A. Mohammadreza, T. Sogand, B. Omid, Measuring safety culture and setting priorities for action at an Iranian hospital, Al Ameen J Med Sci 3 (2010) 237-45.

[58] GD. Dalton, XF. Samaropoulos, AC. Dalton, Improvements in the safety of patient care can help end the medical malpractice crisis in the United States, Health policy 86 (2008) 153-62.

[59] S. Keady, M. Thacker, National Patient Safety Agency: Improving patient safety across all critical care areas, Intensive and Critical Care Nursing 24 (2008) 137-40.

[60] H. Jasti, H. Sheth, M. Verrico, S. Perera, G. Bump, D. Simak, et al., Assessing patient safety culture of internal medicine house staff in an academic teaching hospital, Journal of graduate medical education 1 (2009) 139-45.

[61] DM. Elston, E. Stratman, H. Johnson-Jahangir, A. Watson, S. Swiggum, CW. Hanke, Patient safety: Part II. Opportunities for improvement in patient safety, Journal of the American Academy of Dermatology 61 (2009) 193-205.

[62] M. Hamdan, AAo. Saleem, Assessment of patient safety culture in Palestinian public hospitals, International journal for quality in health care 25 (2013) 167-75.

[63] SM. Keller, Effects of extended work shifts and shift work on patient safety, productivity, and employee health, AAOHN journal: official journal of the American Association of Occupational Health Nurses 57 (2009) 497-502; quiz 3-4.

[64] LL. Leape, DM. Berwick, Five years after To Err Is Human: what have we learned?, Jama 293 (2005) 2384-90.

[65] CL. Uribe, SB. Schweikhart, DS. Pathak, GB. Marsh, RR. Fraley, Perceived barriers to medical-error reporting: an exploratory investigation, Journal of Healthcare Management 47 (2002) 263.

[66] LI. Horwitz, HM. Krumholz, ML. Green, SJ. Huot, Transfers of patient care between house staff on internal medicine wards: a national survey, Archives of internal medicine 166 (2006) 1173-7.

[67] BJ. Weiner, C. Hobgood, MA. Lewis, The meaning of justice in safety incident reporting, Social science & medicine 66 (2008) 403-13.

View Full Article: