# Patient Safety Culture in Hospital Settings Across Continents: A Systematic Review
## 4 Discussion
### Strengths and Weaknesses of Patient Safety Culture  
There was consistency in the identification of \"Teamwork within units\" and \"Organizational Learning: Continuous Improvement\" as strengths of PSC across continents. Most responses from Asian studies reported these dimensions as strengths of their healthcare systems, while few studies in Europe, South America, and Africa did so. Strong scores in Teamwork within units indicate that healthcare providers globally value collaboration for patient safety. Effective teamwork improves communication, coordination, and decision-making, leading to better patient outcomes [107; 108]. Similarly, strong \"Organizational Learning: Continuous Improvement\" scores reflect a faithful commitment to continually learning from errors and implementing improvements [109]. This proactive approach is vital for identifying and addressing safety concerns, and mitigating the risk of adverse events. Therefore, the increasing demand and complexity of healthcare services make this vital. Patient safety and treatment experiences need continuous improvement through innovative solutions. Instead of aiming for \"as few things as possible go wrong,\" we should strive for \"as many things as possible go right.\" Inspired by [PERSON] [110], this approach emphasizes the importance of everyone within the healthcare system working together to create a safe environment. It aligns perfectly with the idea of strong teamwork within units and the continuous improvement that comes from organizational learning.  
However, the consistent emergence of \"Non-punitive Response to Error\" and \"Staffing\" as weaknesses across continents presents a significant challenge to healthcare systems worldwide. Low scores in \"Non-punitive Response to Error\" suggest a potential fear of punishment for reporting errors. Encouraging a non-punitive approach towards errors in healthcare settings can help alleviate the fear of punishment linked to reporting mistakes [110, 111]. This fear blocks open communication and hinders efforts to identify and address safety issues. A lack of blame-free environments conducive to honest reporting of errors is a persistent problem in healthcare.  
Therefore, promoting a \"Just Culture\" is required, which values learning over assigning blame and empowers healthcare providers to report errors freely, enabling ongoing improvement and ultimately enhancing patient safety [110, 112]. Moreover, implementing a patient safety incident reporting system should positively impact PSC [113]. Furthermore, inadequate staffing levels could be the main reason for receiving a low score in the \"Staffing\" dimension, which can directly impact the quality and safety of patient care. An understaffed or overworked environment may result in compromised worker well-being, lowered standards, and a higher risk of errors [85, 114]. These findings are also highlighted in other studies [115, 116].  
Considering the time, previous studies have thoroughly examined both the strength and weakness dimensions of PSC. Recent research emphasized that these aspects persist, indicating that the ongoing challenges in addressing weaknesses and enhancing them have yet to be effectively overcome.