# Patient Safety Culture in Hospital Settings Across Continents: A Systematic Review
## 1 Introduction  
Patient safety has been recognized by the Institute of Medicine (IOM) as a significant cornerstone within healthcare systems, emphasizing its crucial role in improving the overall quality of care [1]. IOM has placed significant emphasis on establishing a safety-oriented culture within healthcare organizations, intending to enhance patient safety and the overall quality of care provided. Ensuring patients are safe is one of the most critical aspects of healthcare. According to the World Health Organization (WHO), \"First, do no harm\". This principle asserts that patient safety should be the root of healthcare services [2]. Globally, in healthcare systems, there is substantial evidence of avoidable patient harm in both developed and developing countries, carrying primary humanitarian, ethical, and financial implications [3]. Patient safety culture research holds paramount importance for healthcare sectors worldwide, as it addresses a critical global and local concern [2]. A report from the IOM drew broad attention due to its extensive recommendations. Entitled \"To Err Is Human: Building a Safer Health System\" and \"Crossing the Quality Chasm: A New Health System for the 21 st Century,\" the data presented in those reports highlight the importanceof a safety-oriented culture in healthcare [1; 4]. Prioritizing safety not only protects patients and reduces errors, but also promotes the well-being of healthcare workers and enhances the overall quality of care within healthcare organizations [1]. Several initiatives are being implemented to address the patient safety issue. One of them is the Global Patient Safety Action Plan 2021-2030. This initiative was adopted in 2021 by the WHO to prevent avoidable harm, promote patient safety across many practice domains, and help countries develop national action plans [5]. This effort emphasizes the importance of healthcare institutions strengthening their policies and strategies rooted in scientific evidence and patient feedback, as well as building national policies consistent with the global goals of a culture of patient safety. The objective is to eradicate risks and preventable harm for patients and healthcare professionals. Investing in people's quality of life is a central aspect of real investment, and one of the primary steps is to liberate healthcare systems from harm. According to the WHO, investing in safety and productivity is crucial for achieving positive organizational outcomes [3; 6]. According to the report of the Health and Safety Commission Advisory Committee [7], safety culture (SC) has been defined as the collective outcome of personal and team beliefs, feelings, viewpoints, skills, and behavioral tendencies that shape the level of dedication, as well as the manner and effectiveness of safety management and an organization's health. The concept of patient safety culture (PSC) is a crucial element within the realm of organizational safety culture in the healthcare sector. It is defined as the mitigation of potential harm connected with healthcare to a tolerable level [8]. The perception of SC might be confused with the quality of healthcare, where the quality of healthcare is multifaceted and lacks a concise definition due to its susceptibility to the many perspectives and interests of those concerned, as well as the disparity characteristics of healthcare facilities [9]. Hence, the concept of quality of care has been delineated by considering various dimensions, including but not limited to accuracy, empathy, safety, reliability, efficacy, affordability, and effectiveness [10]. Patient safety is a paramount aspect of healthcare, aiming to minimize errors and adverse effects associated with medical care. The IOM has delineated six domains of healthcare quality to enhance this [4]. Safety ensures a risk-free environment and systems to mitigate errors. Effectiveness promotes evidence-based practices to provide appropriate care in a timely manner. Patient-centeredness emphasizes respect and responsiveness to individual patient preferences.