# Patient Safety Culture in Hospital Settings Across Continents: A Systematic Review
## 4 Discussion  
As a summary of key findings, the review of PSC highlights that Asia has the highest utilization of HSOPSC instruments, with 63.3% of participants and 63.7% of hospitals. Europe and South America have less representation, while Africa is the least represented. Nurses are the most frequently surveyed group. However, there are significant gaps in hospital and respondent characteristics data, particularly in education (93.8% missing), gender (87.7% missing), and age (93.3% missing). These omissions could potentially affect the overall analysis and our ability to gain a deep understanding of PSC. Regarding the overall positive perception of PSC across continents, it stands at 55.3%. Asia demonstrates strengths in teamwork and organizational learning but shows weaknesses in responses to errors. Europe and South America exhibit notable weaknesses across multiple PSC dimensions. Numerous developed countries have embarked on a journey characterized by strategic initiatives, systematic approaches, and collaborative efforts within their healthcare systems in pursuit of patient safety [99]. However, healthcare sectors worldwide, whether in developed or developing countries, encounter the common challenge of enhancing PSC [100]. In response to this challenge, healthcare providers are working to create supportive environments that empower staff to understand and implement this critical concept effectively [99; 101]. By assessing PSC, an organization becomes aware of the various aspects \begin{table}
\begin{tabular}{c c c c c c c c c c c c c c} \hline  & & **D1** & **D2** & **D3** & **D4** & **D5** & **D6** & **D7** & **D8** & **D9** & **D10** & **D11** & **D12** \\ \hline \multirow{4}{*}{2015–2019 (n = 20)} & Strength Area & 13 (19\%) & 4 (6\%) & 9 (13\%) & 5 (7\%) & - & 3 (4\%) & - & (3\%) & (1\%) & - & (1\%) & (1\%) \\ \cline{2-13}  & \multirow{2}{*}{Weakness Area} & \multirow{2}{*}{-} & 3 & 8 & 16 & 5 & 12 & 10 & 7 & 16 & 10 & 6 \\  & & & (4\%) & - & (11\%) & (23\%) & (7\%) & (17\%) & (14\%) & (10\%) & (23\%) & (14\%) & (9\%) \\ \hline \multirow{4}{*}{2020–2023 (n = 29)} & Strength Area & 13 (19\%) & 3 (4\%) & 17 (24\%) & 7 (10\%) & 3 (4\%) & 5 (7\%) & - & - & 3 & 1 & 2 & 4 \\  & & (19\%) & (4\%) & (24\%) & (10\%) & (4\%) & (7\%) & - & - & (4\%) & (1\%) & (3\%) & (6\%) \\ \cline{1-1} \cline{2-13}  & \multirow{2}{*}{Weakness Area} & 2 & 4 & 2 & 7 & 23 & 7 & 14 & 10 & 8 & 25 & 9 & 9 \\  & & (3\%) & (6\%) & (3\%) & (10\%) & (33\%) & (10\%) & (20\%) & (14\%) & (11\%) & (36\%) & (13\%) & (13\%) \\ \hline \end{tabular}
*: The number of surveys reported this demotion as strong or weak (the percentage from N = 70).  
\end{table} 
Table 6: _Cont._of patient safety that need to be addressed. It also allows hospitals and healthcare providers to identify their organizational culture's strengths and weaknesses in terms of patient safety, as well as any existing problems [13; 15; 16]. Hence, this study contributed to assessing variations in PSC dimensions across continents and professions based on geographical and temporal factors, using studies that employed the HSOPSC. The findings offered valuable insights into the strengths and weaknesses of PSC dimensions, highlighting areas for targeted improvement within global healthcare systems. This review has discerned that the predominant approach among various countries in assessing patient safety culture involves using the HSOPSC 1.0, which was widely acknowledged for its adaptability and efficacy [37]. The utilization of the HSOPSC 2.0 tool is relatively limited in studies, and mainly employed to check the tool's adaptation and validation in a different cultural context. Avoiding the fact that some studies showed low scores in internal consistency in some dimensions [27; 28], it could be the promise of a fairer and improved measurement instrument for assessing PSC in the future [102]. The studies covered in this review primarily focused on cross-sectional assessments of perception, with limited exploration of interventions or psychometric tool analyses.