# Nurses’ perceptions of patient safety culture measured by the Hospital Survey on Patient Safety Culture in the Gulf Cooperation Council region: A systematic review

## TL;DR

This review summarizes nurses' perceptions of patient safety culture in Gulf Cooperation Council hospitals, highlighting strengths in teamwork and weaknesses in staffing and error reporting.

## Contribution

The study provides a systematic synthesis of patient safety culture perceptions among nurses in Gulf Cooperation Council countries using standardized survey data.

## Key findings

- High composite scores for teamwork and continuous improvement were reported across Gulf Cooperation Council hospitals.
- Low scores were observed for staffing, communication openness, and nonpunitive error response.
- Findings suggest a need for culturally tailored strategies to improve patient safety culture in the region.

## Abstract

Patient safety is a global priority, and nurses play a central role in its implementation and monitoring. Understanding nurses’ perceptions of patient safety culture supports refinement of safety strategies, evidence-informed policymaking, and sustained cultural change. This systematic review synthesizes studies using the Hospital Survey on Patient Safety Culture to assess nurses’ perceptions in the Gulf Cooperation Council countries: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates.

The review was registered with PROSPERO and guided by the PRISMA framework. CINAHL, MEDLINE, and EMBASE were searched in September 2024 using predefined keywords related to nursing, patient safety, the Hospital Survey on Patient Safety Culture, and the Gulf Cooperation Council countries. Inclusion criteria were primary studies reporting nurses’ Hospital Survey on Patient Safety Culture scores in hospital settings. Covidence software was used for study screening, duplicate removal, and eligibility assessment.

From 54 identified records, 25 unique studies were screened, 20 underwent full-text review, and 9 met inclusion criteria. Eight studies employed the Hospital Survey on Patient Safety Culture version 1 (nurses: 2591; mean sample size: 323.88) and one study used the Hospital Survey on Patient Safety Culture version 2 (nurses: 402). Across version 1 studies, highest average composite scores were observed for Teamwork Within Units (71.92%) and Organizational Learning–Continuous Improvement (78.70%). Communication Openness (45.51%), Staffing (40.09%), Handoffs and Transitions (40.53%), and Nonpunitive Response to Error (35.42%) were lowest. Version 2 results showed similar trends: Teamwork (77%) and Organizational Learning - Continuous Improvement (72.3%) were high, while Staffing and Work Pace (46.17%) and Response to Error (39.75%) were low. The review’s findings indicated substantial variation in nurses’ perceptions across patient safety culture composites, from high ratings for teamwork to low ratings for staffing and nonpunitive error reporting.

Patient safety culture in the Gulf Cooperation Council hospitals shows strengths in teamwork and continuous improvement, but persistent weaknesses in staffing, error reporting, and care transitions. Aligned with national healthcare visions (e.g., Saudi Vision 2030 and Oman Vision 2040), evidence-based recommendations include implementing structured handoff processes, adopting nonpunitive and confidential approaches to promote nonpunitive error reporting, and strengthening workforce strategies to improve staffing adequacy and workload management. Additionally, it may be useful to develop instruments that are based on the sociocultural realities of these societies and not adapted from other countries' instruments.