The Determinants of Patient Safety Culture – A Systematic Review

Abstract

Background: Patient safety culture (PSC) is a foundational component of healthcare quality and risk reduction in hospital settings. Although numerous studies have assessed PSC levels globally, evidence regarding its determinants remains fragmented and insufficiently integrated across healthcare systems. Objective: This systematic review aimed to identify, synthesize, and hierarchically integrate the determinants of patient safety culture in hospital settings worldwide. Methods: A comprehensive search of PubMed, Scopus, Web of Science, and CINAHL was conducted for peer-reviewed articles published between January 2010 and December 2025. Eligible studies examined determinants of patient safety culture in hospital settings using validated instruments, including the Hospital Survey on Patient Safety Culture (HSOPSC), the Safety Attitudes Questionnaire (SAQ), or equivalent standardized tools. Both empirical studies and structured research syntheses addressing determinants of PSC were considered. Data extraction and methodological appraisal were conducted using Joanna Briggs Institute checklists, and findings were synthesized using a structured narrative approach to assess consistency and convergence across studies. Results: Twenty-six studies met the inclusion criteria. Determinants of PSC were identified across individual, organizational, and structural domains. Organizational determinants demonstrated the strongest and most consistent associations with patient safety culture outcomes across diverse healthcare contexts. Key drivers included leadership practices, management support, staffing adequacy, workload management, teamwork climate, communication openness, and non-punitive response to error. Individual-level factors, particularly education and participation in safety training, showed positive but less consistent associations. Structural characteristics, including hospital type and governance context, functioned primarily as contextual moderators influencing variability in safety culture perceptions. Conclusion: Patient safety culture is predominantly shaped by organizational determinants, with leadership and staffing adequacy representing central leverage points for intervention. Sustainable improvement requires alignment between institutional leadership, workforce capacity, and policy-level governance strategies. This review provides an integrated synthesis of evidence clarifying priority domains for strengthening hospital safety culture globally.