The First Study of Patient Safety Culture in Iranian Primary Health Centers

  • Narges Tabrizchi Department of Community Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Mojtaba Sedaghat Mail Department of Community Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Organizational culture, Primary healthcare, Personnel


Although the error in health care has received attention recently, patient safety culture in health centers has been relatively neglected. To measure the patient safety culture in primary health centers. A cross-sectional study, utilizing the modified version of the Hospital Survey on Patient Safety Culture (HSOPSC) developed by the Agency for Healthcare Research and Quality (AHRQ) and a demographic questionnaire. Healthcare staffs from health centers were participated in the survey. The patient safety culture score including subscores on 11 dimensions and 39 items; patient safety grade and number of events reported. The overall positive response rate of patient safety culture was 57 ±16.8 (CI 9555%-59%). The dimensions that received higher positive response rate were "Teamwork across units of health center", "Teamwork within units", "Head of center support for patient safety". The lowest percentage of positive responses was "Non punitive response to error". There were no relationship between working years and patients safely culture score. Similarly, no relationship was found between professional, gender and total patients safely culture score. Statistical analysis showed discrepancies between Iranian health centers and the US hospitals in three dimensions. For improving patient safety culture in health centers, it is necessary to have enough staff and establish an environment to be open and fair with staff which helps report errors spontaneously and without any fear. The findings of this study could be used to measure changes in patient safety culture over the time.


Fernald DH, Pace WD, Harris DM, West DR, Main DS, Westfall JM. Event reporting to a primary care patient safety reporting system: a report from the ASIPS collaborative. Ann Fam Med 2004;2(4):327-32.

Bates DW, Larizgoitia I, Prasopa-Plaizier N, Jha AK; Research Priority Setting Working Group of the WHO World Alliance for Patient Safety. Global priorities for patient safety research. BMJ 2009;338:b1775.

Kuzel AJ, Woolf SH, Gilchrist VJ, Engel JD, LaVeist TA, Vincent C, Frankel RM. Patient reports of preventable problems and harms in primary health care. Ann Fam Med 2004;2(4):333-40.

Sandars J, Esmail A. The frequency and nature of medical error in primary care: understanding the diversity across studies. Fam Pract 2003;20(3):231-6.

Singer S, Lin S, Falwell A, Gaba D, Baker L. Relationship of safety climate and safety performance in hospitals. Health Serv Res 2009;44(2 Pt 1):399-421.

Milligan F, Dennis S. Building a safety culture. Nurs Stand 2005;20(11):48-52.

Osborn S, Williams S. Seven steps to patient safety for primary care. National Patient Safety Agency, 2006.

Singla AK, Kitch BT, Weissman JS, Campbell EG. Assessing patient safety culture: A review and synthesis of the measurement tools. J Patient Saf 2006;2(3):105-15.

Colla JB, Bracken AC, Kinney LM, Weeks WB. Measuring patient safety climate: a review of surveys. Qual Saf Health Care 2005;14(5):364-6.

Matsubara S, Hagihara A, Nobutomo K. Development of a patient safety climate scale in Japan. Int J Qual Health Care 2008;20(3):211-20.

Nieva VF, Sorra J. Safety culture assessment: a tool forimproving patient safety in healthcare organizations. QualSaf Health Care 2003;12 Suppl 2:ii17-23.

Blegen MA, Gearhart S, O'Brien R, Sehgal NL, Alldredge BK. AHRQ's hospital survey on patient safety culture: psychometric analyses. J Patient Saf 2009;5(3):139-44.

Castle NG, Sonon KE. A culture of patient safety in nursing homes. Qual Saf Health Care 2006;15(6):405-8.

Bodur S, Filiz E. A survey on patient safety culture in primary healthcare services in Turkey. Int J Qual Health Care 2009;21(5):348-55.

Moghri J, Arab M, Akbari Saari A, Nateqi E, Rahimi Forooshani A, Ghiasvand H, Sohrabi R, Goudarzi R. The psychometric properties of the farsi version of “Hospital Survey on Patient Safety Culture” in iran’s hospitals. Iranian J Publ Health 2012;41(4):80-6.

Sorra J, Famloaro T, Dyer N, Nelson D, Khanna K. Rockville, MD: Agency for Healthcare Research and Quality; 2009. AHRQ Publication No. 09-0030.

Asadi-Lari M, Sayyari AA, Akbari ME, Gray D. Public health improvement in Iran: lessons from the last 20 years.Public Health 2004;118(6):395-402.

Mansouri N, Gharaee B, Shariat SV, Bolhari J, Yousefi Nooraie R, Rahimi-Movaghar A, Alirezaie N. The change in attitude and knowledge of health care personnel and general population following trainings provided during integration of mental health in Primary Health Care in Iran: a systematic review. Int J Ment Health Syst 2009;3(1):15.

Hellings J, Schrooten W, Klazinga N, Vleugels A. Challenging patient safety culture: survey results. Int J Health Care Qual Assur 2007;20(7):620-32.

Alahmadi HA. Assessment of patient safety culture in Saudi Arabian hospitals. Qual Saf Health Care 2010;19(5):e17.

Liu Y, Kalisch BJ, Zhang L, Xu J. Perception of safety culture by nurses in hospitals in china. J Nurs Care Qual2009;24(1):63-8.

Kim J, An K, Kim MK, Yoon SH. Nurses' perception of error reporting and patient safety culture in Korea. West J Nurs Res 2007;29(7):827-44.

Singer SJ, Gaba DM, Geppert JJ, Sinaiko AD, Howard SK, Park KC. The culture of safety: results of an organizationwidesurvey in 15 California hospitals. Qual Saf HealthCare 2003;12(2):112-8.

Handler SM, Castle NG, Studenski SA, Perera S, Fridsma DB, Nace DA, Hanlon JT. Patient safety culture assessment in the nursing home. Qual Saf Health Care2006;15(6):400-4.

Barach P, Small SD. Reporting and preventing medical mishaps: lessons from non-medical near miss reporting systems. BMJ 2000;320(7237):759-63.

How to Cite
Tabrizchi N, Sedaghat M. The First Study of Patient Safety Culture in Iranian Primary Health Centers. Acta Med Iran. 50(7):505-510.