Survey of Critical Standards of Patient Safety in Hospitals of Iran: A Systematic Review and Meta‑Analysis

Ali Sahebi, Mohamad Golitaleb, Katayoun Jahangiri


Background: Patient safety is an important and mandatory component of quality health services. Insecure health services, in addition to inflicting pain and suffering to patients, impose a high financial burden on the health system of every society. The present study was conducted to evaluate the critical standards of patient safety based on the Patient Safety Friendly Hospital Initiative (PSFHI) checklist in Iran.

Methods: The present systematic review and meta‑analysis were performed based on the PRISMA guideline. For this purpose, articles related to the critical standards of patient safety based on the PSFHI checklist were obtained by searching valid Persian and English keywords in SID, Magiran, PubMed, Scopus, Web of Science, and Google scholar data resource through the end of 2019. The studies were analyzed using the STATA (version 14) software.

Results: In the initial search, 533 articles were extracted among which 7 were eligible and entered into the meta‑analysis process. Overall, 55 hospitals were surveyed, and the results of the meta‑analysis showed that the average critical standards of patient safety were 69.52% (95%, CI = 57.09–81.95, I2 = 69%, P = 0.004).

Conclusions: The results showed that a moderate level of critical standards of patient safety in hospitals in Iran. Since meta‑regression analysis revealed a decreasing trend in compliance rate, hospital managers should implement principals designated by the World Health Organization to achieve the required standards that are the basis and pillar of a patient‑friendly hospital. With proper management, hospitals should set goals and take steps based on a strategic plan toward achieving these goals.


Friendly hospital; hospitals; patients; safet

Full Text:



Lawati MH, Dennis S, Short SD, Abdulhadi NN. Patient safety

and safety culture in primary health care: A systematic review.

BMC Fam Pract 2018;19:104.

Mostafaei D, Aryankhesal A, Dastoorpoor M,

Rahimikhalifekandi Z, Estebsari F. Patient safety culture

assessment of clinical and paraclinical staff perspective in

selected university of medical sciences hospitals in Tehran. Iran J

Health Educ Health Promot 2018;6:293‑301.

Rezaei TA, Abdullahzadeh F, Ghahramanian A, Asghari

Jafarabadi M, Fadaei Z, Sheikhalipour Z. Patient safety culture

and the factors influencing from the perspective of nurses

of medical center of Imam Reza (AS) Tabriz. J Urmia Nurs

Midwifery Fac 2018;15:767‑76.

Garcia CD, Abreu LC, Ramos JL, Castro CF, Smiderle FR,

Santos JA, et al. Influence of burnout on patient safety:

Systematic review and meta‑analysis. Medicina 2019;55:553.

El‑Jardali F, Jaafar M, Dimassi H, Jamal D, Hamdan R. The

current state of patient safety culture in Lebanese hospitals:

A study at baseline. Int J Qual Health Care 2010;22:386‑95.

Christian CK, Gustafson ML, Roth EM, Sheridan TB,

Gandhi TK, Dwyer K, et al. A prospective study of patient safety

in the operating room. Surgery 2006;139:159‑73.

In: Erickson SM, Wolcott J, Corrigan JM, Aspden P, editors.

Patient Safety: Achieving a New Standard for Care. National

Academies Press; 2003.

World Health Organization ROftEM. Patient safety assessment

manual. 2011.

Pauniaho S, Lepojarvi M, Peltomaa K, Saario I, Isojarvi J,

Malmivaara A, et al. A surgical checklist increases patient safety.

Suomen Lääkärilehti 2009;49:4249‑54.

Nie Y, Mao X, Cui H, He S, Li J, Zhang M. Hospital survey on

patient safety culture in China. BMC Health Serv Res 2013;13:228.

Okuyama A, Wagner C, Bijnen B. Speaking up for patient safety

by hospital‑based health care professionals: A literature review.

BMC Health Serv Res 2014;14:61.

Asefzade S, Mehrabian F, Nikpey A, Kianmehr SH. Assessment

of patient safety based on standards of patient safety friendly

hospitals in education and treatment centers of Rasht city in


Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC,

Mulrow CD, Pocock SJ, et al. Strengthening the reporting of

observational studies in epidemiology (STROBE): Explanation

and elaboration. Int J Surg 2014;12:1500‑24.

Sahebi A, Jahangiri K, Sohrabizadeh S, Golitaleb M. Prevalence

of workplace violence types against personnel of emergency

medical services in Iran: A systematic review and meta‑analysis.

Iran J Psychiatry 2019;14:325‑34.

Yousefi K, Larijani HA, Golitaleb M, Sahebi A. Knowledge,

attitude and performance associated with disaster preparedness

in Iranian nurses: A systematic review and meta‑analysis. Adv J

Emerg Med 2019;3:e42.

Janghorbani M, Raisi A, Dehghani S, Mousavi A. Assessment

of safety status in operating rooms of Shahid Beheshti

hospital, Isfahan, Iran by the World Health Organization

standards for safety‑friendly hospitals. Director General

;9:1066‑72. [Persian]

Jabbari A, Raisi A, Rostami V. Patient safety status in selected

training hospitals affiliated with Isfahan university of medical

sciences. Health Inf Manag 2015;12:99‑108.

Babamohamadi H, Nemati RK, Nobahar M, Keighobady S,

Ghazavi S, Izadi‑Sabet F, et al. Evaluation of patient safety

indicators in Semnan City hospitals by using the Patient safety

friendly hospital initiative (PSFHI). Glob J Health Sci 2016;8:1‑7.

Gazerani A, Aliakbari R, Habibzadeh M, Haresabadi M.

Assessment of safety status in operating room by the World

Health Organization standards for safety‑friendly hospital.

J North Khorasan Univ Med Sci 2015;6:895‑903. [Persian]

Habibzade H, Akbari F, qhavami H, Moradi K. A survey

on the establishment of patient‑friendly safety standards in

Urmia University of medical sciences. Nurs Midwifery J

;17:525‑34. [Persian]

Torka beydokhti M, Hajinabi K, Jahangiri K. The relationship

between the patient’s safety and nurses’ team working in surgical

and intensive care units in Gilan province selected hospitals.

Manage Strat Health Syst 2018;3:33‑43. [Persian]

Mazhari Z, Adel A. Patient safety status in hospitals of

Tehran‑patient safety friendly hospitals standards: 2013.

J Payavard Salamat 2015;8:379‑89. [Persian]

Bairami A, Ghorbanpoor M, Bairami F. Patient safety friendly

hospital initiative: Does it work in Iran? Iran J Public Health


Kondori M. Comparison of managers and employees’s views

about the effects of clinical governance on patient safety. Adv

Nurs Midwifery 2015;25:51‑6. [Persian]

Mohammad AR, Sari AA, Kor EM, Hosseini M, Rakhshan ST,

Ezati M. Patient safety in Tehran university of medical sciences’

general hospitals, Iran. Iran J Public Health 2013;42:306.

Campione J, Famolaro T. Promising practices for improving

hospital patient safety culture. Jt Comm J Qual Patient Saf


Asefzadeh S, Kalhor R, Tir M. Patient safety culture and job

stress among nurses in Mazandaran, Iran. Electron Physician


Behzadifar M, Behzadifar M, Jahanpanah F, Bragazzi NL.

Patient safety culture assessment in Iran using the “Hospital

survey on patient safety culture” tool: A systematic review and

meta‑analysis. Clin Epidemiol Glob Health 2019;7:641‑7.

Bahadori M, Soltanzadeh P, Salimi M, Raadabadi M, Moghri J,

Ravangard R. Application of WHO model for evaluating Patient

safety friendly hospital initiatives (PSFHI) in an eye hospital in

Tehran, Iran. Electron Physician 2013;5:631.