The Determinants of Patient Safety Outcomes; A Systematic Review

Abstract

 Background: Patient safety is a key dimension of healthcare quality, yet preventable adverse events remain a global concern. Evidence suggests that safety outcomes are shaped by interacting determinants at individual, organizational, and system levels, necessitating a comprehensive synthesis of current research.

Objective: This systematic review aimed to identify and synthesize key determinants of patient safety outcomes and examine their associations with adverse events, near misses, reporting practices, and overall safety performance.

Methods: Following PRISMA 2020 guidelines, peer-reviewed studies published between 2020 and 2025 were systematically searched across major electronic databases. Eligible studies examined determinants influencing patient safety outcomes in healthcare settings. Data were extracted and thematically synthesized, with determinants categorized into behavioral, organizational, and contextual domains.

Results: Patient safety outcomes were influenced by multiple interacting determinants. Behavioral factors included clinical competence, communication, fatigue, and professional conduct. Organizational determinants encompassed safety culture, leadership support, staffing adequacy, workload, reporting systems, and organizational learning. Contextual factors involved policy environments, resource availability, accreditation processes, and broader system constraints. These determinants were consistently associated with adverse events, healthcare-associated infections, medication errors, near misses, and mortality.

Conclusions: Patient safety outcomes are multifactorial, arising from interactions across individual, organizational, and contextual levels. Improving safety requires integrated, system-wide strategies that address workforce behavior, organizational structures, and contextual conditions. A holistic, learning-oriented approach is essential to reduce preventable harm and enhance healthcare system resilience.