title: Patient safety culture in hospitals of Iran: a systematic review and meta-analysis.
abstract: BACKGROUND
  Nowadays, for quality improvement, measuring patient safety culture (PSC) in healthcare organizations is being increasingly used. The aim of this study was to clarify PSC status in Iranian hospitals using a meta-analysis method.
  
  
  METHODS
  Six databases were searched: PubMed, Scopus, Google Scholar, Cochrane Library, Magiran, SID and IranMedex using the search terms including patient safety, patient safety culture, patient safety climate and combined with hospital (such as "hospital survey on patient safety culture"), measurement, assessment, survey and Iran. A total of 11 articles which conducted using Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire initially were reviewed. To estimate overall PSC status and perform the meta-analyses, Comprehensive Meta-Analysis (CMA) software v. 2 was employed.
  
  
  RESULTS
  The overall PSC score based on the random model was 50.1%. "Teamwork within hospital units" dimension received the highest score of PSC (67.4%) and "Non-punitive response to error" the lowest score (32.4%). About 41% of participants in reviewed articles evaluate their hospitals' performance in PSC as 'excellent/very good'. Approximately %52.7 of participants did not report any adverse event in the past 12 months.
  
  
  CONCLUSIONS
  The results of this study show that Iranian hospitals' performances in PSC were poor. Among the 12 dimensions of HSOPSC questionnaire, the "Non-punitive response to error" achieved the lowest score and could be a priority for future interventions. In this regard, hospitals staff should be encouraged to report adverse event without fear of punitive action.
authors.affiliation: PhD student, Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran. saberazami@yahoo.com.
authors.forename: Saber
authors.initials: S
authors.lastname: Azami-Aghdash
authors.affiliation: Professor, Health management and economics research center, Iran University of Medical Sciences, Tehran, Iran. f_ebadi@yahoo.com.
authors.forename: Farbod
authors.initials: F
authors.lastname: Ebadifard Azar
authors.affiliation: Assistance Professor, Department of health economics, Health management and economics research center, Iran University of Medical Sciences, of Medical Sciences, Tehran, Iran. rezapoor_a57@yahoo.com.
authors.forename: Aziz
authors.initials: A
authors.lastname: Rezapour
authors.affiliation: MSc, Department of mathematical, Miandoab Branch, Islamic Azad University, Miandoab, Iran. akbar.azami1362@gmail.com.
authors.forename: Akbar
authors.initials: A
authors.lastname: Azami
authors.affiliation: PhD student, Health management and economics research center, Iran University of medical sciences, Tehran, Iran. rasivahid65@yahoo.com.
authors.forename: Vahid
authors.initials: V
authors.lastname: Rasi
authors.affiliation: MSc in Health Services Management, Department of Health Management, School of Health, Qazvin University of Medical Sciences, Qazvin, Iran. modirtbzmed@gmail.com.
authors.forename: Khalil
authors.initials: K
authors.lastname: Klvany
keywords: Culture; HSOPSC questionnaire; Iranian hospitals; Meta-analysis; Patient safety; Quality improvement