title: Quality of care in university hospitals in Saudi Arabia: a systematic review.
abstract: OBJECTIVE
  To identify the key issues, problems, barriers and challenges particularly in relation to the quality of care in university hospitals in the Kingdom of Saudi Arabia (KSA), and to provide recommendations for improvement.
  
  
  METHODS
  A systematic search was carried out using five electronic databases, for articles published between January 2004 and January 2015. We included studies conducted in university hospitals in KSA that focused on the quality of healthcare. Three independent reviewers verified that the studies met the inclusion criteria, assessed the quality of the studies and extracted their relevant characteristics. All studies were assessed using the Institute of Medicine indicators of quality of care.
  
  
  RESULTS
  Of the 1430 references identified in the initial search, eight studies were identified that met the inclusion criteria. The included studies clearly highlight a need to improve the quality of healthcare delivery, specifically in areas of patient safety, clinical effectiveness and patient-centredness, at university hospitals in KSA. Problems with quality of care could be due to failures of leadership, a requirement for better management and a need to establish a culture of safety alongside leadership reform in university hospitals. Lack of instructions given to patients and language communication were key factors impeding optimum delivery of patient-centred care. Decision-makers in KSA university hospitals should consider programmes and assessment tools to reveal problems and issues related to language as a barrier to quality of care.
  
  
  CONCLUSIONS
  This review exemplifies the need for further improvement in the quality of healthcare in university hospitals in KSA. Many of the problems identified in this review could be addressed by establishing an independent body in KSA, which could monitor healthcare services and push for improvements in efficiency and quality of care.
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, UK Department of Health Administration, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Aljuaid
authors.affiliation: Faculty of Medicine, Imperial College London, London, UK.
authors.forename: Fahmida
authors.initials: F
authors.lastname: Mannan
authors.affiliation: Faculty of Medicine, Imperial College London, London, UK.
authors.forename: Zain
authors.initials: Z
authors.lastname: Chaudhry
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, UK.
authors.forename: Salman
authors.identifier: http://orcid.org/0000-0001-7191-2355
authors.initials: S
authors.lastname: Rawaf
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London, UK.
authors.forename: Azeem
authors.identifier: http://orcid.org/0000-0002-2357-9858
authors.initials: A
authors.lastname: Majeed
mesh_terms: D006785:Hospitals, University / Q000592:standards*; D006801:Humans; D061214:Patient Safety / Q000592:standards; D018802:Patient-Centered Care / Q000592:standards; D011787:Quality of Health Care; D012529:Saudi Arabia
keywords: HEALTH SERVICES ADMINISTRATION & MANAGEMENT; PUBLIC HEALTH