The Determinants of Patient Safety; A Systematic Review

Abstract

Patient safety has emerged as a central concern in contemporary healthcare, driven by the persistent occurrence of preventable harm and systemic failures that continue to compromise outcomes across a variety of clinical settings. Although considerable global efforts have been directed toward improving safety, the determinants that influence patient safety remain inherently complex, involving a web of behavioral, organizational, and contextual factors that interact across multiple levels of the healthcare system. This systematic review synthesizes recent evidence on the key determinants of patient safety, exploring how individual actions, institutional practices, and broader system-level dynamics shape safety-related outcomes. Following the PRISMA 2020 guidelines, a comprehensive search of major scholarly databases was conducted, focusing on studies published between 2020 and 2025 that examined predictors or influencing factors of patient safety. Using a thematic synthesis approach, the review categorized findings into behavioral, organizational, and contextual domains. A total of thirty studies met the inclusion criteria for final analysis. The results indicate that behavioral factors such as clinical decision-making skills, professional competence, and systems-thinking capabilities significantly impact safety performance. At the organizational level, determinants including adequate staffing, a robust safety culture, effective leadership, and reliable incident reporting mechanisms were found to be strongly associated with positive safety outcomes. Contextual influences, such as workload pressure, patient overcrowding, diagnostic complexity, and deficiencies in clinical monitoring, also emerged as critical contributors to safety incidents. Collectively, these determinants shape patterns of adverse events, reporting practices, and the overall performance of patient safety systems. In conclusion, patient safety is a dynamic and multifactorial construct shaped by the interaction of individual behaviors, organizational frameworks, and environmental conditions. Enhancing patient safety requires coordinated strategies that promote frontline engagement, strong leadership, optimized staffing models, and the implementation of continuous learning mechanisms. Adopting a systems-based approach is essential for reducing preventable harm and ensuring the quality, safety, and resilience of healthcare delivery.