Physicians' perceptions of patient safety factors: a systematic review and narrative synthesis

Background: Patient safety (PS) is a global issue that affects both developed and developing countries. Physicians play a key role in overcoming this common healthcare issue. Objective: To understand the physicians' perceptions of factors contributing to PS incidents in secondary care. Methods: Covering a period from 1999 to 2011, three electronic databases were used to identify potential studies for inclusion. Individual searching of selected journals and reference scanning of identified studies were also conducted. To summarize and synthesize the findings, we adopted a narrative synthesis approach, and used a content analysis method directed by Vincent's framework. Results: Of 1,405 potentially relevant citations identified, 14 studies ultimately met the inclusion criteria, and were divided into trainee and non-trainee physician studies. Quality scores of included studies ranged from 6 to 12.5 (possible range 1-16). In total, 158 patient safety factors (PSFs) were identified and categorized into seven safety levels and 22 corresponding themes. In all the studies, the rank order of safety levels by frequency of PSFs was; individual = team > work environment > organizational and management > task and technology > contextual > patient. There was an almost similar result in the trainee studies, whereas in the non-trainee studies, the result was almost the reverse. Conclusion: Overall, the results show a clear tendency for physicians to focus on the proximal causes of PS incidents. This suggests the need for safety skills training. The next research generation would provide a holistic view of physicians' perceptions of PSFs by moving toward more sophisticated designs, such as mixed-methods.