Investigating the Challenges in Implementing Mandatory Patient Safety Standards in Kerman Teaching Hospitals: A mixed-Method Study

Document Type : Original Article

Authors
mohammadreza tavakoli 1
mohammadreza amiresmaili 2
mahmood nekoeimohgadam 2
reza kazemi 3
1 PhD, Health Services Management, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
2 Professor, Health Services Management, Health Services Management Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
3 Department of ..orology....., Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
10.48305/him.2026.45901.1360
Abstract
Introduction: The Patient Safety Friendly Hospitals Program involves the implementation of a set of patient safety standards in hospitals. The purpose of this study was to investigate the challenges of implementing mandatory patient safety standards in Kerman’s teaching hospitals.
Methods: This mixed-methods study was conducted in the 2021 academic year. First, using a qualitative content analysis approach, the challenges of mandatory patient safety standards were identified. Twenty interviews were conducted virtually through the online classes of the Kerman University of Medical Sciences using a purposive sampling method. Data analysis was performed using MaxQDA qualitative analysis software. Then, a fuzzy Delphi method was applied in two stages, through which the challenges were either approved or rejected by experts.
Results: Four main themes were identified: structural challenges and physical space, management and clinical challenges, information technology challenges, and human resource challenges..
Conclusion: Identifying the challenges of implementing mandatory patient safety standards and planning to remove existing barriers can facilitate more effective implementation of these standards and ultimately lead to improving the quality of services provided in healthcare centers
Keywords
Patient safety
standards
hospital
Iran
Subjects
1.Young C, Chen X. Patients as consumers in the market for medicine: the halo effect of hospitality. Social Forces. 2020;99(2):504–31.
2. Fulop N, Walters R, Spurgeon P. Implementing changes to hospital services: factors influencing the process and ‘results’ of reconfiguration. Health policy. 2012;104(2):128–35.
3. Tabrizi JS, As' habi A, Nazari M, Tavani ME, Haghi M, Gharibi F. Impacts of accreditation on the performance of primary health care centres: a systematic review. Malaysian Family Physician: the Official Journal of the Academy of Family Physicians of Malaysia. 2023;18:63.
  4. Muzio D, Dionisi M, Simone D, Cianfrocca E, Fabbian F, Barbiero G, et al. Can nurses’ shift work jeopardize the patient safety? A systematic review. European Review for Medical and Pharmacological Sciences. 2019;23(10):4507–19.
5. Xia Y, Sun M, Huang H, Jin W-L. Drug repurposing for cancer therapy. Signal transduction and targeted therapy. 2024;9(1):92.
6. Ravaghi H, Sajadi HS. Research Priorities for Patient Safety in Iran. Hakim Health Systems Research Journal. 2014;16(4):358–66.
7. David G, Gunnarsson CL, Waters HC, Horblyuk R, Kaplan HS. Economic measurement of medical errors using a hospital claims database. Value in Health. 2013;16(2):305–10.
8.  World Health Organization. Global Patient Safety Report 2024. Geneva: World Health Organization; 2024.
9. Pittet D, Donaldson L. Challenging the world: patient safety and health care-associated infection. International journal for quality in health care. 2006;18(1):4–8.
10. Jagannatha A, Liu F, Liu W, Yu H. Overview of the first natural language processing challenge for extracting medication, indication, and adverse drug events from electronic health record notes (MADE 1.0). Drug safety. 2019;42(1):99–111.
11. Organization WH. Patient safety assessment manual. 2016.
12. Mohammad Nahal L, Mirzaei A, Khezeli MJ. Evaluation of COVID-19 patient safety compared to non-COVID-19 patients and predisposing factors of nursing errors. Aquichan. 2022;22(3).
13. Poursadeqiyan M, Arefi MF, Khaleghi S, Moghaddam AS, Mazloumi E, Raei M, et al. Investigation of the relationship between the safety climate and occupational fatigue among the nurses of educational hospitals in Zabol. Journal of education and health promotion. 2020;9:238.
14. Alhusseini N, Alqahtani A. COVID-19 pandemic's impact on eating habits in Saudi Arabia. Journal of public health research. 2020;9(3):jphr. 2020.1868.
15. Vaziri S, Fakouri F, Mirzaei M, Afsharian M, Azizi M, Arab-Zozani M. Prevalence of medical errors in Iran: a systematic review and meta-analysis. BMC health services research. 2019;19(1):622.
16. Etemadifar S, Sedighi Z, Sedehi M, Masoudi R. The effect of situation, background, assessment, recommendation-based safety program on patient safety culture in intensive care unit nurses. Journal of education and health promotion. 2021;10:422. 17.  Faryabi R, Shahbazi H, Alizadehsiuki H, Rahimi T. Investigation of patient safety culture status in hospitals of Jiroft city in 2014. Journal of Torbat Heydariyeh University of Medical Sciences. 2015;2(4):23–30.
18. Lotfi M, Sheikhalipour Z, Zamanzadeh V, Aghazadeh A, Akhuleh OZ. Observance of preventive standards against COVID-19 transmission in operating rooms: A cross-sectional study. Perioperative Care and Operating Room Management. 2021;25:100212.
19. Spranger J, Homberg A, Sonnberger M, Niederberger M. Reporting guidelines for Delphi techniques in health sciences: a methodological review. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen. 2022;172:1–11.
20. Jafari N, Sheikhfarshi S, Raisali F, Aghaei P, Azini P, Estejab H. Design strategies to foster improved experiences for patients in rehabilitation. HERD: Health Environments Research & Design Journal. 2025;18(4):111–24.
21.   Khanjankhani K, Takian A, Shamsi Gooshki E, Mohammadi SM, Arab M. Actors in conflict of interest in Iran's health system: Ranking and policy recommendations for conflict of interest management. World Medical & Health Policy. 2023;15(4):476–488.
22.  Khachian A, Seyedoshohadaee M, Haghani S, Ghanbari M. Nurses' perceptions regarding disclosure of patient safety incidents in selected educational and medical centers of Iran University of Medical Sciences, 2020. Iran J Nurs. 2022;34(134):88-101.
23.  Mostafaei D, Aryankhesal A, Dastoorpoor M, Rahimikhalifekandi Z, Estebsari F. Patient safety culture assessment of clinical and paraclinical staff perspective in selected University of Medical Sciences hospitals in Tehran. Iran J Health Educ Health Promot. 2018;6(3):293–301.
24.  Azarabad S, Zaman SS, Nouri B, Valiee S. Frequency, causes and reporting barriers of nursing errors in operating room students. Research in Medical Education. 2018;10(2):18–27.
25. Wundavalli L, Bulkapuram S, Bhaskar N, Satyanarayana N. Patient safety at a public hospital in southern India: A hospital administration perspective using a mixed methods approach. The national medical journal of India. 2018;31(1):39.
26.   Nabilou B, Rasouli J, Khalilzadeh H. Patient safety status in medical education: Students' perception, knowledge and attitude. Research in Medical Education. 2013;5(2):23–31.
 27. Mazhari Z, Adel A. Patient safety status in hospitals of Tehran-patient safety friendly hospitals standards: 2013. Journal of Payavard Salamat. 2015;8(5):379–89.
28. Sittig DF, Wright A, Coiera E, Magrabi F, Ratwani R, Bates DW, et al. Current challenges in health information technology–related patient safety. Health informatics journal. 2020;26(1):181–9.
 29. Reis CT, Paiva SG, Sousa P. The patient safety culture: a systematic review by characteristics of hospital survey on patient safety culture dimensions. International Journal for Quality in Health Care. 2018;30(9):660–77.
30. Teymoori S. Study of Nurses' Experiences of Safety Challenges of Social Security Hospital Patients. Nursing Development in Health Journal. 2022;12(2):48–59.