Patient safety culture in the operating room of African hospitals: a systematic review.
| Title: | Patient safety culture in the operating room of African hospitals: a systematic review. |
|---|---|
| Authors: | Bake JF; General Surgery Department, University of Goma, Goma, Democratic Republic of the Congo. fadhilibake@gmail.com.; HEAL Africa Hospital, Goma, Democratic Republic of the Congo. fadhilibake@gmail.com.; Ghanmi N; Paediatric Surgery Department, McGill University, Montreal, Canada.; Guadagno E; Paediatric Surgery Department, McGill University, Montreal, Canada.; Claude KM; General Surgery Department, Catholic University of Graben, Butembo, Democratic Republic of the Congo.; Zacharie TK; Internal Medicine Department, University of Kisangani, Kisangani, Democratic Republic of the Congo.; Poenaru D; Paediatric Surgery Department, McGill University, Montreal, Canada. |
| Source: | Patient safety in surgery [Patient Saf Surg] 2026 Jan 29; Vol. 20 (1), pp. 5. Date of Electronic Publication: 2026 Jan 29. |
| Publication Type: | Journal Article; Review |
| Language: | English |
| Journal Info: | Publisher: BioMed Central Country of Publication: England NLM ID: 101319176 Publication Model: Electronic Cited Medium: Print ISSN: 1754-9493 (Print) Linking ISSN: 17549493 NLM ISO Abbreviation: Patient Saf Surg Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: London : BioMed Central |
| Abstract: | Background: Patient safety in operating rooms has globally improved through interventions such as the World Health Organization (WHO) Surgical Safety Checklist and multidisciplinary team training. However, while evidence from high-income countries is well documented, there remains limited consolidated knowledge on the understanding, application, and effectiveness of safety culture interventions in African surgical settings, which this review seeks to address.; Methods: This systematic review examined factors and protocols affecting surgical safety in African operating rooms. We hypothesized that persistent systemic barriers undermine safety culture despite adoption of global measures. Following PRISMA 2020, we searched eight databases (Medline, Embase, Cochrane, Africa-Wide, CINAHL, Global Health, Global Index Medicus, Web of Science) from inception to 5 December 2024, using variations of text words present in the title, abstract, or keyword fields, alongside relevant subject headings, to identify articles addressing surgical safety and culture throughout Africa. Included studies involved operating room professionals in African countries and used quantitative, qualitative, or mixed-methods designs. We excluded non-operating room settings, patient-only studies, inaccessible full texts, reviews, editorials, letters, conference abstracts, and duplicates. Two reviewers independently screened and appraised studies using the Mixed Methods Appraisal Tool. Findings were synthesized narratively with subgroup analysis by study type and theme.; Results: Out of 9,875 identified records, 22 studies from 12 African countries (2014-2024) met inclusion criteria, with Ethiopia contributing the highest number (n = 4). Various assessment tools, including the Hospital Survey on Patient Safety Culture, the Safety Attitudes Questionnaire, and the National Surgical, Obstetric, and Anaesthesia Plans interview manual, revealed recurring challenges: inadequate non-punitive responses to errors, communication barriers, hierarchical structures, and resource constraints. Four interventions showed promise: implementation and training on the WHO Surgical Safety Checklist, Safe Surgery 2020 initiatives, Non-Technical Skills for Surgeons training, and multidisciplinary training.; Conclusion: The heterogeneity of study designs, sample sizes, and outcome measures limited direct comparisons and precluded meta-analysis. Nonetheless, the review highlights persistent barriers and emerging opportunities to strengthen patient safety culture in African operating rooms. While the WHO Surgical Safety Checklist remains valuable, sustainable progress requires multi-level strategies that address systemic constraints and incorporate context-sensitive adaptations.; Registration: PROSPERO, CRD42024627076.; (© 2025. The Author(s).) |
| Competing Interests: | Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Authors information: JFB is a general surgeon and a Fellow of the College of Surgeons of East, Central and Southern Africa (COSECSA). He is currently pursuing a PhD, with research focusing on patient safety culture in operating rooms across hospitals in his region. Registration and protocol: The protocol for this review was developed in advance and registered with the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42024627076 ( https://www.crd.york.ac.uk/PROSPERO/view/CRD42024627076 ). Competing interests: The authors declare no competing interests. |
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| Contributed Indexing: | Keywords: Africa; Global surgery; Operating room; Patient safety culture; Quality improvement; Surgical safety |
| Entry Date(s): | Date Created: 20260130 Date Completed: 20260130 Latest Revision: 20260201 |
| Update Code: | 20260201 |
| PubMed Central ID: | PMC12857098 |
| DOI: | 10.1186/s13037-025-00461-z |
| PMID: | 41612361 |
| Database: | MEDLINE |
Journal Article; Review