Patient safety is a foremost concern worldwide and is a developing field of research with a growing evidence base in western countries, but little has been explored in the Middle East. The aim of this thesis was to conduct the first study to explore patient safety in primary health care in Muscat Oman. The results will inform and fill an evidence gap and contribute to implementation of the Sultanate of Oman Ministry of Health Vision 2050. This study uses mixed method design in three phases, with each phase building on the previous phase to develop a deeper understanding of the phenomenon under study. The phase 1 systematic review of the published literature identified that the most important first step is the assessment of safety culture in an organization. The most commonly used tool was the Hospital Survey on Patient Safety Culture survey (HSOPSC) which had also been used in Kuwait, Turkey, and Iran. In the second phase the HSOPC tool was used to provide a basic understanding of the safetyrelated perceptions of health care professionals. The number of respondents was 186 out of 198 in the questionnaire-based survey (response rate: 94%). Overall, the survey revealed a strong sense of teamwork, organization learning for continuous improvement, and teamwork across the units. The four dimensions which received the lowest scores were communication problems, non-punitive response to errors, frequency of event reporting and errors occurring when transferring patients to higher levels of health care during handoffs and transitions. Two focus group discussions with health care professionals were conducted to explore the root cause of poor scores achieved in phase 2. The results highlighted that error reporting in primary care needs to encourage an atmosphere where a non-punitive response to error reporting is promoted without the fear of blame. The conceptualisation, mixed method design and findings that emerged from this first study of patient safety culture in primary health care in Muscat Oman will provide a base for a national study, and will be used by the Ministry of Health in Oman to inform policies, guidelines and training to strengthen patient safety in primary health care in line with Health Vision 2050.

Patient safety is a foremost concern worldwide and is a developing field of research with a growing evidence base in western countries, but little has been explored in the Middle East. The aim of this thesis was to conduct the first study to explore patient safety in primary health care in Muscat...