A comprehensive national survey on malocclusion prevalence among Palestinian children.

BACKGROUND: This study aims to evaluate the prevalence of malocclusion and orthodontic features among schoolchildren in the West Bank, Palestine. METHODS: A stratified cluster sample of 1278 schoolchildren (620 males, 658 females, mean age 12 years and 5 months (± 0.5)) were examined. Candidates who had not received any previous orthodontic treatment were only included. Dental anomalies like missing and ectopic teeth were recorded. The anteroposterior occlusal relationship was assessed based on Angle classification. Overjet and overbite were measured. Crowding and spacing were recorded subjectively. In addition, crossbite, openbite, and midline displacement were recorded. The chi-square test and descriptive analysis were used statistically. RESULTS: The study found Angle Class I molar relationship in 65%, Class II div 1 in 17%, Class II div 2 in 6%, and Class III in 12% of the sample. An overjet (OJ) of more than 4 mm was present in 17%, and 4% had OJ of more than 6 mm; an OJ of at least 0 mm or less in 36%, and 6% had a reverse OJ. A normal overbite was observed in 53%, while 28% had an increase and 19% had a decreased overbite. An anterior openbite (AOB) was present in 9%, and a scissor bite or anterior crossbite in 6% and 14%, respectively. A posterior crossbite was observed in 12% (9% unilateral and 3% bilateral). Midline displacement was found in (9%). Crowding was observed in 35% and 31% and spacing in 24% and 15% of the maxillary and mandibular arches, respectively. A statistically significant relationship between gender and midline shift, a diastema, spacing in the upper arch, and most dental anomalies was found; males were more affected (p < 0.05). CONCLUSION: This study reported a high prevalence of malocclusion among schoolchildren in Palestine. A collaborative effort should be directed to obtain more monitoring and surveillance of malocclusion more frequently to prevent and control the exacerbation of the problem.

Unmet needs and health-related quality of life of breast cancer survivors: survey from Gaza Strip, Palestine.

BACKGROUND: Cancer, especially breast cancer, remains a public health problem because of its negative consequences, which require long-term programs to alleviate its devastating effects. This study aimed to examine unmet supportive care needs and health-related quality of life of females with breast cancer. METHODS: A cross-sectional study with a mixed-method design was employed. A simple, randomly selected sample of 352 females attending Al-Rantisi and Al-Amal hospitals was included in this study. A validated Arabic version of the Supportive Care Needs Survey (34 items) and The European Organization for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C15-PAL) were used. Moreover, twenty-five semi-structured interviews were performed (13 females, eight husbands, and four healthcare workers). Quantitative data were analysed using descriptive and inferential analysis, whereas thematic analysis was used for qualitative data to highlight main themes. RESULTS: The highest unmet need reported by females with breast cancer was psychological needs (63%), followed by health-related systems and information (62%) and physical and daily life (61%). Pain and fatigue were the most reported symptoms (65.8% and 62.5%, respectively), followed by emotional distress, physical function, and physical symptoms; 55.8%, 54.3%, and 51.5%, respectively. These unmet needs and health-related quality of life-related dimensions were highlighted and elicited by qualitative data analysis. Unmet needs are high among married females, on conservative treatments, young females (< 40 years old), and females in the first year of diagnosis. The presence of chronic diseases did not increase needs. However, health-related quality of life was affected. Six themes are subtracted: availability of anticancer therapy, affordability of healthcare, family and social support, psychological support, health education, and self-image & intimate relationship. CONCLUSION: Many needs are unmet. Caring for females with breast cancer should be comprehensive to fill gaps, including psychological care, health information and education, physical care and support, and medical care.

Improving patient safety in Palestinian hospitals: a cross-sectional and retrospective chart review study.

BACKGROUND: Patient safety is the central component of health-care quality. There is a lack of patient safety data in the occupied Palestinian territory. The aim of this study was to assess patient safety and explore relationships between patient safety culture and the prevalence of adverse events at the department level. METHODS: Between May 25, 2009, and June 1, 2010, the Arabic validated Hospital Survey on Patient Safety Culture was used to measure the norms and perceptions of health professionals regarding safety. The survey was used in eight medical departments in two hospitals (Al Makassed hospital and Al Ahli hospital in the West Bank; four departments per hospital). During the same period, a retrospective review of medical records was done to identify adverse events using the validated Palestinian version of the Global Trigger Tool. Descriptive statistics and Spearman's rho coefficient were used. Ethical approval was obtained from the participating hospital boards and the Palestinian health authorities, and written consent was obtained from participants. FINDINGS: 640 randomly selected records (320 records per hospital) were reviewed, and 428 health-care workers participated in the safety culture assessment (response rate 74%). 213 (50%) participants were nurses, 163 (38%) were doctors, and 52 (12%) were other health-care professionals. Patients had a mean age of 44·2 years (SD 19·6; range 18-95) and a mean length of stay of 4·8 days (SD 5·6; range 1-70). 91 (14%) records included an adverse event. Adverse events were negatively associated with the aggregate safety culture (r=-0·905; p=0·0009), hospital management support (r=-0·881; p=0·0017), non-punitive response to errors (r=-0·731; p=0·019), communication and feedback on errors (r=-0·905; p=0·0009), teamwork (r=-0·886; p=0·0021), organisational learning (r=-0·778; p=0·011), and supervisor actions promoting patient safety (r=-0·857; p=0·0029), indicating that departments with a more positive patient safety culture had lower rates of adverse events. INTERPRETATIONS: Safety must be improved for Palestinian patients. To promote patient safety, managers and policy makers should acknowledge and allocate resources for enhancing overall safety culture, hospital management support, non-punitive response, communication on errors, teamwork, organisational learning, and supervisor actions. FUNDING: Research and development, KU Leuven, Leuven, Belgium.

The Impact of Socio-Economic and Home Environmental Factors on Oral Health-Related Quality of Life Among Children Aged 11-14.

Background and Objectives: Oral diseases are known to negatively impact physical, functional, and emotional well-being, and thus adversely affect quality of life. The aims of the study were (1) to assess the oral health-related quality of life (OHRQoL) and (2) to explore socio-demographic, -economic, and -environmental factors that are associated with OHRQoL among a sample of children aged 11-14 in Saudi Arabia. Materials and Methods: A cross-sectional design was used. The Child Perceptions Questionnaire (CPQ)-a self-administered, validated, and standardized questionnaire was used to collect data on OHRQoL in four domains: oral symptoms, functional limitations, and emotional and social well-being. In addition, data were collected on home environment, socioeconomic/demographic characteristics, and oral hygiene practices of participants and their parents or adult guardians. Univariate descriptive statistics, Spearman's correlation, and Kruskal-Wallis H and Mann-Whitney tests were used. Data were analyzed using SPSS 23 Software. Significance was set at α = 0.05. Results: In total, 534 children participated in the study (91% response rate), of which 60% were females. Twenty percent of children described their oral health as "poor" and one in every four children reported that their oral health had at least some effect on their overall well-being. Children who were male, attending public schools, and living with both parents were more likely to report poor OHRQoL. Conclusions: A considerable proportion of children aged 11-14 could discern that their oral health had some effect on their overall well-being. The results identified potential predictors of OHRQoL. Disparities in OHRQoL exist among certain sub-populations. Active efforts and local interventions are necessary to improve OHRQoL.

The Governance, Policy, Process, and Capacity of Health Workforce Regulation and Accreditation: Qualitative Policy Analysis and Evidence from Palestine.

Background: The significant health development achieved in Palestine last decades has been lost, in Gaza particularly. This requires fundamental health system reform and rebuilding, including health workforces. Strengthening health workforces involves essential elements: leadership, finance, policy, education, partnership, and management. The current unprecedented catastrophe in Gaza and overall instability in Palestine show the utmost necessity for rethinking and reforming all pillars of the already collapsed health system, including the workforce. Health Workforce Accreditation and Regulation (HWAR) standardizes healthcare evaluations, representing a critical research area in Palestine due to limited existing knowledge. Objective: This study aims to enhance understanding of the HWAR in Palestine, and identify gaps and weaknesses, thereby enhancing the HWAR's development and optimization. Methods: This qualitative study used an inductive approach to explore the landscape of HWAR. Data were collected from October to November 2019, when 22 semi-structured in-depth interviews - were conducted with experts, academics, leaders, and policymakers purposely selected from government, academia, and non-governmental organization sectors. Data analysis, namely, thematic and ground theory, was performed using Excel and MS programs. Findings: The study revealed an absence of transparent governance and ineffective communication within HWAR systems. National policies and guidelines are problematic, with HWAR mechanisms fractured and needing reform. Licensing for healthcare workers hinges on local education, while monitoring and evaluation of HWAR are deficient. Some institutions adhere to HWAR standards, yet widespread updates and applications are necessary. Coordination among educational, accreditation, and practice sectors is non-systematic. Adequate human resources exist, but we need to improve HWAR management. Operational and political challenges limit HWAR, leading to a focus on immediate responses over sustainable system integration. Conclusion: Boosting HWAR is critical for Palestine, especially after the ongoing conflict and humanitarian crisis that led to the dysfunction of the entire health system facilities. A collaborative strategy across sectors is needed to improve governance and outcomes. It is essential to foster strategic dialogue among academia, regulatory entities, and healthcare providers to enhance the HWAR system. Further study on HWAR's effectiveness is recommended.

Faith, Meaning, and Quality of Life: Unveiling the Spirituality of Muslim Patients with Advanced Cancer Undergoing Active Treatment in the Gaza Strip, Palestine.

OBJECTIVES: This study aimed to identify the level of spirituality, faith and meaning, and quality of life (QOL) among Muslim advanced cancer patients undergoing active treatment and to enhance the understanding of the relationships among clinical and socio-demographic factors, spirituality, and QOL of patients in the Gaza Strip. METHODS: A secondary analysis was conducted on a convenience sample of 298 advanced cancer patients. The Arabic versions of the Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) and the Functional Assessment of Cancer Therapy-General (FACT-G) were used for data collection. Descriptive statistics and generalized linear regression were utilized for data analysis, performed using SPSS 25.0. RESULTS: Participants reported high spirituality well-being scores (Mean = 31.25, SD = 6.25) and relatively high scores on the subscales of meaning/peace (Mean = 19.15, SD = 4.11) and faith (Mean = 12.03, SD = 3.50). Most patients indicated that their faith and spiritual beliefs increased due to their illness. Furthermore, a significant positive relationship was found between spirituality (including its subscales of faith and meaning in life) and QOL. Despite the generally high level of spirituality, special attention should be paid to patients with lung, bladder, and thyroid cancer, lower education levels, and higher cancer grades. CONCLUSIONS: The Gazan Muslim patients with advanced cancer exhibit high levels of spirituality and faith. We acknowledged that spiritual well-being is a protective factor for QOL. The strong positive correlation between spirituality and QOL emphasizes the need to integrate spiritual care into cancer care. IMPLICATIONS FOR NURSING PRACTICE: It is imperative to incorporate spirituality into health practice and the daily routines of cancer treatment for patients whose spirituality is an important aspect of their identities. The incorporation of spirituality can contribute to the improvement of the quality of patients' life and quality of cancer care.

The Arabic version of the hospital survey on patient safety culture: a psychometric evaluation in a Palestinian sample.

BACKGROUND: A growing global interest in patient safety culture has increased the development of validated instruments to asses this phenomenon. The aim of this study is to investigate the psychometric properties of the Hospital Survey on Patient Safety Culture (HSOPSC) and its appropriateness for Arab hospitals. METHODS: The 7-step guideline of the Agency for Healthcare Research and Quality was used to translate and validate the HSOPSC. A panel of experts evaluated the face and content validity indexing of the Arabic version. Data were collected from 13 Palestinian hospitals including 2022 healthcare professionals who had direct or indirect interaction with patients, hospital supervisors, managers and administrators. Descriptive statistics and psychometric evaluation (a split-half validation technique) were then used to test and strengthen the validity and reliability of the instrument. RESULTS: With respect to face and content validity, the CVI analysis showed excellent results for the Arab context (CVI = 0.96). As to construct validity, the 12 original dimensions could not be applied to the Palestinian data. Furthermore, three of the 12 original dimensions were not reliable (α <0.6). The split-half technique resulted in an optimal 11-factor model. CONCLUSIONS: Our study is the first study in the Arab world to provide an evaluation of the HSOPSC using Arabic data from Palestine. The Arabic translation of the HSOPSC comprises an 11-factor structure showing good validity and acceptable reliability. Despite the similarity between the Arab factor structure of the HSOPSC and that of the original one, and taking into account that our version may be applied in Arabic hospitals, there is a need for caution in comparing HSOPSC data between countries.

The Global Trigger Tool shows that one out of seven patients suffers harm in Palestinian hospitals: challenges for launching a strategic safety plan.

OBJECTIVE: The aim of this study was to evaluate patient safety levels in Palestinian hospitals and to provide guidance for policymakers involved in safety improvement efforts. DESIGN: Retrospective review of hospitalized patient records using the Global Trigger Tool. SETTING: Two large hospitals in Palestine: a referral teaching hospital and a nonprofit, non-governmental hospital. PARTICIPANTS: A total of 640 random records of discharged patients were reviewed by experienced nurses and physicians from the selected hospitals. INTERVENTION: Assessment of adverse events. MAIN OUTCOME MEASURES: Prevalence of adverse events, their preventability and harm category. Descriptive statistics and Cohen kappa coefficients were calculated. RESULTS: One out of seven patients (91 [14.2%]) suffered harm. Fifty-four (59.3%) of these events were preventable; 64 (70.4%) resulted in temporary harm, requiring prolonged hospitalization. Good reliability was achieved among the independent reviewers in identifying adverse events. The Global Trigger Tool showed that adverse events in Palestinian hospitals likely occur at a rate of 20 times higher than previously reported. Although reviewers reported that detecting adverse events was feasible, we identified conditions suggesting that the tool may be challenging to use in daily practice. CONCLUSION: One out of seven patients suffers harm in Palestinian hospitals. Compromised safety represents serious problems for patients, hospitals and governments and should be a high priority public health issue. We argue that direct interventions should be launched immediately to improve safety. Additional costs associated with combating adverse events should be taken into consideration, especially in regions with limited resources, as in Palestine.

Physicians' perceptions of electronic prescribing of controlled medications in the West Bank, Palestine: A pre-implementation assessment.

BACKGROUND: In Palestine, prescribing controlled medications is still done on paper. Despite valuable regulatory efforts, there is a high risk of undetected abuse and "doctor shopping". These problems can be addressed with electronic prescribing of controlled medicines (EPCM). User adoption is essential to the successful implementation of any technology. Therefore, it is crucial to determine the perception of end users at an early stage. This topic has never been addressed in Palestine. Our study aims to investigate the perception of Palestinian physicians towards the introduction of EPCM. METHODS: This cross-sectional study was conducted among Palestinian physicians in the West Bank who are familiar with controlled medications prescribing. Data were collected using a self-administered questionnaire based on the Unified Theory of User Acceptance and Use of Technology (UTAUT) from a convenience sample of 300 physicians. Data were analyzed using SPSS version 26. Bivariate analysis and binary and multivariate logistic regression were performed to identify factors associated with physicians' perceptions of ECPM. RESULTS: Most physicians expressed their willingness to use EPCM, with an acceptance rate of 85%. This perception was significantly affected by performance expectancy, effort expectancy and trust. None was moderated by age, gender, or experience with electronic prescribing. Age and specialization level were independent factors significantly influencing the intention to use EPCM. The level of current workflow challenges did not correlate with the intent to use EPCM. CONCLUSION: Palestinian physicians will accept EPCM. Based on the results of this study, it is recommended that the following be considered: ensuring maximum efficiency of the system, selecting user-friendly interfaces and high-security measures to prevent system breaches.

Assessment of adherence to guidelines for testing and treatment of pharyngitis among children in Palestine: A retrospective review study.

Introduction: One of the most common reasons for pediatric outpatient visits is acute pharyngitis, an upper respiratory tract infection. Bacterial pharyngitis is caused by Group A beta-hemolytic Streptococcus (GABHS), also known as Streptococcus pyogenes. This research aimed to assess physicians' adherence to clinical guidelines for diagnosis, management, and selecting appropriate treatment for children suspected of bacterial pharyngitis. Methods: A retrospective, observational study was conducted by reviewing patient charts for childred aged 3 to 13 years old diagnosed with pharyngitis from June 2019 until December 2019 at the Emergency Department of Palestine Medical Complex (PMC). The Modified Centor score, throat swab collections, and assessment of antimicrobial selection were used to assess the extent of physicians' adherence to clinical guidelines for appropriate diagnosis and management of pharyngitis. SPSS was used for data analysis. Results: Out of 290 cases diagnosed with acute pharyngitis, 217 patients (74.8%) had a Modified Centor score of ≥2; 126 received antibiotics, and eight had their throat swabbed to confirm the diagnosis; furthermore, 73 patients (25.2%) had a Modified Centor score of <2; 34 of them received antibiotics. Azithromycin was the most commonly prescribed antibiotic (41.3%), followed by amoxicillin-clavulanic acid (38.1%). The frequency of empirical antibiotics prescribing was significantly higher among children with a Centor score >2, older children, and those presenting with fever. Conclusions: Most cases were not appropriately tested to confirm the diagnosis of bacterial pharyngitis and were mostly treated with inappropriate antimicrobial agents such as azithromycin. Nonadherence to clinical guidelines is very evident in this study.

Stakeholders' Perception of the Palestinian Health Workforce Accreditation and Regulation System: A Focus on Conceptualization, Influencing Factors and Barriers, and the Way Forward.

The Health Workforce Accreditation and Regulation (HWAR) is a key function of the health system and is the subject of increasing global attention. This study provides an assessment of the factors affecting the Palestinian HWAR system, identifies existing gaps and offers actionable improvement solutions. Data were collected during October and November 2019 in twenty-two semi-structured in-depth interviews conducted with experts, academics, leaders, and policymakers purposely selected from government, academia, and non-governmental organizations. The overall perceptions towards HWAR were inconsistent. The absence of a consolidated HWAR system has led to a lack of communication between actors. Environmental factors also affect HWAR in Palestine. The study highlighted the consensus on addressing further development of HWAR and the subsequent advantages of this enhancement. The current HWAR practices were found to be based on personal initiatives rather than on a systematic evidence-based approach. The need to strengthen law enforcement was raised by numerous participants. Additional challenges were identified, including the lack of knowledge exchange and salary adjustments. HWAR in Palestine needs to be strengthened on the national, institutional, and individual levels through clear and standardized operating processes. All relevant stakeholders should work together through an integrated national accreditation and regulation system.

Determinants of adolescents' perceptions on access to healthcare services in the Kingdom of Saudi Arabia: Jeeluna national survey findings.

OBJECTIVES: The study aimed at identifying the determinants of adolescents' access to healthcare services. SETTING: Intermediate and secondary schools across all 13 regions in the Kingdom of Saudi Arabia (KSA) from 2011 to 2012 through the Jeeluna national school-based survey. PARTICIPANTS: Intermediate and secondary school students participated in the study. A multistage, cluster, random sampling technique was used. Participants responded to a self-administered questionnaire that addressed several domains. MAIN OUTCOME MEASURE: Adolescents' perception of access to healthcare services. RESULTS: Twenty-five per cent of participants reported difficulty in accessing healthcare. Women, early (younger) adolescents and adolescents with three siblings were less likely to report difficulty in accessing healthcare than men, late (older) adolescents and those with fewer than three siblings. Adolescents from low-income families and those with either mental or physical illness were more likely to report difficulty in accessing healthcare than adolescents from higher income families and those without mental or physical illnesses. CONCLUSIONS: Disparities in access to care exist between certain subpopulations of adolescents. Efforts are needed to support enhancing access and making it more equitable. Training for healthcare professionals and targeted health policies are necessary to improve adolescents' access to health services in the KSA. TRIAL REGISTRATION NUMBER: RC08-092; King Abdullah International Medical Research Centre.

The Impact of a National Accreditation Program on Patient Safety Culture in a Tertiary Hospital: Pre- and Post-Evaluation Study.

Introduction: The objective of this study was to assess the effectiveness of the Saudi national accreditation program on patient safety culture in a secondary-tertiary public hospital in Saudi Arabia. Methods: Three hundred health professionals were randomly selected to participate in a survey. The survey was used in three phases: baseline, before accreditation, and after accreditation. Primary and secondary outcome measures were teamwork within hospital units, feedback and communication about errors, hospital handoffs and transitions, overall perceptions of safety, frequency of event reporting, and perception of patient safety grade. Results: The survey response rate was 100%. A statistically significant impact of accreditation was found for teamwork within hospital units, feedback and communication about errors, and hospital handoffs and transitions (p = 0.002, 0.009, and 0.010, respectively). Ordinal logistic regression confirmed that the accreditation program had a significant effect on overall perceptions of safety (odds ratio [OR] [1.42-13.56], p = 0.010), frequency of event reporting (OR [0.91-7.96], p = 0.073), and staff awareness of grading safety culture (OR [0.02-0.70]) and reporting behavior (OR 0.10 [0.03-0.37]). Conclusion: The Saudi national accreditation program had a significant positive impact on some patient safety culture dimensions and outcomes. These findings provide local empirical evidence on the benefits of implementing national accreditation programs. Further research on a larger scale is highly recommended.

Assessing the Feasibility and Effects of Introducing the USA National Surgical Quality Improvement Program on Clinical Outcomes and Cost in Saudi Arabia: An Observational Study.

Introduction: This study aimed at introducing a systematic clinical registry to assess the outcomes of surgical performances and the associated costs of surgical complications in hospitals of Saudi Arabia. Materials and Methods: This was an observational retrospective cohort study. Three large Saudi public hospitals from different regions participated in the study. A systematic sample consisting of 2077 medical records was retrospectively reviewed after being received from the hospitals' surgical wards. The inclusion criteria of the study were inpatients of the surgical cases, patients older than 18 years, and those who underwent major surgery under general anesthesia. The occurrence of adverse events in surgical wards and the direct costs associated with these surgical adverse events were estimated. Results were reported in terms of odds ratio and 95% confidence interval. A value of p < 0.05 was considered statistically significant. Results: Introducing the systematic clinical registry to assess surgical outcomes and complications across multiple hospital sites is feasible. The findings of the study suggest that some areas are exemplary and others need improvement, such as sepsis cases, renal failure, ventilator use for more than 48 h, urinary tract infection, surgical site infection (SSI), length of stay after colorectal surgery, and rehospitalization. Additional costs from surgical complications in Riyadh only were approximately 0.5 million Saudi Arabian Riyal (127,764.40 USD) during that year. Most of the additional costs were due to sepsis and SSI. Conclusion: Empirical evidence derived from the idea of introducing a National Surgical Quality Improvement Program might be generally applicable to other countries in the region and worldwide, and can be used to measure surgical adverse events and track interventions over time. As a result, quality improvement initiatives could be identified to be implemented immediately focusing on preventing several surgical adverse events. A future study is needed to explore the underlying factors that contribute to the occurrence of surgical adverse events to be prevented and/or mitigated.

Similarities and differences in the associations between patient safety culture dimensions and self-reported outcomes in two different cultural settings: a national cross-sectional study in Palestinian and Belgian hospitals.

OBJECTIVES: To investigate the relationships between patient safety culture (PSC) dimensions and PSC self-reported outcomes across different cultures and to gain insights in cultural differences regarding PSC. DESIGN: Observational, cross-sectional study. SETTING: Ninety Belgian hospitals and 13 Palestinian hospitals. PARTICIPANTS: A total of 2836 healthcare professionals matched for profession, tenure and working hours. PRIMARY AND SECONDARY OUTCOME MEASURES: The validated versions of the Belgian and Palestinian Hospital Survey on Patient Safety Culture were used. An exploratory factor analysis was conducted. Reliability was tested using Cronbach's alpha (α). In this study, we examined the specific predictive value of the PSC dimensions and its self-reported outcome measures across different cultures and countries. Hierarchical regression and bivariate analyses were performed. RESULTS: Eight PSC dimensions and four PSC self-reported outcomes were distinguished in both countries. Cronbach's α was α≥0.60. Significant correlations were found between PSC dimensions and its self-reported outcome (p value range <0.05 to <0.001). Hierarchical regression analyses showed overall perception of safety was highly predicted by hospital management support in Palestine (ß=0.16, p<0.001) and staffing in Belgium (ß=0.24, p<0.001). The frequency of events was largely predicted by feedback and communication in both countries (Palestine: ß=0.24, p<0.001; Belgium: ß=0.35, p<0.001). Overall grade for patient safety was predicted by organisational learning in Palestine (ß=0.19, p<0.001) and staffing in Belgium (ß=0.19, p<0.001). Number of events reported was predicted by staffing in Palestine (ß=-0.20, p<0.001) and feedback and communication in Belgium (ß=0.11, p<0.01). CONCLUSION: To promote patient safety in Palestine and Belgium, staffing and communication regarding errors should be improved in both countries. Initiatives to improve hospital management support and establish constructive learning systems would be especially beneficial for patient safety in Palestine. Future research should address the association between safety culture and hard patient safety measures such as patient outcomes.