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Assessment of Patient Safety Culture in Community Pharmacies Using the Pharmacy Survey on Patient Safety Culture (Pharmacy SOPS)

A 2025 cross-sectional study of 350 pharmacy staff in Herat, Afghanistan, utilizing the validated Pharmacy SOPS instrument, revealed a moderate-to-high overall patient safety culture score with notable strengths in counseling but significant challenges related to staffing and workload, which were further influenced by staff age and experience.

Original authors: sara jamili, fatemeh kokabisaghi, Safielah Ishaqzai, Hosein Ebrahimipour

Published 2026-06-29

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CC BY 4.0

Original authors: sara jamili, fatemeh kokabisaghi, Safielah Ishaqzai, Hosein Ebrahimipour

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine a community pharmacy not just as a place to pick up medicine, but as a busy kitchen in a restaurant. The pharmacists are the chefs, the prescriptions are the orders, and the patients are the hungry diners waiting for their meals.

This research paper is like a "health inspection" of these kitchens, but instead of checking for dirty floors, the inspectors are checking the mindset and mood of the staff. They wanted to know: Do the chefs feel safe, supported, and able to cook without burning the food?

Here is the story of what they found in the pharmacies of Herat, Afghanistan, told in simple terms.

The Tool: A Safety Report Card

The researchers used a special report card called the Pharmacy SOPS (Survey on Patient Safety Culture). Think of this as a standardized test that asks the staff questions like:

"Do you feel like you have enough helpers in the kitchen?"
"If you make a mistake, will you get in trouble, or will the team help you fix it?"
"Do you have time to talk to the customers about their food?"

They gave this test to 350 pharmacy workers (chefs, assistants, and students) across five different neighborhoods in Herat.

The Good News: The Heart is Strong

The overall score for safety culture was a 3.8 out of 5. That's a solid "B" grade. About half of the staff felt their pharmacy had a "very high" level of safety.

The strongest areas were:

Talking to Customers (Patient Counseling): This was the highest score (4.4/5). It's like the chefs in Herat are excellent at stopping to explain the recipe to the diner. They take the time to make sure the customer knows how to use the medicine.
Teamwork: The staff gets along well. They help each other out, like a kitchen crew passing plates and shouting "behind you!" to avoid collisions.

The Bad News: The Kitchen is Too Crowded

The weakest area was Staffing, Work Pressure, and Pace (3.7/5).

Imagine a kitchen where there are only two chefs, but the orders are coming in so fast that the line is out the door. The chefs are running, sweating, and getting interrupted every five seconds. They don't have enough hands to keep up.

The study found that the staff feels overworked and rushed.
They feel the "pace" of the work is too fast for the number of people they have.
This is the biggest risk for mistakes. When you are running too fast, you are more likely to grab the wrong spice.

Who Has the Best Safety Culture?

The researchers looked at who gave the best scores. They found that older workers and those with more years of experience felt the safety culture was better.

Think of it like driving a car. A new driver (someone with little experience) might feel more stressed and anxious about safety. An experienced driver (someone with 10+ years on the job) knows the roads, knows the risks, and feels more confident that they can handle the traffic safely. The study suggests that as pharmacists get older and gain experience, they become better at spotting safety issues and managing the chaos.

The Bottom Line

The paper concludes that the pharmacies in Herat are built on a foundation of good teamwork and a desire to help patients. The staff cares deeply.

However, the system is holding them back. It's like having a great team of chefs but not giving them enough pots, pans, or assistants. To make the food (medicine) safer, the managers need to:

Hire more people so the work isn't so heavy.
Slow down the rush so the staff isn't constantly stressed.
Create a "no-blame" zone where if someone drops a plate, the team helps clean it up instead of yelling at them.

In short: The staff has the heart and the skill to be safe, but they are being squeezed by too much work and too few people. Fixing the schedule and the staffing is the key to keeping patients safe.

Technical Summary: Assessment of Patient Safety Culture in Community Pharmacies in Herat, Afghanistan

Problem Statement
Patient safety is a fundamental component of healthcare quality, yet medication errors remain a significant global burden, costing health systems an estimated USD 42 billion annually. While the paradigm of patient safety has shifted from individual blame to a systems-based culture, there is a critical lack of data regarding patient safety culture (PSC) in community pharmacies within low-resource settings, specifically Afghanistan. No prior study had systematically assessed this issue using standardized instruments, creating a gap in understanding the structural and organizational determinants of safety in the Afghan healthcare system. This lack of evidence hinders the development of evidence-based policies and effective improvement strategies.

Methodology
This study employed a descriptive-analytical cross-sectional design conducted in 2025 across Herat province, Afghanistan.

Population and Sampling: The target population included approximately 5,400 staff members working in 870 community pharmacies. A stratified random sampling technique was used to select pharmacies across five geographic strata (North, South, East, West, and Central). The final sample consisted of 350 valid responses from pharmacists, technicians, and students with at least six months of experience, representing a 92.8% response rate.
Instrument: Data were collected using the Persian version of the Agency for Healthcare Research and Quality (AHRQ) Pharmacy Survey on Patient Safety Culture (Pharmacy SOPS). The tool was localized for the Afghan context and validated by a panel of 20 experts, achieving a Content Validity Index (CVI) > 0.79 for all items.
Reliability: The instrument demonstrated acceptable internal consistency with an overall Cronbach's alpha of 0.84.
Analysis: Data were analyzed using SPSS version 16.0. Descriptive statistics were used to characterize the population and safety culture scores. Bivariate analyses (t-test, ANOVA) and multiple linear regression were employed to identify predictors of safety culture. Scores were calculated as "Percent Positive Responses" and mean scores on a 1–5 scale.

Key Contributions and Results
This study provides the first systematic baseline assessment of patient safety culture in Afghan community pharmacies.

Overall Safety Culture: The overall mean PSC score was 3.81 ± 0.86 (out of 5). When converted to a 0–100 scale, 50.3% of participants rated their pharmacy's safety culture as "very high" (≥80), while only 4% rated it as "low."
Dimensional Strengths and Weaknesses:
- Strongest Dimensions: "Patient Counseling" (Mean: 4.4 ± 0.8) and "Teamwork" (Mean: 4.3 ± 0.8) were the highest-scoring areas.
- Weakest Dimensions: "Staffing, Work Pressure, and Pace" was the lowest-scoring dimension (Mean: 3.7 ± 0.6), indicating significant concerns regarding workload and resource allocation.
Predictors of Safety Culture:
- In bivariate analysis, age, work experience, gender, and education level were significantly associated with safety culture scores.
- In multivariate regression analysis, age ( $\beta$ = 0.33, $p$ = 0.003) and work experience ( $\beta$ = 0.21, $p$ = 0.033) emerged as the only significant independent predictors. The regression model explained 32% of the total variance in safety culture scores.
- Notably, gender and education level, while significant in bivariate tests, were not significant in the final multivariate model.

Significance and Claims
The authors claim this study fills a substantial research gap by establishing the first baseline for patient safety culture in Afghanistan. The findings suggest that while community pharmacies in Herat possess strong foundations in professional commitment, teamwork, and patient counseling, these strengths are compromised by systemic issues related to staffing shortages and high work pressure.

The paper posits that improving patient safety in this setting requires a shift from individual efforts to system-level interventions. Specifically, the authors highlight the need for:

Workforce Planning: Addressing staffing shortages to reduce work pressure and pace.
Workflow Improvement: Redesigning workflows to minimize interruptions and manage prescription volumes effectively.
Non-Punitive Environments: Fostering a "just culture" that encourages transparent error reporting and learning from mistakes.

The study concludes that preserving the high quality of patient counseling—a current strength—depends on alleviating the clerical and operational burdens that threaten to compromise it. The authors caution that while the findings are representative of Herat, generalization to other regions of Afghanistan should be made with care due to potential regional infrastructure differences.