Development and Validation of a Safety Management System Implementation Model in Iranian Teaching Hospitals: A Mixed-Methods Study
Irtiqa Imini Pishgiri Masdumiyat (Safety Promotion and Injury Prevention),
Vol. 13 No. 3 (1404),
28 July 2026
,
Page 34-48
https://doi.org/10.22037/iipm.v13i3.52703
Abstract
ence of a comprehensive context-specific framework has hindered the systematic implementation of safety management systems. This study aimed to develop and validate a Safety Management System (SMS) implementation model for Iranian teaching hospitals using a mixed-methods approach.
Methods: This applied mixed-methods study employed a sequential qualitative–quantitative design. In the qualitative phase, 14 experts in healthcare management and patient safety were selected through purposive and snowball sampling, with data saturation achieved after the twelfth interview. Data were collected through semi-structured interviews and analyzed using grounded theory. The test–retest reliability and inter-coder agreement were 90% and 82%, respectively. In the quantitative phase, the study population comprised healthcare personnel and hospitalized patients from 10 teaching hospitals across nine cities in Iran between 2021 and 2023. Based on Morgan's sample size table, 337 participants were selected using stratified random sampling. Data were collected using a researcher-developed questionnaire, and the proposed model was validated through Partial Least Squares Structural Equation Modeling (PLS-SEM).
Results: Qualitative analysis identified 33 codes organized into five major categories: causal factors, contextual factors, intervening factors, strategies, and outcomes. The quantitative findings demonstrated that the proposed model exhibited an acceptable model fit (GOF=0.495, IFI=0.95, CFI=0.95, and SRMR=0.074). Furthermore, the Average Variance Extracted (AVE>0.50) and Composite Reliability (CR>0.70) values confirmed the convergent validity and construct reliability of the model.
Conclusion: The successful implementation of a Safety Management System in teaching hospitals requires the simultaneous integration of individual, organizational, and financial factors. The validated model provides a comprehensive and evidence-based framework for reducing medical errors and improving patient safety in Iranian teaching hospitals.
- Grounded theory
- Patient safety
- Safety Management System
- Structural equation modeling
- Teaching hospitals
How to Cite
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