Factors Influencing Patient Safety Incident Reporting and Evidence-Based Improvement Strategies Among Healthcare Professionals in Saudi Arabia: A Systematic Review Aligned with Vision 2030.

PURPOSE: To systematically review and synthesize existing evidence on the factors influencing patient safety incident (PSI) reporting among healthcare professionals in Saudi Arabia, and to identify context-specific strategies to strengthen reporting culture in alignment with Saudi Vision 2030. PARTICIPANTS AND METHODS: This systematic review followed PRISMA 2020 guidelines. A comprehensive search of three electronic databases (PubMed, Web of Science, and Google Scholar), along with grey literature sources and citation tracking, was conducted to identify studies published between January 2020 and December 2025. Fifteen studies met the inclusion criteria. Quality was assessed using the Joanna Briggs Institute critical appraisal tools. Due to methodological heterogeneity, a narrative synthesis was adopted, guided by the Population-Exposure-Outcome (PEO) framework and a four-domain conceptual model (cultural, organizational, technological, and individual factors). The protocol was registered a priori in PROSPERO (CRD420261334705). RESULTS: Persistent underreporting was observed across the included studies, with 44-50% of healthcare professionals reporting zero incidents, and rates reaching up to 90% in primary healthcare settings. Medication errors and near misses were the most frequently reported incident types. Barriers to reporting were systematically categorized across four interconnected domains: cultural (pervasive blame culture), organizational (heavy workloads, inadequate feedback), technological (poor system usability), and individual (low psychological safety and interpersonal concerns). CONCLUSION: Improving PSI reporting requires a multilevel approach addressing these four domains. Implementing a Just Culture framework, strengthening leadership accountability, enhancing system usability, and improving interprofessional communication are essential to achieving Saudi Vision 2030's patient safety goals.