Abstract
Background
The “Patient Safety Caravan” is a patient safety promotion campaign launched by the Saudi Patient Safety Center and adopted by Riyadh Second Health Cluster hospitals to promote a culture of patient safety. It aimed to educate patients and their families about patient safety, promote patient empowerment, and provide information to help patients be actively involved in their own healthcare. The objective of this study is to report on the implementation of the campaign from November 2022 to December 2023 and evaluate patients’ satisfaction and feedback with the initiative.
Methods
A prospective, intervention-based study was conducted in two phases-planning and implementation-across 11 hospitals within the Riyadh Second Health Cluster from November 2022 to December 2023. A total of 3,244 patients were engaged through structured visits by trained volunteers using standardized educational toolkits. Patient satisfaction was assessed using a 3-point Likert scale survey and open-ended feedback. Descriptive and thematic analyses were used to evaluate quantitative and qualitative data, respectively.
Results
Out of 3,244 patients engaged in the initiative, 604 completed the satisfaction survey. Among them, 96.2% reported satisfaction with the overall Patient Safety Caravan initiative, and 95.6% were satisfied with the educational toolkits. The involved patients’ feedback about the initiative and provided kits were adding more information about patients’ compliance with physicians’ and health educators’ orders and treatment plan, giving more detailed information about the initiative, focus on patients’ rights, and increase frequency of this initiative.
Conclusion
Patient Safety Caravan Initiative was well received by patients, indicating that targeted patient engagement campaigns can successfully enhance patient satisfaction and awareness around safety practices. Broader adoption and continued refinement of such strategies may further empower patients and improve the overall quality of healthcare delivery.
Clinical trial number
Not applicable.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12913-025-13816-0.
Keywords: Patient Safety Caravan, Patient-centered care, Patient experience, Patient satisfaction, Saudi Arabia
Background
Patient harm due to medical errors is one of the top ten global causes of mortality and injuries and it is estimated that roughly 10% of hospitalized patients suffer from injuries [1, 2]. The Institute of Medicine (IOM) has recognized patient safety as a serious concern and emphasized that improving patient safety is essential to enhancing the quality of health care [3]. In particular, the IOM highlights the need to cultivate a culture of patient safety within healthcare systems [3]. The World Health Organization (WHO) describes patient safety as “the prevention of errors and adverse effects to patients associated with health care” and “to do no harm to patients” [4]. Consequently, patient safety has gained broad recognition, leading to its integration into the strategic plans of healthcare systems globally [5]. Nevertheless, patient safety remains a significant challenge due to the persistently high rates of safety errors in health care systems [6].
Patient involvement in healthcare delivery is a cornerstone for leading improvements in the quality of healthcare and is a central tenet of patient safety strategies [7]. Patient involvement has gained prominence due to rising awareness and reporting of serious clinical and service failings [8]. Patients are distinctively placed to contribute to safety in healthcare settings, including the mitigation of errors and adverse events [9], and evidence suggests they are willing to be involved at many levels of the care process—with patient empowerment serving as a critical enabler of such involvement [10, 11].
Accordingly, patient empowerment was introduced as a concept to encourage patients to actively participate in the decision-making process about their healthcare and quality of life [12]. Previous studies link patient empowerment to improved healthcare outcomes, including higher satisfaction levels, better understanding of their care, more involved in their own treatment, and greater confidence in their physicians [13–17]. Moreover, increased patient engagement is associated with reduced hospital expenditure and fewer litigations [18]. Conversely, patients who are not engaged or do not have enough information about their treatment have poorer treatment adherence, reduced medical safety, and lower satisfaction [19].
In response to the IOM’s recommendations, healthcare systems began the process of bridging the deficits in patient safety by cultivating a focus on organizational safety culture centered on support and learning [20]. Specific to the Saudi Arabian setting, a previous study reported several gaps related to patient safety among patients and underscored the need for educating patients on patient safety measures [21].
To empower patients and improve the safety of their care experiences, the Saudi Patient Safety Center launched the Patient Safety Caravan, a large-scale initiative aimed at educating and empowering the largest possible audience of patients and families [22]. Volunteers and healthcare providers visited patients and their families across hospital settings (in inpatient wards, outpatient clinics, emergency departments, etc.) to promote patient safety awareness. The campaign’s objectives were to:
Reach as many patients and families as possible to improve the safety of their healthcare experience.
Increase patient safety level in healthcare facilities and ensure patients and families’ participation in treatment plans with healthcare providers.
Raise volunteers’ awareness about patient safety which they would share with patients and families.
Collaborate with patient experience centers in hospitals to embed patient empowerment into daily hospital activities [22].
The Patient Safety Caravan encouraged patients to ask questions to healthcare providers and actively participate in clinical decisions, thereby, raising community awareness of patient empowerment.
The Patient Safety Caravan was implemented in the Riyadh Second Health Cluster (R2) hospitals. The objective of the present study was to report the campaign’s implementation and evaluate patients’ satisfaction. The insights gained from the campaign’s implementation may inform policy makers, program managers, and stakeholders planning similar patient safety initiatives in Saudi Arabia.
Methods
Study design
The Patient Safety Caravan Initiative was a prospective intervention-based program aimed at promoting patient safety culture through patient and family engagement. The study received approval from the Institutional Review Board of King Fahad Medical City. The study followed a two-phase design:
Phase 1 – Planning: This included team recruitment, stakeholder engagement, preparation of an implementation guide, development of educational toolkits, and volunteer training.
Phase 2 – Implementation: Field activities were executed at multiple hospital sites, with organized patient visits supported by trained volunteers delivering safety education and empowerment toolkits.
Study duration and setting
The initiative was carried out between November 2022 and December 2023 across 11 hospitals within the Riyadh Second Health Cluster in Saudi Arabia. Visits were conducted in diverse hospital units including inpatient wards, outpatient clinics, and emergency departments.
Study sampling and participants
A total of 3,244 patients were approached and involved in the initiative using a convenient sampling technique. Patients included were those who were alert, oriented, and able to comprehend and respond to the survey questions and participate in the study. In addition, the initiative was supported by 168 trained volunteers who completed approximately 300 h of service during the initiative implementation.
Initiative intervention
The initiative comprised of two phases: planning and implementation phases. The planning phase consisted of: (a) recruiting team members, (b) engaging the stakeholders and hospital officials to facilitate the conduct of the initiative, (c) composing the Patient Safety Caravan Usage and Implementation Guide (Appendix 1), (d) developing the Patient Safety Caravan educational toolkits and its objectives (Table-1; Appendices 2–7), and (e) training volunteers and quality and patient safety specialists on the educational toolkits.
Table 1.
Educational toolkits - Patient Safety Caravan
| Toolkit Topics | Empowerment Strategy |
|---|---|
| Be an empowered patient | Empowers patients in general to understand their health condition and know their rights. |
| Be an empowered patient during your hospital stay | Empowers patients to properly communicate with the medical team and how to take care of their health during their admission in hospital. |
| Be an empowered patient in the emergency room | Empowers patients in the emergency room and explain the importance of effective communication and share the correct information about the patient with the medical team and educate them to prevent themselves from infection. |
| Be an empowered patient during your hospital visit (outpatient clinics) | Helps patients prepare before and during the appointment with the health practitioner to make the best decisions about their health and enable patients to discuss and know their medications with the pharmacist. |
| Be an empowered patient before and after surgery | Empowers patients to ask questions, discuss and make correct decisions related to their health before and after surgery and after discharge. |
The second phase included the implementation of the Patient Safety Caravan and consisted of the following steps.
Before the field visit
Communicate with hospital officials to obtain approval and schedule patient visits.
Request volunteers from the same area for easy access to patients in the area.
Conduct a remote training meeting of 60–120 min for the nominated volunteers.
Print the Patient Safety Caravan Bag toolkits to be distributed to patients or made available to them electronically.
The day of the field visit
Head to the health facility accredited to implement the Patient Safety Caravan.
-
Prepare volunteers and distribute the following roles among them:
- Volunteer leader
- Volunteer photographer
- Speaker volunteers
Meet with the responsible person (facility manager, patient experience manager, or quality and patient safety manager) from within the facility who has been coordinating with the volunteer(s).
The start of the tour, wherein volunteers and a member of the facility visit admission departments, outpatient clinics, emergency services, and waiting areas.
-
Distribute specific toolkits to patients in different departments as follows.
- “Be an empowered patient” toolkits are distributed in all sections during the tour.
- “Be an empowered patient during your hospital stay” toolkits are distributed in hospital admission wards.
- “Be an empowered patient in the Emergency Room” toolkits are distributed in the emergency department and emergency department waiting areas.
- “Be an empowered patient during your hospital visit” toolkits are distributed in the outpatient department and waiting areas.
- “Be an empowered patient before and after surgery” toolkits are distributed before and after surgery in the inpatient department and outpatient surgery clinics.
When entering the patient’s room, the volunteer would
Greet the patient then introduce themselves.
Ask about the patient’s name and his condition.
Ask the patient about the extent of their knowledge about the details of their health condition and the doctor in charge.
Introducing the Caravan and its objectives.
Start a dialogue with the patient according to the questions asked in each toolkit and distribute the toolkits according to the patient’s needs.
Data collection and measures
In this initiative, a self-administered questionnaire using a 3-point Likert scale (satisfied, neutral, dissatisfied) was employed to evaluate patients’ satisfaction with both the safety caravan concept and the distributed toolkits. A response of “Satisfied” was considered a positive indication of satisfaction. To capture more in-depth insights, the questionnaire also included an open-ended question for patients to elicit their feedback and suggestions regarding the initiative (see Supplementary File). Moreover, the data collection encompassed the number of volunteers involved, total volunteering hours, number of participating hospitals, and the number of training workshops required for volunteers. The survey instrument was developed based on a comprehensive review of the literature and aligned with the objectives of the Patient Safety Caravan Initiative. The tool was reviewed by a panel of experts in patient safety and healthcare quality to ensure face validity to assess clarity, relevance, and ease of understanding.
Statistical analysis
Data were analyzed using SPSS software v.29. (IBM Corp, Armonk, NY, USA). Descriptive statistics, including frequencies and percentages, were used to summarize the categorical variables. Thematic analysis was conducted manually by two researchers using Braun and Clarke’s framework. Themes were derived inductively. Both researchers independently coded the data and resolved discrepancies through discussion. While inter-coder reliability was not formally calculated, consensus ensured consistency and rigor.
Ethical considerations
The study received approval from the Institutional Review Board of King Fahad Medical City (IRB #: 24 − 008). All participants provided informed consent before taking part in the initiative, and their identities were kept strictly confidential.
Results
A total of 3,244 patients from 11 hospitals within Riyadh Second Health Cluster hospitals were contacted and involved in the initiative between November 2022 and December 2023, through the efforts 168 volunteers who contributed 330 h of volunteering service (Table-2).
Table 2.
Patient and volunteer participation by hospital in the Patient Ssafety Caravan Initiative
| Hospital | Patients n (%) |
Volunteers n (%) |
|---|---|---|
| KFMC* | 500 (15.4%) | 30 (17.9%) |
| Al Majama’ah Hospital | 440 (13.6%) | 11 (6.5%) |
| Al Yamamah | 451 (13.9%) | 25 (14.9%) |
| PMAH* | 365 (11.3%) | 12 (7.1%) |
| Hotat Sudair Hospital | 300 (9.2%) | 12 (7.1%) |
| Al Artawiyah Hospital | 300 (9.2%) | 13 (7.7%) |
| Tumair Hospital | 200 (6.2%) | 14 (8.3%) |
| Rumah Hospital | 200 (6.2%) | 12 (7.1%) |
| Al Ghat Hospital | 200 (6.2%) | 13 (7.7%) |
| King Salam Kidney Disease Center | 158 (4.8%) | 11 (6.5%) |
| Az Zulfi Hospital | 130 (4%) | 15 (8.9%) |
| Total | 3244 | 168 |
*KFMC: King Fahad medical City, PMAH: Prince Mohammed Bin Abdulaziz hospital
Graph 1 presents the number and percentage of patients who reported satisfaction with the overall idea of the Patient Safety Caravan, and the toolkits provided during the campaign. The x-axis shows the survey categories (“overall initiative,” “provided toolkits”), while the y-axis shows the proportion (%) of patients expressing satisfaction. Out of the 604 patients who completed the satisfaction survey, 581 (96.2%) expressed satisfaction with the concept of the Patient Safety Caravan, while 578 (95.6%) were satisfied with the toolkits provided (Graph 1).
Graph 1.
Patients satisfaction on the idea of patient safety caravan and provided toolkits
In addition, the satisfaction survey included a qualitative question about the participant’s feedback or suggestions. The majority of the patients (554; 91.7%) shared positive feedback regarding the initiative. A few suggestions were given to maximize the utilization and improve the initiative and meet its objectives, as follows (Table 3).
Table 3.
Participants’ suggestions
| Add information about compliance with physicians’ health educators orders and treatment plan |
|---|
| Give more detailed information |
| Focus on patients’ rights |
| Increase frequency of this initiative |
| Involve schools/community |
| Need previous booking for the visit |
| Need special setting for the visits |
| Use digital screens in the hospitals’ waiting area |
| Use iKFMC mobile application for this initiative* |
| Use social media |
*iKFMC application: An R2 mobile application available in apple and android stores, designed to serve patients and provide fast and efficient access to patients’ medical services that include appointments, medications, lab tests, radiology, diagnosis, and medical reports
Discussion
Patient engagement in safety initiatives has emerged as a key priority in the global healthcare landscape. Remarkably, efforts are being introduced to actively integrate patients in wider and comprehensive ways, including the redesign the patient engagement services. This study provides a comprehensive insight on a newly-designed patient engagement strategy by the Saudi Patient Safety Center known; the “Patient Safety Caravan Initiative”; to increase patient safety awareness by empowering, educating, and supporting patients. The Patient Safety Caravan employed a range of strategies that optimized patient engagement, including a well- designed initiative, active patient involvement, and leadership support.
Identifying the objectives, roles, and expectations of such initiatives for patients are key elements for designing high quality patient engagement campaigns. This initiative identified clear objectives as outlined by the Saudi patient safety center and Riyadh Second Health Cluster hospitals, and clearly defined the roles of the involved personnel and organizing taskforce to improve the implementation and access to the initiative. An important technique used was conducting training sessions for involved personnel, which provided clarity on roles and responsibilities, ultimately fostering patients’ confidence in the initiative. Such training facilitated building positive relationships between healthcare personnel and patients, while mediating key barriers identified in patient engagement and empowerment [23].
The high levels of patient satisfaction observed in this initiative may be attributed to several contextual and program-specific factors. First, the personalized delivery of empowerment toolkits by trained volunteers in face-to-face settings likely enhanced the perceived value of the information, building trust and encouraging participation. This aligns with evidence that interpersonal, culturally sensitive communication improves patient receptivity and safety behavior [24, 25]. Moreover, the novelty of such a large-scale patient-focused campaign in this context may have sparked interest and goodwill, especially given limited prior exposure to empowerment-based safety strategies in Saudi Arabia [21]. Implementation challenges included variation in volunteer communication skills and inconsistencies in patient availability. These are consistent with challenges reported in earlier empowerment programs and highlight the need for consistent volunteer training and site-level coordination [26]. while the multi-hospital, culturally attuned approach may translate well to other regions in Saudi Arabia with similar population characteristics, differences in infrastructure, health literacy, or local engagement norms may limit broader applicability [27].
With respect to techniques to enhance patient representation, this initiative was implemented across the hospitals of Riyadh Second Health Cluster ensuring diversity and representation consistent with the broader population [23, 28] across different level of care (tertiary vs. secondary), different geographical areas, and in different settings within the hospital, including the inpatients, outpatients, and Emergency Departments.
A key facilitator of successful patient engagement in this initiative was the involvement of hospitals leaders. Having leaders recognize and advocate for the importance of the campaign fosters a sense of commitment and ensures long-term sustainability. Leadership involvement helps implement the lessons obtained from the initiative and ensure that they are incorporated in the hospital’s strategic plans and policies [29].
The Patient Safety Caravan is recognized as an instrumental framework that facilitates the establishment of a secure environment for both patients and healthcare personnel. The initiative has significantly enhanced the mechanisms for incident reporting within the hospital setting, consequently empowering patients and their guardians to express their concerns regarding medical conditions with greater assurance. Furthermore, it has augmented the competencies of healthcare professionals by advocating for patient safety through the identification of near misses, the prevention of healthcare-associated infections, the management of surgical site infections, and the enhancement of patient comfort. The ramifications of the Patient Safety Caravan are profound, as it actively engages patients and their families in the therapeutic process at the hospital level.
Several studies have reported more than one type of outcome on patient engagement in safety initiatives, including enhancing/redesigning the care or service delivery, and enhancing policy governance and education [30]. In this initiative, we conceptualized the development of educational toolkits promoting safety culture and patients reported satisfaction with them. However, the long-term care process or structural outcomes are more likely to reflect the real attained impact of this initiative. Remarkably, the majority of patients reported positive satisfaction about their involvement in the initiative and the provided toolkits.
Patients provided recommendations such as using digital screens in the hospitals’ waiting area and creating a mobile application and using social media for better reach and impact. However, it remains unclear how these initiative has affected patients and whether their improved knowledge and high satisfaction would translate into improved quality of care at a system level. This study provides a comprehensive insight into the strategy of designing and implementing Saudi Patient Safety caravan initiative, and identifies its outcomes. Further evidence is needed to understand the long-term outcomes of the initiative, specifically, on the institutional key performance indicators of whether these outcomes translate into improved quality of care.
The qualitative feedback provided by patients, particularly requests for digital tools such as mobile applications and hospital-based digital screens, as well as calls for more structured or repeated sessions, reflects broader trends in healthcare consumer expectations and evolving digital literacy. Increasing access to smartphones and familiarity with mobile health platforms in Saudi Arabia have heightened patient interest in convenient, on-demand access to health information, which digital modalities can facilitate [31]. Structured sessions may fulfill patients’ desire for continuity and deeper engagement, moving beyond one-time educational encounters toward sustained empowerment and repeated reinforcement of safety messages, which are critical for behavior change and retention of information [24]. These insights highlight the importance of integrating blended approaches—combining face-to-face interactions with digital outreach—to meet diverse patient needs and preferences, thereby enhancing the reach and long-term impact of patient safety initiatives.
To contextualize the Patient Safety Caravan Initiative within the global landscape, we compared it with two internationally recognized patient empowerment campaigns. The Joint Commission’s “Speak Up” campaign in the United States encourages patients to actively question healthcare providers and understand their treatments, promoting a proactive role in care decisions [32]. Similarly, the United Kingdom’s “#hellomynameis” initiative fosters compassionate communication by urging healthcare staff to introduce themselves to patients, thereby humanizing care and building trust [32]. While these initiatives focus on education and communication, the Saudi Patient Safety Caravan distinguishes itself through its mobile, volunteer-driven outreach model that delivers structured, in-person interactions directly within hospital settings. This culturally sensitive and personalized approach ensures accessibility for diverse patient populations, including those with limited digital access or lower health literacy, and aligns with global best practices while being tailored to the local healthcare context. Evidence suggests that such interpersonal approaches enhance patient trust and empowerment [21, 25]. Nevertheless, implementation challenges like volunteer training variability and logistical constraints are similar to those reported globally, emphasizing the importance of sustainable program structures and continuous evaluation efforts [27, 33]. Ultimately, while aligned with global empowerment goals, the initiative underscores the need to adapt strategies culturally and contextually to maximize effectiveness.
This study has several limitations that should be acknowledged. First, the absence of collected demographic data, such as age grouping, which limits the ability to perform subgroup analyses and may affect the generalizability of the findings across different patient populations. Second, the evaluation of the initiative relied primarily on self-reported satisfaction, which may be subject to social desirability or recall bias. Third, due to the cross-sectional nature of the data, causal relationships between the intervention and long-term improvements in patient safety outcomes cannot be established. Finally, while feedback was collected qualitatively, no in-depth interviews or focus groups were conducted, which may have limited the depth of insight into patient experiences It is important to consider that the positive feedback and high satisfaction rates demonstrated in this initiative may be influenced by several potential confounders. The Hawthorne effect, wherein patients modify their behavior because they are aware of being observed or receiving special attention, could have contributed to more favorable responses than might occur routinely [34]. Selection bias is also possible since only patients who were mentally competent, stable, and willing to participate were included, potentially excluding more vulnerable or disengaged populations and thus limiting representativeness [35]. Additionally, social desirability bias may have affected self-reported outcomes, as patients might have felt inclined to give positive feedback to please volunteers or due to the novelty of the intervention [36].
Conclusions
In summary, the Patient Safety Caravan Initiative demonstrated strong patient acceptance and satisfaction, underscoring the potential effectiveness of culturally tailored and volunteer-driven patient empowerment campaigns in enhancing safety awareness within hospital settings. The initiative’s success highlights the importance of personalized, face-to-face interactions and patient-centered educational tools in fostering engagement. Based on these findings, we recommend expanding the program to integrate digital platforms to complement in-person efforts, ensuring ongoing patient education and broader accessibility. Future research should focus on longitudinal evaluations to assess the long-term impact of such initiatives on actual safety outcomes and explore adaptability across diverse healthcare contexts. This will help solidify evidence-based strategies for embedding patient empowerment as a foundational component of patient safety.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
The authors would like to thank all the individuals who participated in the study.
Author contributions
Reem Al Khalil, Faisal Aldalbahi, Amal Al-Wathnani, Mecciya Majrashi, and Turki ALshabib, (Conceptualization, Design & coordination, Writing-original draft), Isamme AlFayyad and Faisal Aldalbahi (Statistical analyses, Data interpretation, Writing-original draft), All authors have reviewed and approved final manuscript.
Funding
Not applicable.
Data availability
The data that support the findings of this study are available from the corresponding author upon prior request.
Declarations
Ethics approval and consent to participate
This project was conducted according to the principles outlined in the Declaration of Helsinki. The project was approved by the Institutional review board of King Fahad Medical City (IRB #: 24 − 008). Participants identities were kept anonymized. The need for written informed consent was waived by the institutional review board of King Fahad Medical City since this study was a survey-based study. In the survey cover letter, the participants were informed that their participation is voluntary, and completion and returning the questionnaire implied their consent for participation.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon prior request.