Aim <p>This review aims to synthesize existing evidence on patient safety culture in hospitals and identify key dimensions and factors that shape its effectiveness and implementation. Patient safety culture is crucial for high-quality hospital care, yet its effectiveness varies worldwide due to economic disparities. Understanding how it functions within different hospital settings is essential for designing effective strategies to improve safety outcomes. This systematic review explores the current state of patient safety culture and identifies critical factors influencing its implementation and success. </p> Subject and methods <p>A systematic review was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, and Web of Science from the year 2000 to 2024. Studies assessing patient safety culture in hospitals using validated instrument were included, following Preferred Reporting Items for Systematic and Meta-Analyses guidelines.</p> Results <p>Thirty-four studies met the inclusion criteria. High-income countries showed higher scores in teamwork, leadership support, and nonpunitive response to errors. In contrast, low- and middle-income countries struggled with staffing and error response. Leadership engagement and continuous education improve safety culture, while limited resources and disengaged staff posed challenges.</p> Conclusion <p>Patient safety culture varies significantly across economic settings. Targeted efforts, especially in error reporting, staffing, and care transition, should be part of safety culture globally.</p>