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Record W4415906511 · doi:10.1136/bmjqs-2025-019118

Integrating equity into incident reporting and patient concerns systems: a critical interpretive synthesis

2025· article· en· W4415906511 on OpenAlexaff
Joanne Goldman, Leahora Rotteau, Lisha Lo, Brian M. Wong, Ayelet Kuper, Allison Kooijman, Maitreya Coffey, Saleem Razack, Shail Rawal, Michael Palomo, Myrtede Alfred, Marie Pinard, Andrew Milroy, Carol Anderson, Arvin Minocha, Patricia Trbovich

Bibliographic record

VenueBMJ Quality & Safety · 2025
Typearticle
Languageen
FieldHealth Professions
TopicPatient Safety and Medication Errors
Canadian institutionsNorth York General HospitalMembrane Reactor Technologies (Canada)AIDS Committee of TorontoWomen's College HospitalToronto Western HospitalUniversity of British ColumbiaHealth Sciences CentreSinai Health SystemCanadian Patient Safety InstituteUniversity of British Columbia, Okanagan CampusOkanagan University CollegeSunnybrook Health Science CentreThe Wilson CentreBC Children's HospitalUniversity of Toronto
Fundersnot available
KeywordsEquity (law)Patient safetyRisk managementCritical Incident TechniqueBest practiceMEDLINECulture changeCustomer service

Abstract

fetched live from OpenAlex

BACKGROUND: Hospital incident reporting and patient concerns systems are widely used to detect and respond to patient harm. Despite increasing recognition of the link between equity and safety, equity remains poorly integrated into the design and function of these systems. Consequently, these systems risk obscuring or reproducing inequities rather than revealing and attending to them. OBJECTIVE: To examine how issues of equity are currently considered in research about hospital incident reporting and patient concerns systems and identify opportunities to more systematically include equity in how patient safety is addressed. METHODS: A critical interpretive synthesis was conducted to develop a theoretical understanding of the topic through inductive analysis and interpretation. The databases CINAHL, EMBASE, MEDLINE and PsycINFO were searched from database inception to 6 February 2024. Select social science, patient safety and health services literature supported the interpretive process. RESULTS: After screening 6508 abstracts and conducting hand searches, we included 30 articles in our review. Our analysis identified four equity-related themes. The first theme describes how knowledge injustices in 'what counts as a safety event or contributor' shape what patient issues are recognised, recorded and addressed. The second theme examines how individual bias and systemic discrimination affect which safety events and concerns get reported. The third theme explores both opportunities and limitations of stratifying data to uncover equity-related patterns of harm. The fourth theme presents alternate frameworks, including restorative and human rights approaches, as ways to address inequities and humanise harm. CONCLUSION: The findings provide direction for changes within incident reporting and patient concerns practices (eg, expanding definitions of harms; creating accessible and culturally safe patient concerns systems). They also affirm the opportunity to learn from, and build on, initiatives such as taking a restorative approach that moves beyond a customer service and risk management framing.

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.

How this classification was reachedexpand

Full frame distilled prediction

Teacher imitation

Not calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.

metaresearch head score (Codex)0.008
metaresearch head score (Gemma)0.185
Version: codex-gemma-dda1882f352aValidation status: machine_predicted_unvalidated
Candidate categoriesMetaresearch
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Qualitative · Consensus signal: none
GenreCandidate signal: Empirical · Consensus signal: none
Teacher disagreement score0.606
Threshold uncertainty score0.879

Codex and Gemma teacher scores by category

CategoryCodexGemma
Metaresearch0.0080.185
Meta-epidemiology (narrow)0.0000.000
Meta-epidemiology (broad)0.0010.000
Bibliometrics0.0000.000
Science and technology studies0.0010.000
Scholarly communication0.0000.000
Open science0.0000.001
Research integrity0.0000.001
Insufficient payload (model declined to judge)0.0000.000

Machine scores (provisional)

The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.

Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.

Opus teacher head0.151
GPT teacher head0.561
Teacher spread0.410 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; a candidate call from one teacher head, not a consensus.

Study designQualitative
Domainnot available
GenreEmpirical

How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".

Quick stats

Citations3
Published2025
Admission routes1
Has abstractyes

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