Action on patient safety can reduce health inequalities (29 March 2022)

Summary

When people already negatively affected by unfavourable social determinants of health seek care, healthcare itself may make health inequalities worse, rather than tackling them. This is seen in certain demographic groups experiencing disproportionate levels of harm.

This article in The BMJ argues that focusing on patient safety in terms of specific health inequalities will help make healthcare more equally safe. It looks at interpersonal and structural factors that shape care experiences for people from marginalised backgrounds, including poor communication, basing treatment on models built around majority norms and healthcare worker bias. It highlights the importance of having a clear line of accountability for unequal harms so that individuals and organisations are given responsibility for taking action to overcome issues.

Content

The authors recommend the following solutions to reduce patient safety inequalities:

Individuals

• More routine involvement of advocates from patients’ communities in healthcare interactions to reinforce communication and ongoing support in care
• Purposeful consideration of how the social background of a patient may dictate risk of harm from healthcare, and adjust management and follow-up plans accordingly
• Use of culturally and linguistically appropriate shared decision making tools to empower involvement of marginalised patient groups in their care and safety

Healthcare leaders

• Support a diverse healthcare leadership that pushes these issues into the consciousness of the workforce and mobilises the system towards meaningful action
• Race conscious approaches to healthcare education with greater emphasis on racism and discrimination (rather than race) as determinants of disease
• Systematised co-design of clinical services and clinical information with members of marginalised patient communities

System level action

• Avoid using systematically biased clinical prediction tools and algorithms unless clear empirical justification for race adjustment has been established
• Strengthen capabilities for stratified analysis of patient safety event reports according to important patient characteristics and the translation of these data into tangible action
• Clinical trials must recruit an appropriately diverse cohort, report relevant social determinant characteristics, and conduct relevant stratified analyses that determine effectiveness and safety of drugs and devices