Integrating equity into incident reporting and patient concerns systems: a critical interpretive synthesis (BMJ, 4 November 2025)

Summary

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. This study examined 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.

Content

The 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.

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.