CompletedPublic Health & HealthcareNIHR-supported projectMental Health
A rapid review of the role of safety science frameworks in informing equity approaches within patient safety research, quality improvement and safety incident investigations
Recipient organisationNIHR Yorkshire and Humber Patient Safety Research Collaboration
NIHR supportRecorded as supported by this research centre
PeriodFeb 2025 — Dec 2025
In plain English
AI plain-English summary
A patient from a minoritised ethnic background is more likely to be harmed by a medical error than a white patient, and current safety frameworks often fail to capture this disparity. This review addresses a gap: safety science has improved how hospitals understand and prevent harm, but it has not systematically accounted for the fact that some groups—older people in care homes, those on lower incomes, and ethnic minorities—face higher risks. The same inequities affect NHS staff, with minoritised ethnic workers experiencing more bullying and harsher discipline, which in turn undermines patient care. The researchers will examine existing safety science frameworks to identify where and how equity can be built into research design, quality improvement, and incident investigations. If successful, the work will produce practical guidance for researchers and NHS teams, ensuring that future patient safety initiatives do not overlook the specific risks faced by marginalised groups. This is not fundamental science; it is a targeted review intended to reshape how safety research is conducted, with the goal of making improvements in care and staff wellbeing more equitable across the board.
View original technical description
Safety science has enhanced our understanding of the complexities of harm and healthcare and therefore supported the development of more comprehensive approaches to address patient safety. However, research shows that safety outcomes are not equal for all patients. Some groups, such as minoritised ethnic individuals, older people in care homes, and those with lower incomes, face a higher risk of medical errors and harm that could be prevented. Studies also suggest that these inequities are not always captured in patient safety data, making the problem harder to address. Beyond patient care, unfair and unsafe workforce experiences in the NHS also affect safety. Since 2015, data from the NHS Staff Survey and Workforce Race Equality Standard show that minoritised ethnic staff face more workplace bullying, discrimination, and harsher disciplinary measures than their white colleagues. These issues contribute to poorer staff wellbeing, affecting patient care and safety. To address these challenges, experts are calling for equity to be integrated into patient safety frameworks. Researchers have highlighted how safety science must move beyond general system-wide improvements to consider specific risks faced by marginalised groups. Safety science frameworks are widely cited in the literature and shape how researchers approach and design patient safety studies. Our equity-focused review will provide guidance on integrating equity into research design, helping to ensure that future studies address both safety inequities and broader safety concerns. The review will inform recommendations for integrating equity into patient safety research and quality improvement to inform practice. By making equity a core component of safety research, this review will support the development of more inclusive and effective patient safety initiatives, ultimately improving outcomes for all patient groups and healthcare staff.
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