{
  "abstract": "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.",
  "authors": [
    {
      "affiliations": [
        "Centre for Quality Improvement and Patient Safety, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada",
        "Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada",
        "Wilson Centre for Research in Education, Temerty Faculty of Medicine, Unversity of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Joanne Goldman"
    },
    {
      "affiliations": [
        "Centre for Quality Improvement and Patient Safety, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada",
        "Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Leahora Rotteau"
    },
    {
      "affiliations": [
        "Centre for Quality Improvement and Patient Safety, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Lisha Lo"
    },
    {
      "affiliations": [
        "Centre for Quality Improvement and Patient Safety, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada",
        "Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada",
        "Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"
      ],
      "name": "Brian M Wong"
    },
    {
      "affiliations": [
        "Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada",
        "Wilson Centre for Research in Education, Temerty Faculty of Medicine, Unversity of Toronto, Toronto, Ontario, Canada",
        "Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"
      ],
      "name": "Ayelet Kuper"
    },
    {
      "affiliations": [
        "School of Nursing, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada"
      ],
      "name": "Allison Kooijman"
    },
    {
      "affiliations": [
        "Center for Clinical Excellence, Nationwide Children’s Hospital, Columbus, Ohio, USA"
      ],
      "name": "Maitreya Coffey"
    },
    {
      "affiliations": [
        "Department of Pediatrics and Centre for Health Education Scholarship, University of British Columbia, Vancouver, British Columbia, Canada",
        "BC Children’s Research Institute, BC Children’s Hospital, Vancouver, British Columbia, Canada"
      ],
      "name": "Saleem Razack"
    },
    {
      "affiliations": [
        "Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada",
        "Division of General Internal Medicine, Toronto Western Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Shail Rawal"
    },
    {
      "affiliations": [
        "Sinai Health, Toronto, Ontario, Canada"
      ],
      "name": "Michael Palomo"
    },
    {
      "affiliations": [
        "Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Myrtede Alfred"
    },
    {
      "affiliations": [
        "Centre for Quality Improvement and Patient Safety, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada",
        "Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada",
        "Women’s College Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Marie Pinard"
    },
    {
      "affiliations": [
        "Patient advisory committee member, Toronto, Ontario, Canada"
      ],
      "name": "Andrew Milroy"
    },
    {
      "affiliations": [
        "Patient advisory committee member, Vancouver, British Columbia, Canada"
      ],
      "name": "Carol Pauline Anderson"
    },
    {
      "affiliations": [
        "Patient advisory committee member, Calgary, Alberta, Canada"
      ],
      "name": "Arvin Minocha"
    },
    {
      "affiliations": [
        "Centre for Quality Improvement and Patient Safety, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada",
        "Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada",
        "North York General Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Patricia Trbovich"
    }
  ],
  "title": "Integrating equity into incident reporting and patient concerns systems: a critical interpretive synthesis",
  "uid": "3842ba12-269b-515a-a6f9-cbd9b9354e35"
}