A Systems-Based Framework for Integrating Health Equity and Patient Safety

Research is needed to better understand inequities in patient safety, to develop interventions to improve safety and equity together, and to measure the efficacy of such interventions. Although measures of disparities in health outcomes, health care access, and quality of care are common, patient safety equity measurement remains underdeveloped. For example, disparities have often been documented in chronic diseases or access to preventive care but are less frequently studied for adverse drug events or postoperative complications. Patients of minority backgrounds experience higher rates of preventable harm-Black patients face increased risk of hospital-acquired infections and medication errors compared to white patients, yet most health systems lack specific tools to systematically measure and address these safety disparities. Based on a literature review and expert panel conducted between January 2023 and December 2023, the authors identified health system-level measures of equity in patient safety and present a preliminary maturity framework for health systems working toward equity in patient safety. This review found several tools for measuring health disparities and health equity more broadly, but few are specifically designed to evaluate equity in patient safety events and processes. To address this critical gap, the authors leveraged feedback from a panel of eight subject matter experts to develop a preliminary framework designed to support health systems in assessing their maturity levels and integrating equity in patient safety in a stepwise manner. The framework consists of three maturity levels (fundamental, intermediate, advanced) and six domains: (1) data collection and training, (2) data validation, (3) data stratification and analysis, (4) communicating findings, (5) addressing and resolving equity gaps in patient safety, and (6) organizational infrastructure and culture.