Patient safety culture research within the chiropractic profession: a scoping review

A proactive patient safety culture is crucial in healthcare to minimize preventable harm and improve patient outcomes. This scoping review explores key themes, trends, and gaps in patient safety culture research within the chiropractic profession.

A comprehensive literature search was conducted across 5 databases from inception to December 2024. Peer-reviewed, English-language studies focusing on chiropractic patient safety culture were included. Following scoping review methodology, articles were screened, data were extracted, and both qualitative and quantitative analyses were conducted. External consultants from patient safety-focused chiropractic groups were sought to review findings. Trends and themes were identified, and findings were compared against established patient safety frameworks to highlight research gaps and future directions.

Of the 3,039 screened articles, 65 met the inclusion criteria, spanning from 1990 to 2024, with 2 identified as randomized trials. Eight major themes were organized: (1) adverse event research, (2) clinical trial safety reporting, (3) patient safety attitudes, (4) clinical decision making, (5) informed consent, (6) reporting and learning systems, (7) office sanitization, and (8) general safety topics. Mapping these studies onto the Patient Safety Culture Pyramid framework revealed that 95% addressed safety performance, 81% covered safety processes, and only 23% explored beliefs and values. Comparisons with the WHO Global Patient Safety Action Plan framework highlighted advancements in clinical process safety while revealing research gaps in patient engagement, policy development, leadership, and interprofessional collaboration. Key recommendations include standardizing adverse event reporting, improving communication strategies, and developing structured approaches to patient and provider safety. External consultation provided minimal feedback requiring modifications.

This review underscores significant advancements and gaps in chiropractic patient safety culture research, particularly in leadership, policy, and interprofessional engagement. Future research should focus on implementing and evaluating evidence-based safety interventions to enhance transparency, improve patient outcomes, and build public trust in chiropractic care. Direct stakeholder engagement, including with patients, is necessary to determine the most effective strategies for integrating patient safety within the global chiropractic profession.