Blind Spots in Safety: A Qualitative Document Review of Incident Analysis Frameworks-Implications and Practice...

Although incident analysis frameworks guide the investigation of safety events and foster organizational learning, few studies have evaluated the extent to which they incorporate social factors [Diversity, Equity, Inclusion, and Belonging (DEIB)] and Just Culture principles. A qualitative document analysis was used to evaluate 6 healthcare incident analysis frameworks published between 2012 and 2025 (M=2019.7, SD = 4.61). Frameworks were evaluated using a purpose-built JUST-DEIB Assessment Integration Tool (J-DAIT) against 10 predefined criteria. The analysis used both thematic and descriptive approaches. Findings revealed recurring inconsistencies in how DEIB and Just Culture principles were operationalized across frameworks. Only 2 of the 6 frameworks explicitly addressed cultural safety and health equity, while attention to culturally responsive practice, structural inequities, and the inclusion of marginalized groups was limited. While the frameworks demonstrated strengths in supporting system-level learning, the majority often fail to fully embed equity, psychological safety, and culturally responsive practices. Incident analysis frameworks must explicitly integrate cultural safety and health equity; strengthen mechanisms for meaningful engagement of patients, families, and other service users as active partners; prioritize the inclusion of racialized and historically marginalized populations; and incorporate structured processes for recognizing and mitigating cognitive and systemic bias. Including these factors results in more equitable safety outcomes, since certain groups experience a higher incidence of recurrent and unrecognized harm.