Cover: Identifying and Understanding Ways to Address the Impact of Racism on Patient Safety in Health Care Settings

Identifying and Understanding Ways to Address the Impact of Racism on Patient Safety in Health Care Settings

Published Aug 8, 2022

by Lucy B. Schulson, Angela D. Thomas, Jeannette Tsuei, Jason Michel Etchegaray

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Research Questions

  1. What role does racism play in the occurrence of patient safety events among minoritized patients?
  2. What factors affect reporting of patient safety events, particularly in minoritized patient populations?
  3. What health system characteristics promote patient safety in minoritized patient populations and empower health care team members to speak up about unsafe care impacting minoritized patients?

RAND Corporation and MedStar researchers examined the intersection of patient safety and racism, focusing on patient safety and health equity from clinician leaders' perspectives. An overarching emphasis of the work concerned the impact of racism and other related factors (i.e., bias) on patient safety events and potential interventions or changes (such as creating a culture of speaking up about racism in care) that can help prevent such events.

The authors conducted an environmental scan of peer-reviewed studies and gray literature to understand established linkages between patient safety events and racism. They also interviewed 14 subject-matter experts (clinicians with patient safety and/or health equity expertise) to understand their perspectives on factors that contribute to patient safety events, factors that influence formal and informal reporting of such events, and the impact of racism on patient safety events. Recommendations are to implement an equity approach to patient safety data collection, improve the user experience in formal reporting systems, and create a culture for speaking up on racism in patient safety.

Key Findings

  • The environmental scan revealed that while patient safety events, overall, were characterized by racial and ethnic disparities, methodological challenges—primarily related to data availability—limited in-depth analysis of this finding.
  • The environmental scan also indicated that racism and its impact on patient safety events was more often discussed in editorials than in peer-reviewed and gray literature.
  • Subject-matter expert interviews indicated that various levels of racism ranging from internalized and interpersonal to institutional and systemic directly impact the risk of patient safety events and highlighted the interplay between racism and social determinants of health.
  • The authors also identified patient, provider, and systems factors that contribute to disparities in patient safety events.


  • Health systems should collect patient safety data with equity in mind so that these systems can analyze patient safety events by sociodemographic factors and look for disparities in these events.
  • Health systems and patient safety reporting vendors must develop more-efficient and user-friendly formal reporting systems so that health care providers are more likely to report patient safety events.
  • Health care as an industry and medicine as a discipline need to create a culture of speaking up that prevents patient safety events caused by racism from happening.
  • Health insurance reform is needed to address some of the underlying drivers of disparities in patient safety events.

Research conducted by

This research was funded by the California Health Care Foundation and carried out within the Quality Measurement and Improvement Program in RAND Health Care.

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