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Equity Belongs on the Patient Safety Agenda
Equity Belongs on the Patient Safety Agenda
Ololade “Lo” Mitchell
Hospital leaders often review patient safety through aggregate data. Those dashboards may suggest stable performance, but a different story can emerge when outcomes are stratified by race, language, disability, payer, or other patient characteristics (Figueroa et al., 2024; NCQA, 2024). If leaders are serious about identifying harm and strengthening safety culture, equity cannot remain a separate conversation. It belongs at the center of patient safety oversight (Van Dyke, 2020).
Too often, safety and equity are handled in separate organizational lanes. Safety discussions focus on event counts, infections, readmissions, or falls, while equity is discussed elsewhere as a strategic or cultural priority. But disparities in communication failures, delayed diagnoses, barriers to access, and uneven care experiences are not just equity issues. They are patient safety issues with operational, legal, and reputational implications (Figueroa et al., 2024).
That is why risk and patient safety teams should press leaders to ask a more important question: not simply whether overall performance is improving, but whether harm is being experienced differently across patient groups. Without that lens, leadership may be making decisions based on incomplete evidence (American College of Healthcare Executives [ACHE], 2025; Parand et al., 2014).
What Leaders Are Missing
Many organizations still rely on topline safety measures. Those measures matter, but they can hide meaningful variation across patient populations. Stratified reporting can reveal risks that remain invisible in summary dashboards (Figueroa et al., 2024; NCQA, 2024). The issue is not whether an organization has a separate diversity, equity, and inclusion strategy. The issue is whether its patient safety oversight is strong enough to detect patterns of harm that disproportionately affect certain groups (Figueroa et al., 2024).
What Leaders Should Do
The first step is practical, requiring a focused set of core safety and quality indicators to be reviewed through an equity lens. Organizations do not need to stratify everything at once. They can start with a manageable set of measures such as falls with harm, serious safety events, readmissions, grievances, or selected diagnostic and communication-related events (Figueroa et al., 2024; NCQA, 2024).
Once those data are visible, leadership oversight becomes more meaningful. The question is no longer only whether performance is improving overall, but whether improvement is reaching the patients at greatest risk of harm. That is a stronger standard for governance and accountability (ACHE, 2023; Van Dyke, 2020).
What Risk and Safety Teams Can Change Now
Risk and safety teams can start by changing how events are reviewed. Root cause analyses, event investigations, and claims reviews should routinely consider whether language barriers, health literacy, disability access, bias, digital access, transportation challenges, or assumptions about the patient contributed to harm (National Center for Biotechnology Information [NCBI], 2023; Figueroa et al., 2024). This is not a separate body of work; it is a more complete way to evaluate risk.
When equity-related contributory factors are documented, patterns can be escalated rather than dismissed as isolated events. Recurring themes may reveal structural risks that deserve executive attention and operational redesign (Figueroa et al., 2024).
Leaders can reinforce this work structurally by making equity part of routine safety oversight. If quality committees, safety councils, and executive dashboards do not ask equity-focused questions, the issue is unlikely to receive sustained strategic attention (Harvard Law School Forum on Corporate Governance, 2021; Van Dyke, 2020).
The Bottom Line
For hospital leaders, the goal is not to add another initiative to an already crowded agenda. It is to make the existing safety agenda more accurate. Equity is not separate from patient safety work; it is part of identifying risk, understanding harm, and governing improvement effectively (ACHE, 2025).
If safety data are not examined through an equity lens, important risks will remain hidden in plain sight (ACHE, 2023; Van Dyke, 2020). For organizations that claim to be committed to safer care, that should no longer be acceptable.
References
American College of Healthcare Executives. (2023). Prioritizing safety remains job no. 1. Healthcare Executive. https://www.healthcareexecutive.org/archives/march-april-2023/prioritizing-safety-remains-job-no-1
American College of Healthcare Executives. (2025). ACHE code of ethics. https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics
Figueroa, J. F., Frakt, A. B., Chatterjee, P., et al. (2024). Disparity dashboards: An evaluation of the literature and framework. https://pmc.ncbi.nlm.nih.gov/articles/PMC10639125/
Harvard Law School Forum on Corporate Governance. (2021, July 21). Board's oversight of racial DE&I. https://corpgov.law.harvard.edu/2021/07/22/boards-oversight-of-racial-dei/
National Center for Biotechnology Information. (2023, August 22). Risk management event evaluation and responsibilities. NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK559326/
NCQA. (2024, April 8). Stratifying HEDIS measures by race & ethnicity. LinkedIn. https://www.linkedin.com/pulse/stratifying-hedis-measures-race-ethnicity-ncqa-ojwxc
Parand, A., Dopson, S., Renz, A., & Vincent, C. (2014). The role of hospital managers in quality and patient safety. https://pmc.ncbi.nlm.nih.gov/articles/PMC4158193/
Van Dyke, M. (2020). Engaging the board in patient safety goals. Healthcare Executive. https://www.healthcareexecutive.org/archives/march-april-2020/engaging-the-board-in-patient-safety-goals
Leadership Equity Through a Full Lens
Healthcare systems are navigating a period defined by workforce shortages, clinician burnout, and shifting patient expectations. In cities like Chicago, these challenges are compounded by long-standing inequities in both health outcomes and leadership representation. Conventional leadership models, prioritizing productivity, financial outcomes, and operational control have proven insufficient in addressing these layered challenges. Emerging evidence suggests that leadership approaches grounded in relational trust, psychological safety, and workforce well-being are more effective in sustaining high-performing systems. The Care: Full Leadership Theory offers a redefinition: leadership not as authority or efficiency alone, but as the intentional practice of care, toward people, systems, and outcomes. Within this framework, equity becomes inseparable from leadership itself, as inequitable systems are often sustained by leadership models that fail to center human experience.
Theoretical Foundation: Care as Leadership Currency
At the core of Care: Full Leadership is a fundamental shift: care is the currency through which trust, engagement, and sustainable excellence are built. Leadership effectiveness is therefore measured not only by outcomes, but by the conditions created for people to thrive. This framework is operationalized through three interdependent precepts:
1. Compassion as Strategy
Compassion is reframed as a strategic lever rather than a peripheral value. Leaders embed empathy into decision-making, recognizing that workforce engagement and patient experience are directly tied to leadership behavior.
2. Human-Centered Decision-Making
Policies and operational decisions are evaluated based on their impact on people: clinicians, staff, patients, and communities, rather than efficiency alone.
3. Healing the Healers
Leadership accountability extends to the well-being of the workforce. Addressing burnout, moral injury, and psychological safety becomes central to organizational sustainability.
Leadership Equity Through a Care: Full Lens
Reframing Equity in Leadership
Leadership equity has traditionally been measured through representation. While representation remains critical, recent literature emphasizes that equity must also encompass access to influence, decision-making authority, and supportive environments. According to Adesina et al. (2025), inequities in leadership are sustained not only by structural barriers but also by organizational cultures that marginalize certain voices and experiences. These dynamics are intensified for individuals navigating intersecting identities. The Care: Full Leadership framework expands this understanding by asserting that inequity persists where care is unevenly distributed.
Compassion as Strategy: Addressing Inequitable Leadership Pathways
Traditional advancement pathways in healthcare leadership often rely on informal networks, sponsorship, and subjective evaluations mechanisms that can perpetuate inequity. Positioning compassion as strategy requires leaders to:
- Recognize and mitigate bias in promotion and evaluation processes
- Ensure equitable access to mentorship and sponsorship
- Evaluate leadership potential through inclusive and holistic criteria
Organizations incorporating structured, bias-aware leadership development processes can improve advancement outcomes for underrepresented groups. Compassion, in this context, is not passive; it is an active, strategic commitment to fairness, recognition, and opportunity.
Human-Centered Decision-Making: Redesigning Leadership Systems
Healthcare organizations frequently prioritize throughput, compliance, and cost containment, often at the expense of workforce experience. This dynamic disproportionately affects individuals in roles with less organizational power. Human-centered decision-making shifts this paradigm by:
- Integrating frontline perspectives into executive decisions
- Designing policies that account for differential impact across roles and identities
- Aligning operational goals with workforce well-being and patient dignity
Hill et al. (2025), found that leadership models incorporating participatory decision-making were associated with improved retention and engagement, particularly among historically marginalized groups.
In healthcare systems, where workforce diversity is high but leadership diversity remains limited, this approach offers a pathway to more equitable leadership ecosystems.
Healing the Healers: Equity in Workforce Experience
Burnout and moral injury are not experienced uniformly across the workforce. Dzau et al. (2020) highlights that clinicians from underrepresented backgrounds often face additional stressors, including discrimination, isolation, and limited advancement opportunities. The “healing the healers” precept addresses these disparities by positioning workforce well-being as a leadership responsibility. Operationalizing this principle includes:
- Establishing psychologically safe environments where all staff can speak without fear
- Implementing structured peer support and debriefing practices
- Aligning incentives to reward supportive and inclusive leadership behaviors
Importantly, healing is both an individual and systemic process. Without addressing the organizational conditions that drive burnout, individual resilience efforts remain insufficient.
Implications for Executive Leadership
The integration of Care: Full Leadership into executive practice has several implications:
1. Redefining Leadership Metrics
Organizations must expand performance metrics to include:
- Workforce well-being and engagement
- Psychological safety
- Equity in advancement and leadership experience
2. Embedding Care into Governance
Boards and executive teams should:
- Hold leaders accountable for workforce outcomes
- Integrate care-based metrics into strategic planning
- Ensure transparency in leadership pathways
3. Aligning Incentives with Care
Compensation and recognition structures should reward:
- Compassionate leadership behaviors
- Team development and mentorship
- Contributions to equitable workplace environments
4. Scaling Human-Centered Systems
Leaders must redesign systems to ensure that care is embedded in:
- Decision-making processes
- Organizational culture
- Leadership development pipelines
The future of healthcare leadership depends on the ability to integrate equity with organizational strategy. The Care: Full Leadership Theory offers a necessary evolution, positioning care as the central currency through which trust, engagement, and sustainable performance are achieved. Advancing leadership equity requires more than increasing representation; it demands a reconfiguration of how leadership is defined, practiced, and evaluated. By embedding compassion as strategy, prioritizing human-centered decision-making, and committing to healing the healers, healthcare organizations can build leadership systems that are not only more equitable, but more effective. In this model, care is not an adjunct to leadership, it is its foundation.
Author: Jamia Thomas, MSN, NE-BC
References
Adesina, I., Joham, A. E., Hamad, N., Pincha Baduge, M. S. S., Garth, B., Nguyen, T. V., & Boyle, J. (2025). Intersectionality in healthcare leadership: A scoping review on the career experiences of racially and ethnically minoritized women health professionals. International Journal for Equity in Health, 24(1), 245.
Dzau, V. J., Kirch, D., & Nasca, T. (2020). Preventing a parallel pandemic: A national strategy to protect clinicians well-being. New England Journal of Medicine, 383(6), 513-515.
Hill, K. A., Austin, A. W., & Enders, F. T. (2025). Workforce interventions to improve representation in U.S. healthcare leadership. SAGE Journals, 12, 1-17. https://doi.org/10.1177/23821205251333034
