Background While substantive efforts have been made to improve the safety of hospital care, these have largely targeted the healthcare professional. Such a focus ignores the patient’s ‘voice’, and the unique insights patients and their families have into healthcare system functioning. Despite international policy shifts toward empowering patients to support patient safety, there remains a lack of knowledge regarding the full range of existing approaches for facilitating patient involvement in measuring and monitoring patient safety (MMS) in the hospital. This umbrella review will aim to identify existing approaches to involving adult inpatients (or family/partners/carers communicating on their behalf ) in MMS in hospital settings, along with evidence supporting their use. Methods The current review will adhere to the Joanna Briggs Institute guidance for umbrella reviews and the Preferred Reporting Items for Overviews of Reviews (PRIOR) checklist. Systematic searches will be conducted across five electronic databases (MEDLINE, CINAHL, PsycINFO, Scopus, and Academic Search Complete) to identify existing reviews that examine patient-involvement in MMS in hospital settings. Data will be extracted on the characteristics of approaches identified (e.g., surveys, interviews, incident reporting) along with any evidence of their feasibility, contextual appropriateness and psychometric properties. Methodological quality will be appraised using the CASP checklist, and certainty of evidence will be assessed via a hybrid GRADE and GRADE-CERQual approach. Conclusions This umbrella review will deliver a comprehensive profile of each different approach to involving patients, families and carers in MMS in hospital settings. By evaluating the psychometric evidence and practical feasibility (affordability, equity, and acceptability) of these approaches, the findings will support the ascertainment of best practice to involving patients in MMS in hospital settings, ultimately supporting an important shift in the framing of patients as passive recipients of care to active partners in safe and effective care delivery.

Background Internationally, there is a growing emphasis on the importance and value of the patient’s “voice”, and the unique insights patients and their families have into healthcare system functioning. However, despite international policy shifts toward empowering patients to support patient safety, there remains a lack of knowledge regarding the full range of existing approaches for facilitating patient involvement in measuring and monitoring patient safety (MMS) in the hospital. This umbrella review will aim to identify existing approaches to involving adult inpatients (or family/partners/carers communicating on their behalf ) in MMS in hospital settings, along with evidence supporting their use. Methods The current review will adhere to the Joanna Briggs Institute guidance for umbrella reviews and the Preferred Reporting Items for Overviews of Reviews (PRIOR) checklist. Systematic searches will be conducted across five electronic databases (MEDLINE, CINAHL, PsycINFO, Scopus, and Academic Search Complete) to identify existing reviews that consider patient-involvement in MMS in hospital settings. Data will be extracted on the characteristics of approaches identified (e.g., surveys, interviews, incident reporting) any evidence of their feasibility, contextual appropriateness and psychometric properties, along with any reported barriers or facilitators relating to their implementation. Methodological quality will be appraised using the CASP checklist, and certainty of evidence will be assessed via a hybrid GRADE and GRADE-CERQual approach. Conclusions This umbrella review will deliver a comprehensive profile of each different approach to involving patients, families and carers in MMS in hospital settings. By evaluating the psychometric evidence and practical feasibility (APEASE criteria and reported barriers and facilitators to use) of these approaches, the findings will support the ascertainment of best practice to involving patients in MMS in hospital settings, ultimately reflecting the important shift in the historical framing of patients as passive recipients of care to active partners in safe and effective care delivery.

Objective To examine socioeconomic and demographic differences in who complains about healthcare and whether these factors are associated with the outcomes of complaint cases. Design Nationwide cross-sectional study in Denmark using linked national health, complaint and administrative registers. Setting The Danish healthcare system provides universal coverage and has a centralised system for handling complaints with linked patient-level data to sociodemographic variables. Participants All healthcare contacts in 2022 in general practice (GP), non-psychiatric hospitals and psychiatric hospitals were included. Primary and secondary outcome measures We examined two outcomes: (1) submission of a complaint and (2) whether the authorities upheld the complaint. We then assessed how these outcomes varied by socioeconomic position (SEP), focusing on the contrast between patients with the lowest and highest SEP profiles. Relative risks (RRs) were estimated using modified Poisson regression with cluster-robust variance estimation at the patient level. Results There were 31.9 million GP contacts, 4.8 million non-psychiatric hospital contacts and 345 000 psychiatric contacts, with 1381, 3545 and 439 complaints, respectively (0.43–12.7 per 10 000 contacts). Clear socioeconomic disparities emerged. Low-income patients were more likely to complain about GP and non-psychiatric hospitals, while higher education was associated with fewer complaints in these settings but more complaints about psychiatry. Patients outside the workforce were more likely to complain, whereas elderly patients were consistently underrepresented in the complaints. Low-SEP profiles had notably higher complaint probabilities than high-SEP profiles in GP (RR 2.60, 95% CI 2.22 to 3.70) and non-psychiatric hospitals (RR 1.69, 95% CI 1.40 to 1.98), but not in psychiatric hospitals (RR 0.93, 95% CI 0.47 to 1.38). Although individual SEP indicators showed no consistent differences in complaint outcomes, the combined SEP profiles revealed lower probabilities for complaints being upheld in lower SEP patients in GP (RR 0.58, 95% CI 0.22 to 0.94) and non-psychiatric hospitals (RR 0.70, 95% CI 0.43 to 0.96), while the estimate for psychiatric hospitals was inconclusive (RR 0.71, 95% CI 0.24 to 1.66). Conclusions In this nationwide study, socioeconomic and demographic factors were linked to clear differences in both complaint submission and complaint outcomes. Except for psychiatric hospital services, patients with fewer socioeconomic resources were more likely to file a complaint yet had a lower probability of having it upheld. These findings point to disparities in who complains and in how complaints are assessed, and they underline the need to consider all complaints, regardless of outcome, when using complaint data to inform quality improvement efforts.

Background Internationally, there is a growing emphasis on the importance and value of the patient’s “voice”, and the unique insights patients and their families have into healthcare system functioning. However, despite international policy shifts toward empowering patients to support patient safety, there remains a lack of knowledge regarding the full range of existing approaches for facilitating patient involvement in measuring and monitoring patient safety (MMS) in the hospital. This umbrella review will aim to identify existing approaches to involving adult inpatients (or family/partners/carers communicating on their behalf ) in MMS in hospital settings, along with evidence supporting their use. Methods The current review will adhere to the Joanna Briggs Institute guidance for umbrella reviews and the Preferred Reporting Items for Overviews of Reviews (PRIOR) checklist. Systematic searches will be conducted across five electronic databases (MEDLINE, CINAHL, PsycINFO, Scopus, and Academic Search Complete) to identify existing reviews that consider patient-involvement in MMS in hospital settings. Data will be extracted on the characteristics of approaches identified (e.g., surveys, interviews, incident reporting) any evidence of their feasibility, contextual appropriateness and psychometric properties, along with any reported barriers or facilitators relating to their implementation. Methodological quality will be appraised using the CASP checklist, and certainty of evidence will be assessed via a hybrid GRADE and GRADE-CERQual approach. Conclusions This umbrella review will deliver a comprehensive profile of each different approach to involving patients, families and carers in MMS in hospital settings. By evaluating the psychometric evidence and practical feasibility (APEASE criteria and reported barriers and facilitators to use) of these approaches, the findings will support the ascertainment of best practice to involving patients in MMS in hospital settings, ultimately reflecting the important shift in the historical framing of patients as passive recipients of care to active partners in safe and effective care delivery.

Safety listening-responses to voice acts aimed at preventing harm-can avert organizational failures like airplane crashes. Research often focuses on attitudes and perceptions of listening using self-report measures; consequently, little is known about how safety listening occurs behaviorally and influences safety outcomes in high-risk situations. Using directed and summative content analysis, we analyzed 45 transcripts of flightdeck communication before crashes and near misses to develop a framework of safety listening behavior in risky contexts. We also used abductive top-down theorizing to identify the processes through which such behaviors prevent harm. We propose that effective safety listening behaviors engage with voice through action and sensemaking, whereas ineffective listening behaviors dismiss or exhibit token engagement with speaking-up. Our analysis illustrates that engaging with voice enables teams to develop shared and accurate situation awareness of emerging risks, thus potentially averting accidents. Our findings demonstrate the importance of a behavioral approach to safety listening, illustrating that assessing listener engagement with safety voice-rather than attitudes-can provide an accurate and practical explanation for how safety listening influences organizational safety outcomes.

IntroductionSafety communication is crucial for accident aversion across industries. While researchers often focus on encouraging concern-raising (‘safety voice’), responses to these concerns (‘safety listening’) remain underexplored. Existing studies primarily use self-report measures; however, these tend to focus on perceptions of listening rather than behaviors. To fully understand and examine how safety listening is enacted and influential in safety-critical environments, a tool for reliably assessing naturalistic safety listening behaviors in high-risk settings is required. Accordingly, we developed and tested the Ecological Assessment of Responses to Speaking-up (EARS) tool to code safety listening behaviors in flightdeck conversations.MethodsThere were three analysis phases: (1) developing the taxonomy through a qualitative content analysis (n = 45 transcripts); (2) evaluating interrater reliability and coder feedback (n = 40 transcripts); and (3) testing the taxonomy’s interrater reliability in a larger unseen dataset (n = 110 transcripts) and with an additional coder (n = 50 transcripts).ResultsContrary to the notion that effective listening is agreement, our findings emphasize engagement with safety voice, including reasonable disagreement. The final taxonomy identifies six safety listening behaviors: action (implementing, declining), sensemaking (questioning, elaborating), and non-engagement (dismissing, token listening) and two additional voice acts (escalating, amplifying). EARS achieved substantial interrater reliability (Krippendorff’s alpha of 0.73 to 0.77 and Gwet’s ACT1 of 0.80 to 0.87).DiscussionThe EARS tool allows researchers to assess safety listening in naturalistic conversations, facilitating analysis of its antecedents, its interplay with safety voice, and the impact of interventions on outcomes.

Defensiveness is often implicated in systemic organisational failures to explain why early warning signs were ignored and organisational resilience was compromised. But how does an organisation become defensive? We propose that defensiveness can arise as a response to contradictory work demands. Our research focuses on UK hospital staff tasked with responding to criticism online (herein complaint handlers). We examine these responses to criticism using a mixed methods explanatory sequential design. Six defensive tactics were reliably identified: redirecting patients to other channels, evading issues, psychologising concerns, invalidating concerns as incomplete, closing the feedback episode, and individualising concerns with bespoke workarounds. These defensive tactics were generally associated with less organisational learning and were sometimes viewed as unhelpful. To explain these results, we introduce the complaint handler's bind: staff are tasked with responding to complaints without a viable pathway for organisational learning and an implicit injunction against voicing this dilemma. This demand-control double bind unwittingly gives staff little alternative but to be defensive. Future research, we conclude, needs to conceptualise defensiveness as sometimes a symptom rather than a cause of problems in organisational learning.

Large language models (LLMs) are being used to classify texts into categories informed by psychological theory (“psychological text classification”). However, the use of LLMs in psychological text classification requires validation, and it remains unclear exactly how psychologists should prompt and validate LLMs for this purpose. To address this gap, we examined the potential of using LLMs for psychological text classification, focusing on ways to ensure validity. We employed OpenAI's GPT-4o to classify (1) reported speech in online diaries, (2) other-initiations of conversational repair in Reddit dialogues, and (3) harm reported in healthcare complaints submitted to NHS hospitals and trusts. Employing a two-stage methodology, we developed and tested the validity of the prompts used to instruct GPT-4o using manually labeled data (N = 1,500 for each task). First, we iteratively developed three types of prompts using one-third of each manually coded dataset, examining their semantic validity, exploratory predictive validity, and content validity. Second, we performed a confirmatory predictive validity test on the final prompts using the remaining two-thirds of each dataset. Our findings contribute to the literature by demonstrating that LLMs can serve as valid coders of psychological phenomena in text, on the condition that researchers work with the LLM to secure semantic, predictive, and content validity. They also demonstrate the potential of using LLMs in rapid and cost-effective iterations over big qualitative datasets, enabling psychologists to explore and iteratively refine their concepts and operationalizations during manual coding and classifier development. Accordingly, as a secondary contribution, we demonstrate that LLMs enable an intellectual partnership with the researcher, defined by a synergistic and recursive text classification process where the LLM's generative nature facilitates validity checks. We argue that using LLMs for psychological text classification may signify a paradigm shift toward a novel, iterative approach that may improve the validity of psychological concepts and operationalizations.

Failures of listening to individuals raising concerns are often implicated in safety incidents. To better understand this and theorize the communicative processes by which safety voice averts harm, we undertook a conceptual review of “safety listening” in organizations: responses to any voice that calls for action to prevent harm. Synthesizing research from disparate fields, we found 36 terms/definitions describing safety listening which typically framed it in terms of listeners’ motivations. These motivational accounts, we propose, are a by-product of the self-report methods used to study listening (e.g., surveys, interviews), which focus on listening perceptions rather than actual responses following speaking-up. In contrast, we define safety listening as a behavioral response to safety voice in organizational contexts to prevent harms. Influenced by cognitive, interactional, and environmental factors, safety listening may prevent incidents through enabling cooperative sensemaking processes for building shared awareness and understanding of risks and hazards.