Equity-focused patient safety: reframing cultural competence, cultural humility and structural competence as determinants of patient safety.

Cultural competence and cultural humility have previously been framed as concepts reflecting the knowledge, skills and commitment to self-reflection concerning person-centred healthcare. Emerging evidence has linked cultural misunderstanding, language barriers and implicit bias with diagnostic error, medication mismanagement and inequitable health outcomes for patients. Beyond this, the concept of structural competence has acknowledged how organisational, institutional, social and political structures can shape care and impact patient safety. There has yet to be appreciation of these terms together, integrating them towards a common goal of preventing avoidable harm arising from inequity. In this viewpoint, we argue that, together, cultural competence, cultural humility and structural competence are central to safe, equitable and person-centred care. We propose a new paradigm, equity-focused patient safety, to promote the integration of cultural competence, cultural humility and structural competence to enable healthcare professionals and organisations to proactively anticipate, recognise and mitigate inequitable risks to patient safety across healthcare practice, organisations and systems. We also debate that equity-focused patient safety should be embedded across the undergraduate education, postgraduate training and continuing professional development for healthcare professional groups to position equity as a fundamental determinant of patient safety.