Over the last few months in this space we’ve discussed kindness and the importance of being trustworthy; safety is the third cornerstone of humanistic care.
It may seem odd to position safety under the umbrella of humanism, because in most healthcare settings and structures, patient safety refers almost exclusively to physical harm: medical errors, surgical complications, hospital-acquired infections. We mitigate those risks through such safety protocols as universal precautions, surgical checklists, and alarm systems. These interventions are crucial, but they represent only part of what it means to keep patients truly safe.
We need to think more broadly about safety and include humanistic considerations. Does a patient feel safe raising concerns with their care team without worrying if they will be believed? Does a patient trust that their fears and hopes will be listened to? When a patient feels dismissed by their care team, when communication breaks down between healthcare professionals, when workplace incivility silences staff, or when a patient’s dignity is violated — these are also patient safety issues.
The research featured here tells a progressive story of how healthcare is beginning to recognize this broader conception of safety. Interestingly, most research on the humanism-safety connection is being done outside of the United States. By the end of this Research Roundup, we hope you’ll be convinced that humanism IS safety and consider bringing this focus to your institutions and research teams.
The first article presents research by Dr. Lara Dreismann and colleagues from Switzerland that makes the paradigm-shifting case that psychological harm is not only a byproduct of medical errors or other safety breaches but is a key primary harm in and of itself.
Invisible harm in patient safety: a framework and definition for preventable psychological harm in cancer care. Dreismann, L., Zambrano, S., Pfeiffer, Y., and Schwappach, D. (2025). BMJ Open Quality 14:e003466. Access the Free Article
What: This paradigm-shifting research redefines preventable psychological harm (PPH) to include poor communication, disrespect for autonomy, and privacy violations that harm a patient’s dignity and emotional well-being. Through literature review, expert interviews, and patient workshops, the authors demonstrate that PPH affects patients, families, and healthcare professionals and stems from individual failures, organizational practices, or system-wide pressures.
So What: PPH has direct links to patient safety — patients may refuse life-saving treatment, lose trust in their care team, or develop healthcare-avoidance behaviors. What might be dismissed as “communication issues” or “bedside manner problems” are actually patient safety incidents requiring prevention and response interventions.
Now What: Healthcare leaders must expand safety definitions beyond physical harm, implement measurement systems that capture PPH incidents, and create cultures that recognize dignity violations as serious safety issues requiring investigation and intervention.
One of Dr. Lara Dreismann and colleagues’ “Now What” elements — the need for a reporting tool — is directly addressed in our second article by UK researcher Dr. Abubakar Sha’aban and colleagues.
Coproducing data-driven organizational safety with patients: development and cognitive testing of a multisetting patient-reported safety concern tool. Sha’aban, A., Torrens-Burton, A., Williams, D., Carson-Stevens, A., Edwards, A., Joseph, L., and Joseph-Williams, N. (2025). International Journal for Quality in Health Care. 37(3). Access the Free Article
What: Through focus groups and cognitive testing with 36 participants, the research team co-produced and validated the first Patient Reported Safety Concern Tool designed to capture both physical and emotional harm across healthcare settings. Participants preferred “safety concern” over “incident” or “event” because it felt more inclusive, capturing concerns like disrespectful communication and privacy violations that traditional reporting misses.
So What: Traditional incident reporting focuses on what healthcare professionals identify as problems, missing the patient experience of psychological harm, communication failures, and dignity violations that impact well-being. The tool’s validation process demonstrated that patients want to help improve care, not just complain about it.
Now What: Healthcare organizations should pilot this validated tool as part of routine patient feedback systems, turning abstract “patient engagement in safety” into concrete, measurable action while identifying patterns that existing tools miss.
A common finding in the first two articles is the impact the culture of a clinical care environment can have on how patients perceive safety. This next article by an Australian team led by Benjamin Freedman explores incivility in hospitals and how it critically impacts patient safety.
The prevalence of incivility in hospitals and the effects of incivility on patient safety culture and outcomes: A systematic review and meta-analysis. Freedman, B., Li, W.W., Liang, Z., Hartin, P., Biedermann, N. (Print 2024/Online 2025) Journal of Advanced Nursing. 81:5603-22. Access the Free Article
What: This analysis of 41 studies of over 16,000 healthcare professionals across 12 countries found that 25% experienced workplace incivility and 30% witnessed it. Further, incivility reduces patient safety culture by 41% and is directly associated with adverse events, medical errors, and mortality.
So What: Unkind workplace behavior is not just a “culture” problem — it’s a patient safety crisis. Physicians and supervisors are the most common sources of incivility, while nurses are both frequent targets and perpetrators, creating cycles that damage interprofessional collaboration essential for safe care.
Now What: Healthcare leaders must recognize that civility interventions are essential patient safety measures. Medical educators should teach respectful communications as a core clinical competency. Individual healthcare professionals should address incivility when witnessed, knowing that silence contributes to environments where patients are measurably less safe.
A UK-based study team, led by Dr. Leila Keshtkar, focuses on communication — one of the areas most hard hit by incivility — as important in its own right as a factor in patient safety.
The impacts of Communication Type and Quality on Patient Safety Incidents: A Systematic Review. Keshtkar, L., Bennett-Weston, A., Khan, A.S., Mohan, S., Jones, M., Nockels, K., Gunn, S., Armstrong, N., Bostock, J., and Howick, J. (2025). Annals of Internal Medicine; 178:687-700. Access the Article or the Free Video Summary
What: This systematic review of 46 studies involving 67,826 patients found that poor communication contributes to approximately one quarter of all patient safety incidents and is the sole identified cause of about 1 in 10 incidents. Problems include breakdowns between staff and patients, inadequate documentation, and lack of shared care plans. The research spanned multiple continents and healthcare settings, demonstrating that communication-related safety incidents are a universal healthcare challenge rather than isolated problems.
So What: Communication is not a “soft skill” but a core competency essential for patient safety. When information is communicated “inaccurately, inappropriately, or not at all,” patients suffer measurable harm through delayed care, medication errors, and diagnostic mistakes. Improving healthcare communication could prevent thousands of adverse events annually.
Now What: Healthcare organizations must prioritize communication training with the same rigor as clinical skills, implementing standardized communication tools and structured handoff protocols. Medical and nursing schools should integrate communication competencies throughout curricula. Healthcare systems need robust communication infrastructure including shared electronic health records, standardized documentation practices, and clear protocols for sharing critical patient information across departments and shifts. Individual practitioners should recognize that every patient interaction either enhances or compromises safety through communication quality.
Our last article — and the only one from a U.S.-based team — presents a simple but highly practical and actionable intervention to facilitate communication in in-patient settings.
Whiteboards to Facilitate Hospitalized Patient Communication, Safety, and Education: A Scoping Review. Gregg, A.T., Herzig, S.J., and Nelson, R.E. (2025) Journal of General Internal Medicine 40(6):1411-8. Access the Article
What: This scoping review of 13 studies found that simple bedside whiteboards can meaningfully improve patient communication, with six studies showing significant improvements in provider identification, patient engagement, and patient-provider communication. However, only two studies examined safety applications and two explored educational uses — a significant missed opportunity for this accessible, low-cost intervention.
So What: Simple humanistic interventions have untapped potential. Basic actions like clearly writing care team member names and daily goals can significantly improve patient engagement and understanding. While 95% of patients found whiteboards “helpful,” only 60% knew they could use them for communication, suggesting many humanistic tools fail because we don’t empower patients to use them effectively. The scarcity of research on safety and education applications points to healthcare’s tendency to focus on high-tech solutions while overlooking low-tech opportunities for human connection.
Now What: Healthcare teams should view whiteboards as communication tools requiring intentional use across disciplines. In resource-strained environments, whiteboards exemplify how small humanistic touches can meaningfully impact trust and safety while offering unexplored opportunities for safety and education interventions.
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