{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T19:17:10Z","timestamp":1789586230078,"version":"build-2803163510"},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Expectations"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patient safety incidents cause substantial harm globally, with affected patients and families often experiencing additional \u2018compounded harm\u2019 from inadequate organisational responses. Despite policy imperatives emphasising engagement as essential for safety improvement, significant gaps persist in the National Health Service (NHS), where involvement in Serious Incident (SI) investigations is often overlooked or treated as a p2assive process. While previous qualitative research has primarily used thematic analysis, discourse analytic approaches can offer deeper insights into nuanced patterns of meaning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design\/Objective<\/jats:title>\n                    <jats:p>We conducted discourse analysis on 49 semi\u2010structured interviews with healthcare professionals across six NHS Trusts to examine how staff construct agency in their accounts of engaging patients and families in SI investigations and how these discourses are linked to the broader organisational context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Findings illustrate two prevailing but contested discourses: one depicting staff engagement with patients and families as inconsistent and limited, and the other emphasising their integral role in the investigation process. Interviewees framed themselves as either powerless or powerful, aligning with these respective discourses, while organisational factors, such as professional roles and work relationships, also influenced those constructions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>A focus on the linguistic construction of agency, control and responsibility provides a powerful lens for understanding persistent gaps in patient and family engagement and highlights the value of incorporating discourse analytic approaches into health policy development and implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>\n                      A Citizens' Panel (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200916) was involved throughout the broader research programme, ensuring public accountability; supporting wider discussions about the emergent findings of the research and their implications for fairness, equality, diversity and inclusion; and supporting the dissemination of findings in creative and accessible ways.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hex.70743","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T06:14:19Z","timestamp":1782972859000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Powerless or Powerful? Healthcare Professionals' Construction of Agency in Patient and Family Engagement Accounts"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2071-7303","authenticated-orcid":false,"given":"Polina","family":"Mesinioti","sequence":"first","affiliation":[{"name":"Department of Health Sciences University of York York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Sheard","sequence":"additional","affiliation":[{"name":"School of Health Sciences University of Manchester Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Hampton","sequence":"additional","affiliation":[{"name":"University College London (UCL) London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6946-3693","authenticated-orcid":false,"given":"Gemma","family":"Louch","sequence":"additional","affiliation":[{"name":"School of Healthcare University of Leeds Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl","family":"Macrae","sequence":"additional","affiliation":[{"name":"Nottingham University Business School University of Nottingham Nottingham UK"},{"name":"The Healthcare Improvement Studies (THIS) Institute University of Cambridge Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"O'Hara","sequence":"additional","affiliation":[{"name":"The Healthcare Improvement Studies (THIS) Institute University of Cambridge Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"World Health Organization 2023 Patient Safety accessed May 1 2024 https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/patient-safety."},{"key":"e_1_2_12_3_1","unstructured":"NHS England 2022a Using Patient Safety Events Data to Keep Patients Safe accessed March 24 2024 https:\/\/www.england.nhs.uk\/patient-safety\/patient-safety-insight\/learning-from-patient-safety-events\/using-patient-safety-events-data-to-keep-patients-safe\/."},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/hex.13478"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2017-006974"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/PTS.0000000000001054"},{"key":"e_1_2_12_7_1","unstructured":"National Patient Safety Agency 2009 Being Open: Communicating Patient Safety Incidents With Patients Their Families and Their Carers. National Patient Safety Agency."},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-024-11626-4"},{"key":"e_1_2_12_9_1","unstructured":"NHS England 2015 Serious Incident Framework: Supporting Learning to Prevent Recurrence accessed March 26 2025 https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2015\/04\/serious-incidnt-framwrk-upd.pdf."},{"key":"e_1_2_12_10_1","unstructured":"NHS England 2022b Patient Safety Incident Response Framework accessed February 26 2025 https:\/\/www.england.nhs.uk\/long-read\/patient-safety-incident-response-framework\/."},{"key":"e_1_2_12_11_1","unstructured":"CQC 2016 Briefing: Learning From Serious Incidents in NHS Acute Hospitals accessed January 19 2025 https:\/\/www.cqc.org.uk\/sites\/default\/files\/20160608_learning_from_harm_briefing_paper.pdf."},{"key":"e_1_2_12_12_1","unstructured":"HCI Care 2021 The Healthcare System: Will We Ever Learn? Review of the Common Themes Arising From UK and Ireland Healthcare Inquiries accessed April 1 2025 https:\/\/hci.care\/wp-content\/uploads\/HCI-Research-Paper.pdf."},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.3389\/frhs.2025.1520816"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssci.2025.106999"},{"key":"e_1_2_12_15_1","doi-asserted-by":"crossref","unstructured":"G.Gumperz \u201cInteractional Sociolinguistics\u2014A Personal Perspective \u201d inThe Handbook of Discourse Analysis ed. D. Tannen H. Hamilton and D. Schiffrin 2nd ed. (John Wiley & Sons 2015) 309\u2013323.","DOI":"10.1002\/9781118584194.ch14"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.5334\/ijic.6446"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-088201"},{"key":"e_1_2_12_18_1","unstructured":"T.Tsindos.2023. \u201cChapter 23: Discourse Analysis\u201d inQualitative Research: A Practical Guide for Health and Social Care Researchers and Practitioners edited D. Ayton T. Tsindos and D. Berkovic (Monash University Library 2023): 203\u2013210."},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.4324\/9780203697078"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.edurev.2013.05.001"},{"key":"e_1_2_12_21_1","unstructured":"A.Giddens.1986. The Constitution of Society: Outline of the Theory of Structuration. Polity Press."},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.2196\/50388"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/14705958231216936"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1177\/13674935231196197"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2017.02.005"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/nin.12571"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1080\/13645579.2020.1766757"}],"container-title":["Health Expectations"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hex.70743","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/hex.70743","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/hex.70743","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T02:14:29Z","timestamp":1787796869000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/hex.70743"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":26,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1111\/hex.70743"],"URL":"https:\/\/doi.org\/10.1111\/hex.70743","archive":["Portico"],"relation":{},"ISSN":["1369-6513","1369-7625"],"issn-type":[{"value":"1369-6513","type":"print"},{"value":"1369-7625","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,1]]},"assertion":[{"value":"2026-01-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70743"}}