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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.<\/jats:p>","DOI":"10.1136\/bmjqs-2026-020554","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T14:30:30Z","timestamp":1789137030000},"page":"bmjqs-2026-020554","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Equity-focused patient safety: reframing cultural competence, cultural humility and structural competence as determinants of patient safety"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9523-4760","authenticated-orcid":false,"given":"Anna","family":"Robinson-Barella","sequence":"first","affiliation":[{"name":"School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK"},{"name":"Newcastle NIHR Patient Safety Research Collaboration (PSRC), Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiranmayi","family":"Madabhushi Hari","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayleigh","family":"Davison","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK"},{"name":"Newcastle NIHR Patient Safety Research Collaboration (PSRC), Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5915-2429","authenticated-orcid":false,"given":"Matthew","family":"Cooper","sequence":"additional","affiliation":[{"name":"Newcastle NIHR Patient Safety Research Collaboration (PSRC), Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evgenia","family":"Stepanova","sequence":"additional","affiliation":[{"name":"Newcastle NIHR Patient Safety Research Collaboration (PSRC), Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8162-8278","authenticated-orcid":false,"given":"Andrew Kenneth","family":"Husband","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK"},{"name":"Newcastle NIHR Patient Safety Research Collaboration (PSRC), Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3168-5386","authenticated-orcid":false,"given":"Hamde","family":"Nazar","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK"},{"name":"Newcastle NIHR Patient Safety Research Collaboration (PSRC), Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"2026091107302230000_bmjqs-2026-020554v1.1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.13-0634"},{"key":"2026091107302230000_bmjqs-2026-020554v1.2","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0252750","article-title":"Attitudes, beliefs and behaviors of religiosity, spirituality, and cultural competence in the medical profession: A cross-sectional survey study","volume":"16","author":"Dillard","year":"2021","journal-title":"PLoS One"},{"key":"2026091107302230000_bmjqs-2026-020554v1.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2013.06.032"},{"key":"2026091107302230000_bmjqs-2026-020554v1.4","doi-asserted-by":"crossref","DOI":"10.1136\/bmjoq-2022-002020","article-title":"Thematic reviews of patient safety incidents as a tool for systems thinking: a quality improvement report","volume":"12","author":"Machen","year":"2023","journal-title":"BMJ Open Qual"},{"key":"2026091107302230000_bmjqs-2026-020554v1.5","unstructured":"World Health Organization . 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