Evidence on the links between patient experience and safety: a systematic review

Background

Patient experience and safety are central to healthcare quality, yet their relationship remains underexplored. While earlier evidence suggests a positive association, policy and practice are continually developing around the world. This review systematically examines the literature to better understand how patient experience and safety are linked.

Methods

Searches were conducted via PubMed (2000–2023) using predefined terms on patient experience and safety. Articles were uploaded to Rayyan, duplicates removed and titles and abstracts screened for relevance. Full articles were reviewed and 30 eligible studies were included. A narrative synthesis was performed, with quality and evidence strength assessed using the Mixed Methods Appraisal Tool and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework.

Results

Evidence regarding the relationship between patient experience and safety was heterogeneous. Seven studies demonstrated consistent positive associations, 6 reported no association and 17 yielded mixed findings across different safety metrics. Among these 17 studies, 7 tended to support a positive association, 5 suggested no association and 5 reported results that varied according to the analytical approach.

Discussion

This review found mixed evidence on the relationship between patient experience and safety, and causality remains unknown. While some research identified clear associations, others showed considerable variation, often influenced by the specific measures used. Studies focused on secondary care, leaving gaps in primary and mental health settings. Notably, no research examined links between safety and the Picker Principles of ‘fast access to healthcare advice’ or ‘family and carer involvement’—domains considered vital to safety.

The review suggests that future research should explore domain-specific links and include experimental designs to strengthen causal understanding of the granular elements of safety and experience. Further investigation across care settings and population subgroups would help to fully understand how patient experience influences safety and vice versa.

Overall, this review provides evidence that patient experience and safety are related but distinct concepts that should be addressed together in quality improvement efforts.