Development of a Quality Improvement and Patient Safety Research Conceptual Framework to Inform Research Priorities for the Irish Healthcare System: Protocol for a Scoping Review

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McCarthy" }, { "@type": "Person", "name": "Jill Poots" }, { "@type": "Person", "name": "John McCaffrey" }, { "@type": "Person", "name": "Emily O'Dowd" }, { "@type": "Person", "name": "Anna V. Chatzi" }, { "@type": "Person", "name": "Killian Walsh" }, { "@type": "Person", "name": "Jennifer A. Pallin" }, { "@type": "Person", "name": "Clíodhna McGowan" }, { "@type": "Person", "name": "Tommy Kyaw Tun" }, { "@type": "Person", "name": "John Brennan" }, { "@type": "Person", "name": "Samuel Cromie" }, { "@type": "Person", "name": "Edward W. Gregg" } ], "publisher": { "@type": "Organization", "name": "HRB Open Research", "logo": { "@type": "ImageObject", "url": "https://hrbopenresearch.org/img/AMP/HRB_image.png", "height": 566, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://hrbopenresearch.org/img/AMP/HRB_image.png", "height": 1200, "width": 127 }, "description": " Background A core part of the remit of the Evidence Based QUality Improvement and Patient Safety (EQUIPS) Research Network (2024–2029) is to inform research priorities for the Irish healthcare system. Previously, research prioritisation exercises have treated quality improvement (QI) and patient safety research as separate fields. Given the growth of QI research, an integrated approach is required to generate a full view of the continuum of knowledge generation and translation activities in quality and safety contexts. The co-creation of a Quality Improvement and Patient Safety Research Conceptual Framework among researchers, knowledge users and patient groups is required to outline important topics, research questions and methodologies, applicable to all areas of healthcare. A scoping review of the literature is required to examine existing QI and patient safety research frameworks to inform the development of a harmonised conceptual framework for the Irish context. Methods The scoping review will follow JBI guidelines for developing and co-creating scoping review protocols with knowledge users. The completed review will be reported according to the PRISMA extension for Scoping Reviews, and Guidance for Reporting Involvement of Patients and the Public 2 (GRIPP2) checklist which supports enhanced reporting of patient and public involvement in research. We will search the following databases from 2000–2025 focussing on literature sources from developed countries: Ovid MEDLINE, Embase, CINAHL, Scopus, Cochrane Library, Web of Science. We will map included papers using an extraction template developed to fulfil the study aims. Two reviewers will independently screen studies, and discrepancies will be addressed by consensus using a third reviewer. Dissemination Findings will be used to inform the development of a meta-framework that will be used to guide QI and patient safety research priority setting, measurement and monitoring, implementation, and knowledge translation activities in Ireland, at local and national levels. OSF https://doi.org/10.17605/OSF.IO/FGWUA " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://hrbopenresearch.org/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://hrbopenresearch.org/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://hrbopenresearch.org/articles/8-92/v1", "name": "Development of a Quality Improvement and Patient Safety Research Conceptual..." } } ] } Home Browse Development of a Quality Improvement and Patient Safety Research Conceptual... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article McCarthy SE, Poots J, McCaffrey J et al. Development of a Quality Improvement and Patient Safety Research Conceptual Framework to Inform Research Priorities for the Irish Healthcare System: Protocol for a Scoping Review [version 1; peer review: 2 not approved] . HRB Open Res 2025, 8 :92 ( https://doi.org/10.12688/hrbopenres.14173.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Study Protocol Development of a Quality Improvement and Patient Safety Research Conceptual Framework to Inform Research Priorities for the Irish Healthcare System: Protocol for a Scoping Review [version 1; peer review: 2 not approved] Siobhán E. McCarthy https://orcid.org/0000-0001-5651-2409 1 , Jill Poots https://orcid.org/0000-0002-1575-6121 2 , John McCaffrey https://orcid.org/0000-0003-0304-153X 3 , [...] Emily O'Dowd https://orcid.org/0000-0001-9283-5459 4 , Anna V. Chatzi https://orcid.org/0000-0003-4089-577X 5 , Killian Walsh 6 , Jennifer A. Pallin https://orcid.org/0000-0003-1434-6152 3 , Clíodhna McGowan https://orcid.org/0000-0001-7023-3844 3 , Tommy Kyaw Tun 7 , John Brennan https://orcid.org/0009-0005-8395-6204 8 , Samuel Cromie https://orcid.org/0000-0001-5023-0435 2 , Edward W. Gregg 3,9 Siobhán E. McCarthy https://orcid.org/0000-0001-5651-2409 1 , Jill Poots https://orcid.org/0000-0002-1575-6121 2 , [...] John McCaffrey https://orcid.org/0000-0003-0304-153X 3 , Emily O'Dowd https://orcid.org/0000-0001-9283-5459 4 , Anna V. Chatzi https://orcid.org/0000-0003-4089-577X 5 , Killian Walsh 6 , Jennifer A. Pallin https://orcid.org/0000-0003-1434-6152 3 , Clíodhna McGowan https://orcid.org/0000-0001-7023-3844 3 , Tommy Kyaw Tun 7 , John Brennan https://orcid.org/0009-0005-8395-6204 8 , Samuel Cromie https://orcid.org/0000-0001-5023-0435 2 , Edward W. Gregg 3,9 PUBLISHED 18 Aug 2025 Author details Author details 1 Graduate School of Healthcare Management, RCSI University of Medicine and Health Sciences, Dublin, Ireland 2 Centre for Innovative Human Systems, School of Psychology, Trinity College Dublin, Dublin, Ireland 3 School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland 4 Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Dublin, Ireland 5 School of Nursing and Midwifery, University of Limerick, Limerick, Ireland 6 RCSI Library, RCSI University of Medicine and Health Sciences, Dublin, Ireland 7 School of Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland 8 Royal College of Physicians of Ireland, Dublin, Ireland 9 School of Public Health, Imperial College London, London, UK Siobhán E. McCarthy Roles: Conceptualization, Funding Acquisition, Methodology, Project Administration, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Jill Poots Roles: Conceptualization, Methodology, Writing – Review & Editing John McCaffrey Roles: Conceptualization, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Emily O'Dowd Roles: Conceptualization, Methodology, Writing – Review & Editing Anna V. Chatzi Roles: Conceptualization, Methodology, Writing – Review & Editing Killian Walsh Roles: Methodology, Writing – Review & Editing Jennifer A. Pallin Roles: Conceptualization, Methodology, Writing – Review & Editing Clíodhna McGowan Roles: Conceptualization, Methodology, Writing – Review & Editing Tommy Kyaw Tun Roles: Conceptualization, Methodology, Writing – Review & Editing John Brennan Roles: Conceptualization, Methodology, Writing – Review & Editing Samuel Cromie Roles: Conceptualization, Funding Acquisition, Methodology, Writing – Review & Editing Edward W. Gregg Roles: Conceptualization, Funding Acquisition, Methodology, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Evidence-based QUality Improvement and Patient Safety (EQUIPS) Research Network gateway. Abstract Background A core part of the remit of the Evidence Based QUality Improvement and Patient Safety (EQUIPS) Research Network (2024–2029) is to inform research priorities for the Irish healthcare system. Previously, research prioritisation exercises have treated quality improvement (QI) and patient safety research as separate fields. Given the growth of QI research, an integrated approach is required to generate a full view of the continuum of knowledge generation and translation activities in quality and safety contexts. The co-creation of a Quality Improvement and Patient Safety Research Conceptual Framework among researchers, knowledge users and patient groups is required to outline important topics, research questions and methodologies, applicable to all areas of healthcare. A scoping review of the literature is required to examine existing QI and patient safety research frameworks to inform the development of a harmonised conceptual framework for the Irish context. Methods The scoping review will follow JBI guidelines for developing and co-creating scoping review protocols with knowledge users. The completed review will be reported according to the PRISMA extension for Scoping Reviews, and Guidance for Reporting Involvement of Patients and the Public 2 (GRIPP2) checklist which supports enhanced reporting of patient and public involvement in research. We will search the following databases from 2000–2025 focussing on literature sources from developed countries: Ovid MEDLINE, Embase, CINAHL, Scopus, Cochrane Library, Web of Science. We will map included papers using an extraction template developed to fulfil the study aims. Two reviewers will independently screen studies, and discrepancies will be addressed by consensus using a third reviewer. Dissemination Findings will be used to inform the development of a meta-framework that will be used to guide QI and patient safety research priority setting, measurement and monitoring, implementation, and knowledge translation activities in Ireland, at local and national levels. OSF https://doi.org/10.17605/OSF.IO/FGWUA READ ALL READ LESS Keywords quality improvement, patient safety, research priorities, co-design, conceptual framework, scoping review Corresponding Author(s) Siobhán E. McCarthy ( [email protected] ) Close Corresponding author: Siobhán E. McCarthy Competing interests: No competing interests were disclosed. Grant information: Health Research Board [PSRN-2023-001]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2025 McCarthy SE et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: McCarthy SE, Poots J, McCaffrey J et al. Development of a Quality Improvement and Patient Safety Research Conceptual Framework to Inform Research Priorities for the Irish Healthcare System: Protocol for a Scoping Review [version 1; peer review: 2 not approved] . HRB Open Res 2025, 8 :92 ( https://doi.org/10.12688/hrbopenres.14173.1 ) First published: 18 Aug 2025, 8 :92 ( https://doi.org/10.12688/hrbopenres.14173.1 ) Latest published: 28 Apr 2026, 8 :92 ( https://doi.org/10.12688/hrbopenres.14173.3 )  There is a newer version of this article available. Suppress this message for one day. Introduction A core aim of the Evidence Based QUality Improvement and Patient Safety (EQUIPS) Research Network (2024–2029), a collaboration of Irish Universities, patient representatives, and the Health Service Executive (HSE) in Ireland, is to inform research priorities for the Irish healthcare system. A conceptual understanding of quality improvement (QI) and patient safety as individual and inter-related fields is required to inform a research agenda. Up to now, research prioritisation exercises in Ireland and internationally have treated these as separate fields. The co-creation of a Quality Improvement and Patient Safety Research Conceptual Framework among researchers, knowledge users and patient groups is warranted to outline important topics, research questions and methodologies, applicable and relevant to all areas of healthcare. The conceptual framework will enable tailoring of research priorities and methodologies to the needs of service users and staff at unit, organisational and national levels in Ireland. First, a scoping review of the literature is required to examine existing QI and patient safety research frameworks to inform the development of a harmonised conceptual framework for the Irish context. This paper sets out the background, aims and methodology for the scoping review. The background section defines key concepts, identifies research gaps and discusses relevant health systems developments which inform the review protocol. Background Quality Improvement QI is the systemic use of data-guided activities to bring about immediate improvements in healthcare delivery 1 , and is considered a routine part of healthcare 1 , 2 . In Ireland, the HSE Quality and Patient Safety Competency Navigator outlines the expectation for all healthcare staff to engage in QI activities, to a level commensurate with their role and function in the health service 3 . Internationally, QI is perceived as essential for achieving competency in supporting quality and safety 4 – 6 and United Nations (UN) Sustainable Development Goals (SDGs) 7 . Quality Improvement methodologies QI methodologies include any suite of tools (e.g. process maps, driver diagrams, statistical process control charts) and methods (e.g. model for improvement, lean, six-sigma) which provide a structured scientific approach to making improvements in healthcare 8 . According to a scoping review, most published QI initiatives conducted in Ireland (2015–2020) report use of an established QI methodology and achievement of aims 9 . The aims of the QI initiatives mainly related to improving the effectiveness, efficiency, and safety of care processes and outcomes, and few aimed to enhance patient-centredness, value for money, or staff well-being 9 . Initiatives rarely aimed to enhance the equity domain of quality 9 , an often ‘forgotten goal’ of QI internationally 10 . One example from the Irish context is available from the literature 11 . However, most QI initiatives are unpublished. The conceptual framework is required to support research questions about all levels of QI work, irrespective of whether the QIs are published and available in the public domain. Quality Improvement research The primary purpose of QI is improved care and outcomes near to the time of data collection whereas research primarily aims to generate and disseminate new knowledge 12 , 13 . The term ‘QI research’ brings these activities together and is defined as ‘the pursuit of generalizable new knowledge related to creating and sustaining improvement in health care delivery in real world settings’ 14 . Additionally, terms such as ‘QI evaluation studies’ and ‘improvement science’ have been use to describe the study of improvement work 15 – 18 . The conduct of QI research, like conventional research studies, requires alignment between the study questions and methodology. However, the intervention and the context are primary parts of the effectiveness of improvement, making traditional high-status methodologies such as randomised control trials an inappropriate fit for the study of improvement 19 . General questions important to the field are (a) how can we attain improvement in complex systems?, and (b) how can we improve the way we improve? 8 . Dependent on the research question, multiple designs are recommended 18 with increasing emphasis on realist syntheses 20 , 21 , implementation science, health economic evaluation and behavioural science methods 22 . Quality Improvement research priorities for the Irish healthcare system QI research is considered to be in its infancy in Ireland and globally 8 . There is a need to align designs to important questions, which address a QI knowledge gap, and in particular a QI research priority. General knowledge gaps include the when, why and how of effective adaptation of improvement initiatives to context, and impacts on effectiveness and sustainability 23 . In Ireland, even though, the National Patient Safety Strategy has established thirteen ‘patient safety improvement priorities’ 24 , criteria for establishing ‘QI research priorities’ are not yet known. In addition, there is a lack of co-ordination between established improvement priorities and research strategy for the healthcare system 24 , 25 . There is also no current guidance on prioritising QI activities across quality domains, settings, and populations, and on selecting appropriate research methodologies and frameworks. Additionally, there is no guidance for identifying which QI initiatives (small- and large- scale) would make a valid and important contribution to generalisable new knowledge about creating and sustaining improvement. A conceptual framework aligning research questions about improvement, with appropriate designs, allied to improvement priorities for the Irish Health System is needed. This framework should integrate fundamentally with patient safety research, given QI’s role in enhancing safe processes and outcomes and the focus of the EQUIPS Research Network. Patient safety research Patient safety is considered an attribute of healthcare systems 26 , 27 , and safe systems seek to avoid, prevent and ameliorate adverse outcomes or injuries stemming from care 28 , 29 . Patient safety, as a discipline of study, applies ‘safety science methods toward the goal of achieving a trustworthy health system of care’ 26 . Research is core to enabling the acquisition and application of knowledge to create fail safe and resilient systems 26 , 30 . In the early 2000s, the World Health Organisation (WHO) published the Patient Safety Research Cycle which outlined the core research functions of patient safety research. These were 1) measuring harm, 2) understanding the causes of harm, 3) identifying locally affordable solutions, 4) evaluating impact and 5) translating evidence into safer care 31 . The 2017 Organisation for Economic Co-operation and Development (OECD) Report ‘The Economics of Patient Safety’ highlighted multiple patient safety solutions which require evaluation and tailoring to local contexts 32 , 33 . Together, these reports highlight the applied and evaluative nature of patient safety research which aims to lead to the development or adaptation of locally effective, appropriate and affordable solutions 32 . In a similar vein, the European Medicines Agency have highlighted the role of perceptions and behavioural research to enhance adherence and strengthen safety 34 . Patient safety research in Ireland A 2023 scoping review identified only a modest amount of patient safety research studies conducted in Ireland 35 . Most focussed on measuring past harm and safety culture and a minority evaluated patient safety solutions 35 . The review called for the availability of patient record data, tailored to distinct aspects of patient harm (e.g. specific care-related injuries, missed diagnoses that lead to harm) to address HSE strategic goals to measure and monitor safety, and establish and evaluate safety improvement initiatives 35 . Limitations of the review were a hospital focus, and exclusion of studies which focussed on the safety of one process e.g. medication errors, or patients with a particular medical condition e.g. patients with diabetes 35 . For practicality, the scoping review examined safety in the generic sense and studies which addressed many of the 13 HSE patient safety improvement priorities (e.g., falls, pressure ulcers, sepsis etc.) were excluded. Patient safety research priorities for the Irish healthcare system Criteria for establishing patient safety research priorities have evolved over time. In the early 2000s, relevant WHO criteria were ‘the frequency of the safety issue; the magnitude of harm and its distribution within the population; the effect on the efficiency of the health system; the availability, feasibility, and sustainability of solutions; and the urgency or political backing required to tackle the problem’ 32 . Fifty identified research priorities for developed countries are detailed in WHO reports 32 . It was expected that further knowledge in these substantial knowledge gaps would contribute to improving patient safety 32 . Priorities for developed countries like Ireland focussed on the underlying processes and organisational factors that lead to unsafe care and the cost-effectiveness of risk-reducing strategies 32 . Recently, safety prioritisation exercises have included equity as a key criterion. For example, a 2017 WHO exercise, which consulted global experts, identified research priorities/questions for medication safety research based on the criteria of answerability, effectiveness, innovativeness, implementation, burden reduction and equity 36 . In England, an inductive approach to the development of patient safety research priorities for primary care among healthcare staff and patients identified concern for the most vulnerable in society as a key priority 37 . The equity emphasis is underpinned by the WHO Global Action Plan for Patient Safety 2021–2030, which has aligned patient safety with United Nation’s Sustainable Development Goals UNSDGs 38 . These SDGs reinforce new priority areas in the literature such as the impact of staff well-being on patient safety 39 , 40 and the need for environmental sustainability and safety to co-exist, without additional risk to patients 41 . Yet, in Ireland, the current criteria for establishing patient safety research priorities have yet to be agreed, as well as the mode for establishing the criteria. Irish health system developments In recent years, new infrastructural developments in the Irish Health System, have linked QI and safety goals, making the current integrated assessment of research priorities timely to inform future policy and practice. For example, Ireland established a National Patient Safety Agency and introduced a new Patient Safety Act, mandating open disclosure 42 . Healthcare regions have recently been redefined with the aim of integrating hospital and community care and facilitating the right care at the right time and place 43 . Despite Ireland being a relatively late adopter of integrated digital technologies 44 , the use of electronic health records, digital solutions and artificial intelligence is expected to increase over the next decade. For example, a new digitally-powered National Patient Safety Surveillance System is soon to be developed, which will draw on existing HSE Quality and Safety Signals data sources and the National Centre for Clinical Audit data 45 . The system will be pro-actively engaged in risk management and improvement work, and will generate greater capacity for QI and patient safety research in Ireland. This enhanced capacity may in turn impact the feasibility of certain research priorities. However, if not carefully implemented, a digital strategy could also contribute to harm and inequities. Therefore, given the strategic reforms 46 and digitisation of healthcare 47 , now is an ideal time to ‘design in’ quality and safety into new models of care, and identify relevant quality and safety challenges, and consequent research priorities for the Irish health system. A scoping review is needed to collate all the relevant evidence and inform discussions about harmonised QI and patient safety research priorities for the Irish context. Aims and objectives The aim of this scoping review is to inform the development of a meta-framework that will be used to guide QI and patient safety research (QIPS-R) related priority setting, measurement and monitoring, implementation, and knowledge translation activities in Ireland. The objective is to identify and describe the conceptual frameworks relating to QIPS-R in healthcare. The research questions guiding this review are: 1. What conceptual frameworks are available for QIPS-R and how have they been applied in healthcare? 2. How are the concepts of QI and patient safety research defined in available QIPS-R frameworks? 3. What are the reported objectives of available QIPS-R frameworks? 4. What domains and sub-domains are addressed in available QIPS-R frameworks? 5. What structure-, process- and outcome- related indicators are used in available QIPS-R frameworks? 6. What criteria for research priorities have been established? 7. What research priorities have been established? Methods The review follows JBI methodological guidance for scoping reviews 48 , and will be reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The review protocol was structured using JBI guidelines for developing and co-creating scoping review protocols with knowledge users 49 , 50 and adaption of the PRISMA extension for Scoping Reviews checklist (PRISMA-ScR) 51 . All review materials will be available on the Open Science Framework (OSF; https://doi.org/10.17605/OSF.IO/FGWUA ). Eligibility criteria The eligibility criteria are informed by a Phenomenon of Interest, Concept, Context approach, as presented in Table 1 . We will include all study types across peer reviewed and grey literature. Editorials, book chapters and conference proceedings will be excluded. Since we want to identify frameworks and research priorities applicable to the Irish healthcare context, we will focus on papers from developed countries only, as these will have similar healthcare challenges and research needs. For example, a prior global WHO patient research prioritisation exercise took the approach of identifying priorities for developed, transitional and developing countries 31 . Only English language sources will be reviewed due to language limitations of the review team. Similar to other reviews 41 , for practicality reasons and to avoid duplication with other research areas, we will exclude papers that focus on the improvement and safety of singular medical processes (e.g. medication safety) and particular patient groups (e.g. patients with diabetes), unless their primary focus is on discussion of research definitions, frameworks, models and/or priorities for QI and/or patient safety research. All healthcare settings will be included. Table 1. Scoping Review Focus. Phenomenon of Interest Quality Improvement and/ or Patient Safety Research Frameworks used in healthcare Concept Quality improvement and patient safety research questions, priorities, and methodologies Context Healthcare settings across the globe Information sources and search strategy A search strategy was developed in consultation with an information specialist (KW) for the selected databases (2000–2025): Ovid MEDLINE, Embase, CINAHL, Scopus, Cochrane Library, Web of Science. Grey literature sources will include international and national government and agency reports, relevant to QI and patient safety research and will be purposively selected from established agencies websites (e.g., World Health Organisation, Agency for Healthcare Research and Quality Patient Safety Network) known to the authors. The search strategy for an example database is presented in Table 2 . The full search strategy for each database is available on OSF ( https://doi.org/10.17605/OSF.IO/FGWUA ; see Supplementary File 1). Table 2. Database Search Terms (Draft). ("Patient Safety" OR "Healthcare Safety" OR "Safety" OR "Quality Improvement" OR "Improvement Science" Or "Human Factors" Or "Resilience Engineering" Or "Safety I" Or "Safety II" Or "High Reliability" Or "Ergonomics" Or "Socio-technical Systems") AND ("Healthcare") AND ("Research Priorities" OR "Research Framework" OR "Research Methodologies" OR "Research Models" OR "Implementation Science" OR "Behavioural Science" OR "Behaviour Change" OR "Knowledge Translation") Data management and study selection Identified records will be imported to Covidence to manage screening and extraction. Two reviewers will independently assess retrieved records against eligibility criteria. Titles and abstracts will be screened for relevance, followed by full-text review to examine if eligibility criteria are met. Disagreement among reviewers will be resolved by consulting a third reviewer to reach consensus. A PRISMA flow diagram will be generated to map out the number of records identified, included and excluded, and the reasons for exclusion. Data extraction Two reviewers will use a piloted, standardised data extraction form, developed in Covidence, to independently extract data relevant to the scoping review aims (see Table 3 for draft template). Disagreement among reviewers will be resolved by a third reviewer. Table 3. Draft Data Extraction Template Headings. Author Year Country of the Research study (one or more) QI/PS-R Focus QI/PS-R Definitions Conceptual Framework Name Framework Goals Framework Domains Framework Sub-Domains Recommended Research Methodologies/Indicators Criteria for Establishing Research Priorities Research Priorities Established Note . QI/PS-R = Quality Improvement/Patient Safety - Research Data analysis and presentation Tables and graphs will be used to present data which address the study research questions. Findings will demonstrate the breadth of QI and patient safety research frameworks, and will indicate synergies and gaps. Researchers and Knowledge Users will be involved in the analysis and presentation of findings, which will be used to develop a research conceptual framework and to inform a research prioritisation exercise among EQUIPS members. Knowledge user engagement and co-creation In accordance with the JBI guidance and operating principles of the EQUIPS Research Network, knowledge users (i.e., healthcare staff and patient partners) will co-create all elements of the scoping review 50 . The knowledge users are the Lead Knowledge users who volunteered and self-selected to work together with the Researchers in Strand 2.1 of EQUIPS Research Network, and those who may join this strand of work as it develops. The work of Strand 2.1 primarily concerns establishing relevant research priorities and methodologies, to better facilitate multi-disciplinary and applied research relevant to the HSE patient safety and improvement priorities. As such, prior to the development of the scoping review protocol, pre-planning meetings for the conceptualisation of the review took place with knowledge users 50 . Then as part of the protocol development, knowledge users (TK, JB) helped develop the research questions, search strategy, and reviewed drafts of the protocol manuscript to ensure its helpfulness to their role. Due to time and resource constraints, knowledge users have decided not to take an active role in prospective scoping review screening, selecting and extracting articles, though this option was available if desired. Knowledge users will, in accordance with the guidance, review results to see if these ‘make sense’ and how they may best contribute to the planned development and usability of a QI and Patient Safety Research Conceptual Framework relevant for the Irish context 50 . Using their unique experiences, context and perspectives, after the scoping review is published, knowledge users will alongside the researchers, support dissemination activities, and in ways uniquely relevant in their communities and healthcare settings (e.g. sharing on social media or at journal clubs) 50 . Where researchers and knowledge users contribute substantially to the work, authorship rights will be applied in accordance with the International Committee of Medial Journal Editors Criteria 52 . The actual process of the co-creation of the scoping review will be reported in the final study manuscript using the Guidance for Reporting Involvement of Patients and the Public 2 (GRIPP2) short form checklist, a tool which supports improved reporting of patient and public involvement in research 53 . Conclusion In Ireland, there is a need for greater guidance for researchers involved in studying improvement work and patient safety. The completed review will provide a shared understanding of QI and patient safety research. Based on this understanding the review will enable production of practical tools to assist researchers and improvers. First, the development of a QI and Patient Safety Research Conceptual Framework suitable for the Irish context, that will enable users of the Framework to identify research priorities and methodologies relevant for their areas of work. Secondly, the review will inform a research prioritisation exercise among members of the EQUIPS Research Network, to best inform research funders and policy makers at national level of the key research areas that will make a difference to improving the safety and quality of care in the Irish healthcare system. These dual planned outputs will provide evidenced based priorities and methodologies, and a practical tool to support acceleration of QI and patient safety research in Ireland. Dissemination The paper will be submitted for publication in a peer-reviewed journal, and presented at national and international quality and safety conferences. Study status Between 12 June 2025 and 18 July 2025, the search strategy was developed, piloted, and refined, in consultation with an information specialist. The final search was conducted on 18 July 2025. Title and abstract screening commenced on 21 July 2025 and is ongoing at the time of submission. Ethics and consent Ethical approval and consent were not required. Data availability Underlying data No underlying data are associated with this article. Extended data Extended data associated with this article are available on OSF, under the project title “Development of a Quality Improvement and Patient Safety Research Conceptual Framework to Inform Research Priorities for the Irish Healthcare System: A Scoping Review”, https://doi.org/10.17605/OSF.IO/FGWUA (McCarthy, S et al . 2025) 54 The following extended data are associated with this article: PRISMA Scoping Review Checklist_Protocol Supplementary File 1_Search strategy Data are available under the terms of the Creative Commons Attribution 4.0 International Public License (CC BY 4.0). Reporting guidelines An adapted version of PRISMA Scoping Review checklist for the protocol is available on the OSF, under the project title “Development of a Quality Improvement and Patient Safety Research Conceptual Framework to Inform Research Priorities for the Irish Healthcare System: A Scoping Review”, https://doi.org/10.17605/OSF.IO/FGWUA (McCarthy, S et al . 2025) 54 Data are available under the terms of the Creative Commons Attribution 4.0 International Public License (CC BY 4.0). Acknowledgements This research was completed as part of the HRB and HSE funded Evidence-Based Quality Improvement and Patient Safety Research Network work programme (PSRN-2023-001). EWG is supported by Research Ireland [22/RP/10091] and JM, JAP, CM supported by the RCSI Converge Programme. Faculty Opinions recommended References 1. Lynn J, Baily MA, Bottrell M, et al. : The ethics of using quality improvement methods in health care. Ann Intern Med. 2007; 146 (9): 666–73. PubMed Abstract | Publisher Full Text 2. Batalden PB, Davidoff F: What is "quality improvement" and how can it transform healthcare? Qual Saf Health Care. 2007; 16 (1): 2–3. PubMed Abstract | Publisher Full Text | Free Full Text 3. National Quality and Patient Safety: The quality and patient safety competency navigator 2025. V 1.0. Dublin, Ireland, 2025. Reference Source 4. Canadian Patient Safety Institute: The safety competencies: enhancing patient safety across the health professions. Edmonton, Alberta, 2020. Reference Source 5. Clinical Excellence Commission: Healthcare safety and quality capabilities: an occupation-specific set for healthcare workers in NSW health. Sydney, 2021. Reference Source 6. Welsh Government: Quality and safety framework. 2021. Reference Source 7. Mensah Abrampah N, Syed SB, Hirschhorn LR, et al. : Quality improvement and emerging global health priorities. Int J Qual Health Care. 2018; 30 (suppl_1): 5–9. PubMed Abstract | Publisher Full Text | Free Full Text 8. Reed JE, Antonacci G, Armstrong N, et al. : What is improvement science, and what makes it different? An outline of the field and its frontiers. Front Health Serv. 2025; 4 : 1454658. PubMed Abstract | Publisher Full Text | Free Full Text 9. McCarthy SE, Jabakhanji SB, Martin J, et al. : Reporting standards, outcomes and costs of quality improvement studies in Ireland: a scoping review. BMJ Open Qual. 2021; 10 (3): e001319. PubMed Abstract | Publisher Full Text | Free Full Text 10. Ford J, Johnson L, Blythe J, et al. : Evidence brief: what works – leveraging quality improvement to address health and care inequalities. Health Equity Evidence Centre , 2025. 11. Doran E, Barron E, Healy L, et al. : Improving access to epilepsy care for homeless patients in the Dublin Inner City: a collaborative quality improvement project joining hospital and community care. BMJ Open Qual. 2021; 10 (2): e001367. PubMed Abstract | Publisher Full Text | Free Full Text 12. Foster J: Differentiating quality improvement and research activities. Clin Nurse Spec. 2013; 27 (1): 10–3. PubMed Abstract | Publisher Full Text 13. Ogrinc G, Nelson WA, Adams SM, et al. : An instrument to differentiate between clinical research and quality improvement. IRB. 2013; 35 (5): 1–8. PubMed Abstract 14. Margolis P, Provost LP, Schoettker PJ, et al. : Quality improvement, clinical research, and quality improvement research--opportunities for integration. Pediatr Clin North Am. 2009; 56 (4): 831–41. PubMed Abstract | Publisher Full Text 15. Nilsen P, Thor J, Bender M, et al. : Bridging the silos: a comparative analysis of implementation science and improvement science. Front Health Serv. 2022; 1 : 817750. PubMed Abstract | Publisher Full Text | Free Full Text 16. Cribb A: Improvement science meets improvement scholarship: reframing research for better healthcare. Health Care Anal. 2018; 26 (2): 109–23. PubMed Abstract | Publisher Full Text | Free Full Text 17. Perla RJ, Provost LP, Parry GJ: Seven propositions of the science of improvement: exploring foundations. Qual Manag Health Care. 2013; 22 (3): 170–86. PubMed Abstract | Publisher Full Text 18. Portela MC, Pronovost PJ, Woodcock T, et al. : Republished: how to study improvement interventions: a brief overview of possible study types. Postgrad Med J. 2015; 91 (1076): 343–54. PubMed Abstract | Publisher Full Text | Free Full Text 19. Øvretveit J: Perspectives: answering questions about quality improvement: suggestions for investigators. Int J Qual Health Care. 2017; 29 (1): 137–42. PubMed Abstract | Publisher Full Text 20. Duddy C, Wong G: Grand rounds in methodology: when are realist reviews useful, and what does a 'good' realist review look like? BMJ Qual Saf. 2023; 32 (3): 173–80. PubMed Abstract | Publisher Full Text 21. Johnson LL, Wong G, Kuhn I, et al. : A realist review of how, why, for whom and in which contexts quality improvement in healthcare impacts inequalities. BMJ Qual Saf. 2025; 34 (8): 537–546. PubMed Abstract | Publisher Full Text 22. Lachman P: Oxford professional practice handbook of quality improvement in healthcare. Oxford University Press, 2024. Reference Source 23. Ovretveit J, Dolan-Branton L, Marx M, et al. : Adapting improvements to context: when, why and how? Int J Qual Health Care. 2018; 30 (suppl_1): 20–3. PubMed Abstract | Publisher Full Text | Free Full Text 24. Health Service Executive: Patient safety strategy 2019 - 2024. 2019. Reference Source 25. Terrés A: HSE action plan for health research 2019–2029. 2019. Reference Source 26. Emanuel L, Berwick D, Conway J, et al. : What exactly is patient safety? J Med Regul. 2009; 95 (1): 13–24. Publisher Full Text 27. Back J, Owens D, Benneyworth R: The Health Services Safety Investigations Body (HSSIB) and safety management systems: an integrated approach to managing safety in healthcare. J Patient Saf Risk Manag. 2024; 29 (2): 79–82. Publisher Full Text 28. Grober ED, Bohnen JM: Defining medical error. Can J Surg. 2005; 48 (1): 39–44. PubMed Abstract | Free Full Text 29. Chatzi AV, Malliarou M: The need for a nursing specific patient safety definition, a viewpoint paper. Int J Health Gov. 2023; 28 (2): 108–16. Publisher Full Text 30. Wiig S, Aase K, Billett S, et al. : Defining the boundaries and operational concepts of resilience in the resilience in healthcare research program. BMC Health Serv Res. 2020; 20 (1): 330. PubMed Abstract | Publisher Full Text | Free Full Text 31. World Health Organization, WHO Patient Safety: WHO patient safety research: better knowledge for safer care. World Health Organization, ‎2009. Reference Source 32. Bates DW, Larizgoitia I, Prasopa-Plaizier N, et al. : Global priorities for patient safety research. BMJ. 2009; 338 : b1775. PubMed Abstract | Publisher Full Text 33. Slawomirski L, Auraaen A, Klazinga NS: The economics of patient safety: strengthening a value-based approach to reducing patient harm at national level. 2017. Publisher Full Text 34. European Medicines Agency (EMA), Heads of Medicines Agencies (HMA): Guideline on good pharmacovigilance practices (GVP)—Module XV—Safety communication (Rev 1). EMA/118465/2012 Rev 1. 2022. Reference Source 35. O'Connor P, O'Malley R, Kaud Y, et al. : A scoping review of patient safety research carried out in the Republic of Ireland. Ir J Med Sci. 2023; 192 (1): 1–9. PubMed Abstract | Publisher Full Text | Free Full Text 36. Sheikh A, Rudan I, Cresswell K, et al. : Agreeing on global research priorities for medication safety: an international prioritisation exercise. J Glob Health. 2019; 9 (1): 010422. PubMed Abstract | Publisher Full Text | Free Full Text 37. Morris RL, Stocks SJ, Alam R, et al. : Identifying primary care patient safety research priorities in the UK: a James Lind Alliance priority setting partnership. BMJ Open. 2018; 8 (2): e020870. PubMed Abstract | Publisher Full Text | Free Full Text 38. World Health Organisation: Global patient safety action plan 2021-2030: towards eliminating avoidable harm in health care. World Health Organization, 2021. Reference Source 39. Benishek LE, Kachalia A, Biddison LD: Improving clinician well-being and patient safety through human-centered design. JAMA. 2023; 329 (14): 1149–1150. PubMed Abstract | Publisher Full Text 40. Ray-Sannerud BN, Leyshon S, Vallevik VB: Introducing routine measurement of healthcare worker's well-being as a leading indicator for proactive safety management systems based on resilience engineering. Procedia Manuf. 2015; 3 : 319–26. Publisher Full Text 41. Lachman P, Batalden P, Vanhaecht K: A multidimensional quality model: an opportunity for patients, their kin, healthcare providers and professionals to coproduce health [version 3; peer review: 2 approved, 1 approved with reservations]. F1000Res. 2020; 9 : 1140. PubMed Abstract | Publisher Full Text | Free Full Text 42. Madden D, Tumelty ME: Open disclosure of patient safety incidents: legislative developments in Ireland. Management. 2019; 179 : 180. 43. Committee on the Future of Healthcare: Slaintecare Report. 2017. Reference Source 44. Invent C, Page M, Winkel R, et al. : 2024 digital decade eHealth indicator study. 2024. Reference Source 45. Directorate NQaPS: Quality and safety signals - a quality and patient safety surveillence system for Ireland. 2024. 46. Government of Ireland: Path to Universal Healthcare: Sláintecare & Programme for Government 2025+. Dublin: Government of Ireland, 2025. Reference Source 47. Department of Health: Digital for care: a digital health framework for ireland 2024-2030. 2024. Reference Source 48. Peters MD, Godfrey C, McInerney P, et al. : Scoping reviews. JBI manual for evidence synthesis . 2020; 10 . Publisher Full Text 49. Peters MD, Godfrey C, McInerney P, et al. : Best practice guidance and reporting items for the development of scoping review protocols. JBI Evid Synth. 2022; 20 (4): 953–68. PubMed Abstract | Publisher Full Text 50. Pollock D, Alexander L, Munn Z, et al. : Moving from consultation to co-creation with knowledge users in scoping reviews: guidance from the JBI scoping review methodology group. JBI Evid Synth. 2022; 20 (4): 969–79. PubMed Abstract | Publisher Full Text 51. Tricco AC, Lillie E, Zarin W, et al. : PRISMA extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018; 169 (7): 467–73. PubMed Abstract | Publisher Full Text 52. Pollock A, Campbell P, Struthers C, et al. : Stakeholder involvement in systematic reviews: a protocol for a systematic review of methods, outcomes and effects. Res Involv Engagem. 2017; 3 : 9. PubMed Abstract | Publisher Full Text | Free Full Text 53. Staniszewska S, Brett J, Simera I, et al. : GRIPP2 reporting checklists: tools to improve reporting of patient and public involvement in research. BMJ. 2017; 358 : j3453. PubMed Abstract | Publisher Full Text | Free Full Text 54. McCarthy S, Poots J, McCaffrey J, et al. : Development of a quality improvement and patient safety research conceptual framework to inform research priorities for the Irish healthcare system: a scoping review.Open Science Framework.2025. http://www.doi.org/10.17605/OSF.IO/FGWUA Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 18 Aug 2025 ADD YOUR COMMENT Comment Author details Author details 1 Graduate School of Healthcare Management, RCSI University of Medicine and Health Sciences, Dublin, Ireland 2 Centre for Innovative Human Systems, School of Psychology, Trinity College Dublin, Dublin, Ireland 3 School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland 4 Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Dublin, Ireland 5 School of Nursing and Midwifery, University of Limerick, Limerick, Ireland 6 RCSI Library, RCSI University of Medicine and Health Sciences, Dublin, Ireland 7 School of Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland 8 Royal College of Physicians of Ireland, Dublin, Ireland 9 School of Public Health, Imperial College London, London, UK Siobhán E. McCarthy Roles: Conceptualization, Funding Acquisition, Methodology, Project Administration, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Jill Poots Roles: Conceptualization, Methodology, Writing – Review & Editing John McCaffrey Roles: Conceptualization, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Emily O'Dowd Roles: Conceptualization, Methodology, Writing – Review & Editing Anna V. Chatzi Roles: Conceptualization, Methodology, Writing – Review & Editing Killian Walsh Roles: Methodology, Writing – Review & Editing Jennifer A. Pallin Roles: Conceptualization, Methodology, Writing – Review & Editing Clíodhna McGowan Roles: Conceptualization, Methodology, Writing – Review & Editing Tommy Kyaw Tun Roles: Conceptualization, Methodology, Writing – Review & Editing John Brennan Roles: Conceptualization, Methodology, Writing – Review & Editing Samuel Cromie Roles: Conceptualization, Funding Acquisition, Methodology, Writing – Review & Editing Edward W. Gregg Roles: Conceptualization, Funding Acquisition, Methodology, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information Health Research Board [PSRN-2023-001]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (3) version 3 Revised Published: 28 Apr 2026, 8:92 https://doi.org/10.12688/hrbopenres.14173.3 version 2 Revised Published: 11 Feb 2026, 8:92 https://doi.org/10.12688/hrbopenres.14173.2 version 1 Published: 18 Aug 2025, 8:92 https://doi.org/10.12688/hrbopenres.14173.1 Copyright © 2025 McCarthy SE et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics VIEWS $counts.viewCount downloads Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article McCarthy SE, Poots J, McCaffrey J et al. Development of a Quality Improvement and Patient Safety Research Conceptual Framework to Inform Research Priorities for the Irish Healthcare System: Protocol for a Scoping Review [version 1; peer review: 2 not approved] . HRB Open Res 2025, 8 :92 ( https://doi.org/10.12688/hrbopenres.14173.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 18 Aug 2025 Views 0 Cite How to cite this report: Sutherland AB. Reviewer Report For: Development of a Quality Improvement and Patient Safety Research Conceptual Framework to Inform Research Priorities for the Irish Healthcare System: Protocol for a Scoping Review [version 1; peer review: 2 not approved] . HRB Open Res 2025, 8 :92 ( https://doi.org/10.21956/hrbopenres.15586.r51963 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-92/v1#referee-response-51963 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 08 Jan 2026 Adam B Sutherland , University of Bradford, Bradford, England, UK Not Approved VIEWS 0 https://doi.org/10.21956/hrbopenres.15586.r51963 Thanks so much for the opportunity to review this paper, which I have read with interest. My interest comes from your position of attempting to tie together safety science with implementation science. I am in agreement with the previous reviewer ... Continue reading READ ALL Thanks so much for the opportunity to review this paper, which I have read with interest. My interest comes from your position of attempting to tie together safety science with implementation science. I am in agreement with the previous reviewer that this has not been achieved. Theoretical Grounding The manuscript is weakened by only offering a superficial theoretical exploration of the differences and alignments between improvement science and safety science. One of your review questions (Nr 5) is framed in Donabedian's "Structure-Process-Outcome" structure but there has been no exploration of this as a fundamental principle of quality improvement. Furthermore there has been no attempt to link improvement and safety science principles, which weakens the structure of your proposed analytical approach as it is unclear how you are going to ensure theoretical alignment between the concepts and the future framework you intend to develop. End User Involvement A core principle of scoping review methodology is the involvement of service users in the creation of the review and its questions. There is only a fleeting reference to service user involvement in the manuscript and I see no service users represented in the author list. I am very strongly on the opinion that where patient safety is involved, patients must be part of the research journey from start to end and this should be reconsidered. Search Strategy I've taken some time to look at your search strategies and have concerns that some of the terms you have used may skew your search results. I see behavioural science and implementation science included, human factors and sociotechnical systems but these are all very different concepts. Again,this is related to the lack of theoretical grounding of the proposal. I also wonder about the feasibility of this review. Notwithstanding the theoretical weaknesses I can imagine that the initial search strategies will yield many hundreds of thousands of titles that require screening, and there may be insufficient resource available for this in the methods. Data extraction I think a bit more information is needed for the readers to understand what is meant by "QI/PS-R Focus" and "QI/PS-R Definitions" - perhaps this just relates to the theoretical positions taken? How will extractors manage those studies that report BOTH QI and PS factors? I would fully expect that there would be substantial overlap between patient safety and quality improvement. You would need to separate the two concepts and demonstrate how they align (or indeed sit in tension) Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Partly Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: Human Factors; Patient Safety I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Sutherland AB. Reviewer Report For: Development of a Quality Improvement and Patient Safety Research Conceptual Framework to Inform Research Priorities for the Irish Healthcare System: Protocol for a Scoping Review [version 1; peer review: 2 not approved] . HRB Open Res 2025, 8 :92 ( https://doi.org/10.21956/hrbopenres.15586.r51963 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-92/v1#referee-response-51963 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 11 Feb 2026 John McCaffrey , School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland 11 Feb 2026 Author Response Thanks so much for the opportunity to review this paper, which I have read with interest. My interest comes from your position of attempting to tie together safety science with ... Continue reading Thanks so much for the opportunity to review this paper, which I have read with interest. My interest comes from your position of attempting to tie together safety science with implementation science. I am in agreement with the previous reviewer that this has not been achieved. Response: Thank you for this observation. Please see reply to reviewer 1. Overall, we have updated the scoping review aims to profiling QI Research Frameworks, Patient Safety Research Frameworks, and Frameworks which may already combine QI and Patient Safety as part of an overall research framework. The paper title has been reorientated to reflect the aims of the scoping review and not a planned application of the findings, i.e. the development of a conceptual framework. “Profiling and Mapping Quality Improvement and Patient Safety Research Frameworks: Protocol for a Scoping Review to Guide Integration Theoretical Grounding The manuscript is weakened by only offering a superficial theoretical exploration of the differences and alignments between improvement science and safety science . Response: The paper has incorporated an additional paragraph on the rationale for combining QI and patient safety research frameworks as below. Since part of our data extraction concerns how frameworks define QI and/or patient safety research, the scoping review findings with further detail difference and alignments between these. “ Rationale for combining Quality Improvement and Patient Safety Research Framework The US Institute of Medicine have long established patient safety, alongside timeliness, effectiveness, efficiency, equity and patient centredness, as a core goal of quality in healthcare (IOM, 2001). Since QI methodologies use data for diagnosing improvement opportunities in healthcare systems and for implementing and monitoring improvements in system performance, there are natural conceptual overlaps between the study of improvement and patient safety research. For example, in healthcare settings, QI methodology (e.g. PDSA) is regularly used to help implement, monitor, and adapt patient safety interventions (e.g. safe surgery checklist) over time with the goal of improving safety. At the same time, using routine and additional data sources, researchers examine implementation and effectiveness outcomes (e.g. compliance with safe surgery checklist and surgical outcomes) to inform decision-making about adoption of policies and practices. To reflect the multiple approaches to improving safety in practice, researchers require guidance about selecting evaluation foci and research methodology. For example, a recent Canadian Patient Safety Institute publication, offers guidance on how to combine quality improvement and implementation science research frameworks in efforts to enhance patient safety (CPSI, 2020). Additionally, there was a recent call for QIPS to be combined in clinical education (Wong et al., 2022). Currently there is no known collated body of literature which profiles stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research Frameworks) and guides on how these may be best utilised.” One of your review questions is framed in Donabedian's "Structure-Process-Outcome" structure but there has been no exploration of this as a fundamental principle of quality improvement. Response : Thank you for this observation. An explanation of Donabedian’s Structure-Process-and Outcome Quality Framework is now provided in the introductory text. Additionally, examples of structures, processes and outcomes are now provided in the study data extraction table (Table 3) in the manuscript, and as identified below (4.12 – 4.14). “Fifty identified research priorities for developed countries are detailed in WHO reports 32 . These were summarised using Donabedian’s structure, process and outcome quality framework to identify research areas that were the results or consequences of care (outcomes), due to resourcing and organisational arrangements (structures) or influenced by the delivery of care (processes). It was expected that further knowledge in these substantial knowledge gaps would contribute to improving patient safety (WHO, 2008) . Priorities for developed countries like Ireland focused on the underlying processes and organisational factors that lead to unsafe care, the cost-effectiveness of risk-reducing strategies, and the development of better safety indicators 32” 4.12 Were structural indicators established? (i.e. building blocks of care, e.g. buildings, staff, equipment, policies) 4.13 Were process indicators established? (i.e. management, organisational, and clinical processes, e.g. use of checklists) 4.14 Were outcome indicators established? (i.e. outcomes of care, e.g. adverse events) World Alliance for Patient Safety. Summary of the Evidence on Patient Safety: Implications for Research. Geneva: World Health Organization, 2008 Furthermore, there has been no attempt to link improvement and safety science principles, which weakens the structure of your proposed analytical approach as it is unclear how you are going to ensure theoretical alignment between the concepts and the future framework you intend to develop. Response : Thank you for this observation. A table (Table 1) outlining similarities and differences across principles of quality improvement, quality improvement research and patient safety research has been included in the introductory section. Completion of the scoping review, profiling the frameworks, will identify within existing frameworks where synergies across aims, methodology and outcome are, and where there are opportunities for integration. “For illustration and reflecting the literature above, Table 1, details multiple similarities and differences across QI, QI research and Patient Safety research. To reflect these multiple approaches and interdependencies in improving safety in practice, researchers require guidance about selecting evaluation foci and research methodology”. End User Involvement A core principle of scoping review methodology is the involvement of service users in the creation of the review and its questions. There is only a fleeting reference to service user involvement in the manuscript and I see no service users represented in the author list. I am very strongly on the opinion that where patient safety is involved, patients must be part of the research journey from start to end and this should be reconsidered. Response: Thank you for this observation. EQUIPS has a small but growing number of patient partners and collaborates regularly with other patient organisations (e.g., Patients for Patient Safety Ireland). All patient partners were invited to participate in scoping review development and we anticipate they will continue to play an active role in further stages of this research. Authors are listed according to the International Committee of Medical Journal Editors (ICMJE) Recommendations. Please see reply to Reviewer 1 above. More detail has been added on sharing of findings: “Scoping review findings will be presented at a dedicated QI and Patient Safety Research symposium at the RCSI University of Medicine & Health Sciences and other fora. Here, consultation will take place with stakeholders (i.e. healthcare professionals, healthcare managers, researchers, academics, patient representatives, research funders, and EQUIPS members). Discussion will focus on how the findings may be used to develop Quality Improvement and Patient Safety Research Conceptual Framework and inform the prioritisation of research topics and methodologies within the context of the Irish healthcare system”. Search Strategy I've taken some time to look at your search strategies and have concerns that some of the terms you have used may skew your search results. I see behavioural science and implementation science included, human factors and sociotechnical systems but these are all very different concepts. Again, this is related to the lack of theoretical grounding of the proposal. Response : Thank you for this observation. We have clarified we are profiling stand-alone and or integrated QI and Patient Safety Frameworks, and have provided more theoretical grounding, I think these address the concerns. Moreover, details of expertise supporting the project are more clearly outlined, and this should instil confidence that papers addressing the theoretical aims of the study will be included. I also wonder about the feasibility of this review. Notwithstanding the theoretical weaknesses I can imagine that the initial search strategies will yield many hundreds of thousands of titles that require screening, and there may be insufficient resource available for this in the methods. Response: We are confident in the feasibility of the review, given our aim to profile research frameworks, specifically. Data extraction I think a bit more information is needed for the readers to understand what is meant by "QI/PS-R Focus" and "QI/PS-R Definitions" - perhaps this just relates to the theoretical positions taken? How will extractors manage those studies that report BOTH QI and PS factors? I would fully expect that there would be substantial overlap between patient safety and quality improvement. You would need to separate the two concepts and demonstrate how they align (or indeed sit in tension) Response: Thank you for this observation. I think this had been addressed by our clarification of aims. Please see reply to reviewer 1 above and below We have clarified our overall aim is identify stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks), and not necessarily hybrid approaches only, which are in their infancy. Additionally, we have clarified that the results of the scoping review will be used to develop a meta-framework, the methodology for which is beyond the parameters of the scoping review protocol. “The aim of this scoping review is to identify and describe the conceptual frameworks relating to stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks) in healthcare. The research questions guiding this review are: 1. What conceptual frameworks are available for Quality Improvement and/or Patient Safety Research and how have they been applied in healthcare? 2. How are the concepts of QI and patient safety research defined in available Quality Improvement and/or Patient Safety Research Frameworks? 3. What are the reported objectives of available Quality Improvement and/or Patient Safety Research frameworks? 4. What domains and sub-domains are addressed in available Quality Improvement and/or Patient Safety Research Frameworks? 5. What structure-, process- and outcome- related indicators are used in available Quality Improvement and/or Patient Safety Research Frameworks? 6. What criteria for research priorities have been established? 7. What research priorities have been established? Scoping review findings will be used to inform the development of a meta-framework that will be used to guide QI and patient safety research related priority setting, measurement and monitoring, implementation, and knowledge translation activities in Ireland.” Thanks so much for the opportunity to review this paper, which I have read with interest. My interest comes from your position of attempting to tie together safety science with implementation science. I am in agreement with the previous reviewer that this has not been achieved. Response: Thank you for this observation. Please see reply to reviewer 1. Overall, we have updated the scoping review aims to profiling QI Research Frameworks, Patient Safety Research Frameworks, and Frameworks which may already combine QI and Patient Safety as part of an overall research framework. The paper title has been reorientated to reflect the aims of the scoping review and not a planned application of the findings, i.e. the development of a conceptual framework. “Profiling and Mapping Quality Improvement and Patient Safety Research Frameworks: Protocol for a Scoping Review to Guide Integration Theoretical Grounding The manuscript is weakened by only offering a superficial theoretical exploration of the differences and alignments between improvement science and safety science . Response: The paper has incorporated an additional paragraph on the rationale for combining QI and patient safety research frameworks as below. Since part of our data extraction concerns how frameworks define QI and/or patient safety research, the scoping review findings with further detail difference and alignments between these. “ Rationale for combining Quality Improvement and Patient Safety Research Framework The US Institute of Medicine have long established patient safety, alongside timeliness, effectiveness, efficiency, equity and patient centredness, as a core goal of quality in healthcare (IOM, 2001). Since QI methodologies use data for diagnosing improvement opportunities in healthcare systems and for implementing and monitoring improvements in system performance, there are natural conceptual overlaps between the study of improvement and patient safety research. For example, in healthcare settings, QI methodology (e.g. PDSA) is regularly used to help implement, monitor, and adapt patient safety interventions (e.g. safe surgery checklist) over time with the goal of improving safety. At the same time, using routine and additional data sources, researchers examine implementation and effectiveness outcomes (e.g. compliance with safe surgery checklist and surgical outcomes) to inform decision-making about adoption of policies and practices. To reflect the multiple approaches to improving safety in practice, researchers require guidance about selecting evaluation foci and research methodology. For example, a recent Canadian Patient Safety Institute publication, offers guidance on how to combine quality improvement and implementation science research frameworks in efforts to enhance patient safety (CPSI, 2020). Additionally, there was a recent call for QIPS to be combined in clinical education (Wong et al., 2022). Currently there is no known collated body of literature which profiles stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research Frameworks) and guides on how these may be best utilised.” One of your review questions is framed in Donabedian's "Structure-Process-Outcome" structure but there has been no exploration of this as a fundamental principle of quality improvement. Response : Thank you for this observation. An explanation of Donabedian’s Structure-Process-and Outcome Quality Framework is now provided in the introductory text. Additionally, examples of structures, processes and outcomes are now provided in the study data extraction table (Table 3) in the manuscript, and as identified below (4.12 – 4.14). “Fifty identified research priorities for developed countries are detailed in WHO reports 32 . These were summarised using Donabedian’s structure, process and outcome quality framework to identify research areas that were the results or consequences of care (outcomes), due to resourcing and organisational arrangements (structures) or influenced by the delivery of care (processes). It was expected that further knowledge in these substantial knowledge gaps would contribute to improving patient safety (WHO, 2008) . Priorities for developed countries like Ireland focused on the underlying processes and organisational factors that lead to unsafe care, the cost-effectiveness of risk-reducing strategies, and the development of better safety indicators 32” 4.12 Were structural indicators established? (i.e. building blocks of care, e.g. buildings, staff, equipment, policies) 4.13 Were process indicators established? (i.e. management, organisational, and clinical processes, e.g. use of checklists) 4.14 Were outcome indicators established? (i.e. outcomes of care, e.g. adverse events) World Alliance for Patient Safety. Summary of the Evidence on Patient Safety: Implications for Research. Geneva: World Health Organization, 2008 Furthermore, there has been no attempt to link improvement and safety science principles, which weakens the structure of your proposed analytical approach as it is unclear how you are going to ensure theoretical alignment between the concepts and the future framework you intend to develop. Response : Thank you for this observation. A table (Table 1) outlining similarities and differences across principles of quality improvement, quality improvement research and patient safety research has been included in the introductory section. Completion of the scoping review, profiling the frameworks, will identify within existing frameworks where synergies across aims, methodology and outcome are, and where there are opportunities for integration. “For illustration and reflecting the literature above, Table 1, details multiple similarities and differences across QI, QI research and Patient Safety research. To reflect these multiple approaches and interdependencies in improving safety in practice, researchers require guidance about selecting evaluation foci and research methodology”. End User Involvement A core principle of scoping review methodology is the involvement of service users in the creation of the review and its questions. There is only a fleeting reference to service user involvement in the manuscript and I see no service users represented in the author list. I am very strongly on the opinion that where patient safety is involved, patients must be part of the research journey from start to end and this should be reconsidered. Response: Thank you for this observation. EQUIPS has a small but growing number of patient partners and collaborates regularly with other patient organisations (e.g., Patients for Patient Safety Ireland). All patient partners were invited to participate in scoping review development and we anticipate they will continue to play an active role in further stages of this research. Authors are listed according to the International Committee of Medical Journal Editors (ICMJE) Recommendations. Please see reply to Reviewer 1 above. More detail has been added on sharing of findings: “Scoping review findings will be presented at a dedicated QI and Patient Safety Research symposium at the RCSI University of Medicine & Health Sciences and other fora. Here, consultation will take place with stakeholders (i.e. healthcare professionals, healthcare managers, researchers, academics, patient representatives, research funders, and EQUIPS members). Discussion will focus on how the findings may be used to develop Quality Improvement and Patient Safety Research Conceptual Framework and inform the prioritisation of research topics and methodologies within the context of the Irish healthcare system”. Search Strategy I've taken some time to look at your search strategies and have concerns that some of the terms you have used may skew your search results. I see behavioural science and implementation science included, human factors and sociotechnical systems but these are all very different concepts. Again, this is related to the lack of theoretical grounding of the proposal. Response : Thank you for this observation. We have clarified we are profiling stand-alone and or integrated QI and Patient Safety Frameworks, and have provided more theoretical grounding, I think these address the concerns. Moreover, details of expertise supporting the project are more clearly outlined, and this should instil confidence that papers addressing the theoretical aims of the study will be included. I also wonder about the feasibility of this review. Notwithstanding the theoretical weaknesses I can imagine that the initial search strategies will yield many hundreds of thousands of titles that require screening, and there may be insufficient resource available for this in the methods. Response: We are confident in the feasibility of the review, given our aim to profile research frameworks, specifically. Data extraction I think a bit more information is needed for the readers to understand what is meant by "QI/PS-R Focus" and "QI/PS-R Definitions" - perhaps this just relates to the theoretical positions taken? How will extractors manage those studies that report BOTH QI and PS factors? I would fully expect that there would be substantial overlap between patient safety and quality improvement. You would need to separate the two concepts and demonstrate how they align (or indeed sit in tension) Response: Thank you for this observation. I think this had been addressed by our clarification of aims. Please see reply to reviewer 1 above and below We have clarified our overall aim is identify stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks), and not necessarily hybrid approaches only, which are in their infancy. Additionally, we have clarified that the results of the scoping review will be used to develop a meta-framework, the methodology for which is beyond the parameters of the scoping review protocol. “The aim of this scoping review is to identify and describe the conceptual frameworks relating to stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks) in healthcare. The research questions guiding this review are: 1. What conceptual frameworks are available for Quality Improvement and/or Patient Safety Research and how have they been applied in healthcare? 2. How are the concepts of QI and patient safety research defined in available Quality Improvement and/or Patient Safety Research Frameworks? 3. What are the reported objectives of available Quality Improvement and/or Patient Safety Research frameworks? 4. What domains and sub-domains are addressed in available Quality Improvement and/or Patient Safety Research Frameworks? 5. What structure-, process- and outcome- related indicators are used in available Quality Improvement and/or Patient Safety Research Frameworks? 6. What criteria for research priorities have been established? 7. What research priorities have been established? Scoping review findings will be used to inform the development of a meta-framework that will be used to guide QI and patient safety research related priority setting, measurement and monitoring, implementation, and knowledge translation activities in Ireland.” Competing Interests: No competing interests to disclose Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 11 Feb 2026 John McCaffrey , School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland 11 Feb 2026 Author Response Thanks so much for the opportunity to review this paper, which I have read with interest. My interest comes from your position of attempting to tie together safety science with ... Continue reading Thanks so much for the opportunity to review this paper, which I have read with interest. My interest comes from your position of attempting to tie together safety science with implementation science. I am in agreement with the previous reviewer that this has not been achieved. Response: Thank you for this observation. Please see reply to reviewer 1. Overall, we have updated the scoping review aims to profiling QI Research Frameworks, Patient Safety Research Frameworks, and Frameworks which may already combine QI and Patient Safety as part of an overall research framework. The paper title has been reorientated to reflect the aims of the scoping review and not a planned application of the findings, i.e. the development of a conceptual framework. “Profiling and Mapping Quality Improvement and Patient Safety Research Frameworks: Protocol for a Scoping Review to Guide Integration Theoretical Grounding The manuscript is weakened by only offering a superficial theoretical exploration of the differences and alignments between improvement science and safety science . Response: The paper has incorporated an additional paragraph on the rationale for combining QI and patient safety research frameworks as below. Since part of our data extraction concerns how frameworks define QI and/or patient safety research, the scoping review findings with further detail difference and alignments between these. “ Rationale for combining Quality Improvement and Patient Safety Research Framework The US Institute of Medicine have long established patient safety, alongside timeliness, effectiveness, efficiency, equity and patient centredness, as a core goal of quality in healthcare (IOM, 2001). Since QI methodologies use data for diagnosing improvement opportunities in healthcare systems and for implementing and monitoring improvements in system performance, there are natural conceptual overlaps between the study of improvement and patient safety research. For example, in healthcare settings, QI methodology (e.g. PDSA) is regularly used to help implement, monitor, and adapt patient safety interventions (e.g. safe surgery checklist) over time with the goal of improving safety. At the same time, using routine and additional data sources, researchers examine implementation and effectiveness outcomes (e.g. compliance with safe surgery checklist and surgical outcomes) to inform decision-making about adoption of policies and practices. To reflect the multiple approaches to improving safety in practice, researchers require guidance about selecting evaluation foci and research methodology. For example, a recent Canadian Patient Safety Institute publication, offers guidance on how to combine quality improvement and implementation science research frameworks in efforts to enhance patient safety (CPSI, 2020). Additionally, there was a recent call for QIPS to be combined in clinical education (Wong et al., 2022). Currently there is no known collated body of literature which profiles stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research Frameworks) and guides on how these may be best utilised.” One of your review questions is framed in Donabedian's "Structure-Process-Outcome" structure but there has been no exploration of this as a fundamental principle of quality improvement. Response : Thank you for this observation. An explanation of Donabedian’s Structure-Process-and Outcome Quality Framework is now provided in the introductory text. Additionally, examples of structures, processes and outcomes are now provided in the study data extraction table (Table 3) in the manuscript, and as identified below (4.12 – 4.14). “Fifty identified research priorities for developed countries are detailed in WHO reports 32 . These were summarised using Donabedian’s structure, process and outcome quality framework to identify research areas that were the results or consequences of care (outcomes), due to resourcing and organisational arrangements (structures) or influenced by the delivery of care (processes). It was expected that further knowledge in these substantial knowledge gaps would contribute to improving patient safety (WHO, 2008) . Priorities for developed countries like Ireland focused on the underlying processes and organisational factors that lead to unsafe care, the cost-effectiveness of risk-reducing strategies, and the development of better safety indicators 32” 4.12 Were structural indicators established? (i.e. building blocks of care, e.g. buildings, staff, equipment, policies) 4.13 Were process indicators established? (i.e. management, organisational, and clinical processes, e.g. use of checklists) 4.14 Were outcome indicators established? (i.e. outcomes of care, e.g. adverse events) World Alliance for Patient Safety. Summary of the Evidence on Patient Safety: Implications for Research. Geneva: World Health Organization, 2008 Furthermore, there has been no attempt to link improvement and safety science principles, which weakens the structure of your proposed analytical approach as it is unclear how you are going to ensure theoretical alignment between the concepts and the future framework you intend to develop. Response : Thank you for this observation. A table (Table 1) outlining similarities and differences across principles of quality improvement, quality improvement research and patient safety research has been included in the introductory section. Completion of the scoping review, profiling the frameworks, will identify within existing frameworks where synergies across aims, methodology and outcome are, and where there are opportunities for integration. “For illustration and reflecting the literature above, Table 1, details multiple similarities and differences across QI, QI research and Patient Safety research. To reflect these multiple approaches and interdependencies in improving safety in practice, researchers require guidance about selecting evaluation foci and research methodology”. End User Involvement A core principle of scoping review methodology is the involvement of service users in the creation of the review and its questions. There is only a fleeting reference to service user involvement in the manuscript and I see no service users represented in the author list. I am very strongly on the opinion that where patient safety is involved, patients must be part of the research journey from start to end and this should be reconsidered. Response: Thank you for this observation. EQUIPS has a small but growing number of patient partners and collaborates regularly with other patient organisations (e.g., Patients for Patient Safety Ireland). All patient partners were invited to participate in scoping review development and we anticipate they will continue to play an active role in further stages of this research. Authors are listed according to the International Committee of Medical Journal Editors (ICMJE) Recommendations. Please see reply to Reviewer 1 above. More detail has been added on sharing of findings: “Scoping review findings will be presented at a dedicated QI and Patient Safety Research symposium at the RCSI University of Medicine & Health Sciences and other fora. Here, consultation will take place with stakeholders (i.e. healthcare professionals, healthcare managers, researchers, academics, patient representatives, research funders, and EQUIPS members). Discussion will focus on how the findings may be used to develop Quality Improvement and Patient Safety Research Conceptual Framework and inform the prioritisation of research topics and methodologies within the context of the Irish healthcare system”. Search Strategy I've taken some time to look at your search strategies and have concerns that some of the terms you have used may skew your search results. I see behavioural science and implementation science included, human factors and sociotechnical systems but these are all very different concepts. Again, this is related to the lack of theoretical grounding of the proposal. Response : Thank you for this observation. We have clarified we are profiling stand-alone and or integrated QI and Patient Safety Frameworks, and have provided more theoretical grounding, I think these address the concerns. Moreover, details of expertise supporting the project are more clearly outlined, and this should instil confidence that papers addressing the theoretical aims of the study will be included. I also wonder about the feasibility of this review. Notwithstanding the theoretical weaknesses I can imagine that the initial search strategies will yield many hundreds of thousands of titles that require screening, and there may be insufficient resource available for this in the methods. Response: We are confident in the feasibility of the review, given our aim to profile research frameworks, specifically. Data extraction I think a bit more information is needed for the readers to understand what is meant by "QI/PS-R Focus" and "QI/PS-R Definitions" - perhaps this just relates to the theoretical positions taken? How will extractors manage those studies that report BOTH QI and PS factors? I would fully expect that there would be substantial overlap between patient safety and quality improvement. You would need to separate the two concepts and demonstrate how they align (or indeed sit in tension) Response: Thank you for this observation. I think this had been addressed by our clarification of aims. Please see reply to reviewer 1 above and below We have clarified our overall aim is identify stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks), and not necessarily hybrid approaches only, which are in their infancy. Additionally, we have clarified that the results of the scoping review will be used to develop a meta-framework, the methodology for which is beyond the parameters of the scoping review protocol. “The aim of this scoping review is to identify and describe the conceptual frameworks relating to stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks) in healthcare. The research questions guiding this review are: 1. What conceptual frameworks are available for Quality Improvement and/or Patient Safety Research and how have they been applied in healthcare? 2. How are the concepts of QI and patient safety research defined in available Quality Improvement and/or Patient Safety Research Frameworks? 3. What are the reported objectives of available Quality Improvement and/or Patient Safety Research frameworks? 4. What domains and sub-domains are addressed in available Quality Improvement and/or Patient Safety Research Frameworks? 5. What structure-, process- and outcome- related indicators are used in available Quality Improvement and/or Patient Safety Research Frameworks? 6. What criteria for research priorities have been established? 7. What research priorities have been established? Scoping review findings will be used to inform the development of a meta-framework that will be used to guide QI and patient safety research related priority setting, measurement and monitoring, implementation, and knowledge translation activities in Ireland.” Thanks so much for the opportunity to review this paper, which I have read with interest. My interest comes from your position of attempting to tie together safety science with implementation science. I am in agreement with the previous reviewer that this has not been achieved. Response: Thank you for this observation. Please see reply to reviewer 1. Overall, we have updated the scoping review aims to profiling QI Research Frameworks, Patient Safety Research Frameworks, and Frameworks which may already combine QI and Patient Safety as part of an overall research framework. The paper title has been reorientated to reflect the aims of the scoping review and not a planned application of the findings, i.e. the development of a conceptual framework. “Profiling and Mapping Quality Improvement and Patient Safety Research Frameworks: Protocol for a Scoping Review to Guide Integration Theoretical Grounding The manuscript is weakened by only offering a superficial theoretical exploration of the differences and alignments between improvement science and safety science . Response: The paper has incorporated an additional paragraph on the rationale for combining QI and patient safety research frameworks as below. Since part of our data extraction concerns how frameworks define QI and/or patient safety research, the scoping review findings with further detail difference and alignments between these. “ Rationale for combining Quality Improvement and Patient Safety Research Framework The US Institute of Medicine have long established patient safety, alongside timeliness, effectiveness, efficiency, equity and patient centredness, as a core goal of quality in healthcare (IOM, 2001). Since QI methodologies use data for diagnosing improvement opportunities in healthcare systems and for implementing and monitoring improvements in system performance, there are natural conceptual overlaps between the study of improvement and patient safety research. For example, in healthcare settings, QI methodology (e.g. PDSA) is regularly used to help implement, monitor, and adapt patient safety interventions (e.g. safe surgery checklist) over time with the goal of improving safety. At the same time, using routine and additional data sources, researchers examine implementation and effectiveness outcomes (e.g. compliance with safe surgery checklist and surgical outcomes) to inform decision-making about adoption of policies and practices. To reflect the multiple approaches to improving safety in practice, researchers require guidance about selecting evaluation foci and research methodology. For example, a recent Canadian Patient Safety Institute publication, offers guidance on how to combine quality improvement and implementation science research frameworks in efforts to enhance patient safety (CPSI, 2020). Additionally, there was a recent call for QIPS to be combined in clinical education (Wong et al., 2022). Currently there is no known collated body of literature which profiles stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research Frameworks) and guides on how these may be best utilised.” One of your review questions is framed in Donabedian's "Structure-Process-Outcome" structure but there has been no exploration of this as a fundamental principle of quality improvement. Response : Thank you for this observation. An explanation of Donabedian’s Structure-Process-and Outcome Quality Framework is now provided in the introductory text. Additionally, examples of structures, processes and outcomes are now provided in the study data extraction table (Table 3) in the manuscript, and as identified below (4.12 – 4.14). “Fifty identified research priorities for developed countries are detailed in WHO reports 32 . These were summarised using Donabedian’s structure, process and outcome quality framework to identify research areas that were the results or consequences of care (outcomes), due to resourcing and organisational arrangements (structures) or influenced by the delivery of care (processes). It was expected that further knowledge in these substantial knowledge gaps would contribute to improving patient safety (WHO, 2008) . Priorities for developed countries like Ireland focused on the underlying processes and organisational factors that lead to unsafe care, the cost-effectiveness of risk-reducing strategies, and the development of better safety indicators 32” 4.12 Were structural indicators established? (i.e. building blocks of care, e.g. buildings, staff, equipment, policies) 4.13 Were process indicators established? (i.e. management, organisational, and clinical processes, e.g. use of checklists) 4.14 Were outcome indicators established? (i.e. outcomes of care, e.g. adverse events) World Alliance for Patient Safety. Summary of the Evidence on Patient Safety: Implications for Research. Geneva: World Health Organization, 2008 Furthermore, there has been no attempt to link improvement and safety science principles, which weakens the structure of your proposed analytical approach as it is unclear how you are going to ensure theoretical alignment between the concepts and the future framework you intend to develop. Response : Thank you for this observation. A table (Table 1) outlining similarities and differences across principles of quality improvement, quality improvement research and patient safety research has been included in the introductory section. Completion of the scoping review, profiling the frameworks, will identify within existing frameworks where synergies across aims, methodology and outcome are, and where there are opportunities for integration. “For illustration and reflecting the literature above, Table 1, details multiple similarities and differences across QI, QI research and Patient Safety research. To reflect these multiple approaches and interdependencies in improving safety in practice, researchers require guidance about selecting evaluation foci and research methodology”. End User Involvement A core principle of scoping review methodology is the involvement of service users in the creation of the review and its questions. There is only a fleeting reference to service user involvement in the manuscript and I see no service users represented in the author list. I am very strongly on the opinion that where patient safety is involved, patients must be part of the research journey from start to end and this should be reconsidered. Response: Thank you for this observation. EQUIPS has a small but growing number of patient partners and collaborates regularly with other patient organisations (e.g., Patients for Patient Safety Ireland). All patient partners were invited to participate in scoping review development and we anticipate they will continue to play an active role in further stages of this research. Authors are listed according to the International Committee of Medical Journal Editors (ICMJE) Recommendations. Please see reply to Reviewer 1 above. More detail has been added on sharing of findings: “Scoping review findings will be presented at a dedicated QI and Patient Safety Research symposium at the RCSI University of Medicine & Health Sciences and other fora. Here, consultation will take place with stakeholders (i.e. healthcare professionals, healthcare managers, researchers, academics, patient representatives, research funders, and EQUIPS members). Discussion will focus on how the findings may be used to develop Quality Improvement and Patient Safety Research Conceptual Framework and inform the prioritisation of research topics and methodologies within the context of the Irish healthcare system”. Search Strategy I've taken some time to look at your search strategies and have concerns that some of the terms you have used may skew your search results. I see behavioural science and implementation science included, human factors and sociotechnical systems but these are all very different concepts. Again, this is related to the lack of theoretical grounding of the proposal. Response : Thank you for this observation. We have clarified we are profiling stand-alone and or integrated QI and Patient Safety Frameworks, and have provided more theoretical grounding, I think these address the concerns. Moreover, details of expertise supporting the project are more clearly outlined, and this should instil confidence that papers addressing the theoretical aims of the study will be included. I also wonder about the feasibility of this review. Notwithstanding the theoretical weaknesses I can imagine that the initial search strategies will yield many hundreds of thousands of titles that require screening, and there may be insufficient resource available for this in the methods. Response: We are confident in the feasibility of the review, given our aim to profile research frameworks, specifically. Data extraction I think a bit more information is needed for the readers to understand what is meant by "QI/PS-R Focus" and "QI/PS-R Definitions" - perhaps this just relates to the theoretical positions taken? How will extractors manage those studies that report BOTH QI and PS factors? I would fully expect that there would be substantial overlap between patient safety and quality improvement. You would need to separate the two concepts and demonstrate how they align (or indeed sit in tension) Response: Thank you for this observation. I think this had been addressed by our clarification of aims. Please see reply to reviewer 1 above and below We have clarified our overall aim is identify stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks), and not necessarily hybrid approaches only, which are in their infancy. Additionally, we have clarified that the results of the scoping review will be used to develop a meta-framework, the methodology for which is beyond the parameters of the scoping review protocol. “The aim of this scoping review is to identify and describe the conceptual frameworks relating to stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks) in healthcare. The research questions guiding this review are: 1. What conceptual frameworks are available for Quality Improvement and/or Patient Safety Research and how have they been applied in healthcare? 2. How are the concepts of QI and patient safety research defined in available Quality Improvement and/or Patient Safety Research Frameworks? 3. What are the reported objectives of available Quality Improvement and/or Patient Safety Research frameworks? 4. What domains and sub-domains are addressed in available Quality Improvement and/or Patient Safety Research Frameworks? 5. What structure-, process- and outcome- related indicators are used in available Quality Improvement and/or Patient Safety Research Frameworks? 6. What criteria for research priorities have been established? 7. What research priorities have been established? Scoping review findings will be used to inform the development of a meta-framework that will be used to guide QI and patient safety research related priority setting, measurement and monitoring, implementation, and knowledge translation activities in Ireland.” Competing Interests: No competing interests to disclose Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Okesanya OJ. Reviewer Report For: Development of a Quality Improvement and Patient Safety Research Conceptual Framework to Inform Research Priorities for the Irish Healthcare System: Protocol for a Scoping Review [version 1; peer review: 2 not approved] . HRB Open Res 2025, 8 :92 ( https://doi.org/10.21956/hrbopenres.15586.r50211 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-92/v1#referee-response-50211 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 22 Nov 2025 Olalekan John Okesanya , Neuropsychiatric Hospital, Aro, Nigeria Not Approved VIEWS 0 https://doi.org/10.21956/hrbopenres.15586.r50211 The paper suffers from multiple deficiencies, as mentioned below, which diminish its academic value. The paper aims to integrate quality improvement (QI) and patient safety (PS), though the scarcity of a clear theoretical model linking these concepts hinders ... Continue reading READ ALL The paper suffers from multiple deficiencies, as mentioned below, which diminish its academic value. The paper aims to integrate quality improvement (QI) and patient safety (PS), though the scarcity of a clear theoretical model linking these concepts hinders the strength of the proposed meta-framework with insufficient explanation of their connection. Moreover, while “knowledge user engagement” is emphasised, the protocol offers minimal discussion on the participatory mechanisms involved. The omission of concrete example regarding decision-making structures leaves the co-creation assertion somewhat unsupported. Also, the authors state ethical approval is unnecessary yet moral considerations in stakeholder engagement and interpretation are overlooked parting the ethical structure incomplete. Equally, although dual independent reviewers are noted, key details about their training and calibration are left out this failure raises concerns regarding consistency in inclusion decisions and inter rater reliability. In addition, the draft extraction template is presented, though it is vague in relation to coding schemes and variable definitions, making it difficult to understand the way multi-domain data will be categorized. Furthermore, the review’s findings aim to contribute to a conceptual framework, but the process for developing this framework remains unaddressed, making it unclear whether it should be inductively derived or theoretically imposed. Meanwhile, covidence is mentioned, lacking elaboration on how data validation, version control and reviewer calibration will be managed raising concerns about internal consistency and data integrity. Then, the adherence to JBI and PRISMA-ScR guidelines is outlined though procedural details on how these frameworks will be executed remain inadequately clarified. The shortcoming of explicit inclusion thresholds and screening examples impacts the review’s reproducibility, rendering it questionable. Subsequently, the research plans to retrieve multiple frameworks addressing similar concepts, yet a method for reconciling duplicates as well as overlaps is absent which could result in data redundancy, distorting the synthesis. Finally, the Irish healthcare system is described in broad terms, without addressing system-specific factors that could influence the research, limiting its ability to provide contextually relevant recommendations. Is the rationale for, and objectives of, the study clearly described? No Is the study design appropriate for the research question? No Are sufficient details of the methods provided to allow replication by others? No Are the datasets clearly presented in a useable and accessible format? No Competing Interests: No competing interests were disclosed. Reviewer Expertise: IoT, Health care, AI and Cloud I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Okesanya OJ. Reviewer Report For: Development of a Quality Improvement and Patient Safety Research Conceptual Framework to Inform Research Priorities for the Irish Healthcare System: Protocol for a Scoping Review [version 1; peer review: 2 not approved] . HRB Open Res 2025, 8 :92 ( https://doi.org/10.21956/hrbopenres.15586.r50211 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-92/v1#referee-response-50211 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 11 Feb 2026 John McCaffrey , School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland 11 Feb 2026 Author Response Thank you for time and expertise in providing the peer review. We have reflected on each of the comments and provide the below clarifications and revisions, which have strengthened and ... Continue reading Thank you for time and expertise in providing the peer review. We have reflected on each of the comments and provide the below clarifications and revisions, which have strengthened and clarified the academic value of our planned study. Theoretical Rationale for Study Research Questions The paper aims to integrate quality improvement (QI) and patient safety (PS), though the scarcity of a clear theoretical model linking these concepts hinders the strength of the proposed meta-framework with insufficient explanation of their connection. Response: We have revised the study background to make clear the conceptual overlap between QI Research and Patient Safety Research and have clarified the study aims and objectives. We are aware that QI Research Frameworks exist in the literature, as do Patient Safety Research Frameworks. These are valid and are required to guide researchers in their fields. We have added a definition of a framework to the introductory paragraph: A framework is considered ‘a structure, overview, outline, system or plan consisting of various descriptive categories, e.g. concepts, constructs or variables, and the relations between them that are presumed to account for a phenomenon’ 1 Nilsen, P. Making Sense of Implementation Theories, Models, and Frameworks. In: Albers, B., Shlonsky, A., Mildon, R. (eds) Implementation Science 3.0. 2020. Springer, Cham. https://doi.org/10.1007/978-3-030-03874-8. We are also aware that both QI research and Patient Safety research address overlapping goals (i.e. contributing to knowledge to enhance safety), and while we are aware of some recent frameworks that guide both QI and Patient Safety Research (e.g. Canadian Patient Safety Institute (2020) A Guide to Patient Safety Improvement: Integrating Knowledge Translation & Quality Improvement Approaches), there is no systematic collation of such frameworks available from the literature that we could identify. The availability of existing frameworks like this strengthens our proposal to develop a meta-framework, which could be used partially or in-full dependent on the needs of end-users such as those within our diverse network. For example, researchers may take guidance from a full meta-framework or elements of it, dependent on their context or the aims of their study. For health professionals, there has been a call to integrate quality improvement and patient safety research in clinical education ( Wong et al., 2020) which a meta-framework could support . In essence, individual QI and Patient Safety Research Frameworks are still required, but since they are part of the knowledge generation and translation continuum that aims to improve safety, a meta-research framework is required to reflect and understand the co-occurring approaches to improving patient safety in practice. As such, the primary aim of this scoping review is to profile stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research Frameworks). Thereafter, at the end of the scoping review study, we will use this understanding to inform the development of a meta-framework. We appreciate this was not sufficiently clear in the original submission. We have added the below paragraph on the rationale for combining the QI and patient safety research frameworks, and have clarified our review aims and objectives. “ Rationale for combining Quality Improvement and Patient Safety Research Framework The US Institute of Medicine have long established patient safety, alongside timeliness, effectiveness, efficiency, equity and patient centredness, as a core goal of quality in healthcare (IOM, 2001). Since QI methodologies use data for diagnosing improvement opportunities in healthcare systems and for implementing and monitoring improvements in system performance, there are natural conceptual overlaps between the study of improvement and patient safety research. For example, in healthcare settings, QI methodology (e.g. PDSA) is regularly used to help implement, monitor, and adapt patient safety interventions (e.g. safe surgery checklist) over time with the goal of improving safety. At the same time, using routine and additional data sources, researchers examine implementation and effectiveness outcomes (e.g. compliance with safe surgery checklist and surgical outcomes) to inform decision-making about adoption of policies and practices. To reflect the multiple approaches to improving safety in practice, researchers require guidance about selecting evaluation foci and research methodology. For example, a recent Canadian Patient Safety Institute publication, offers guidance on how to combine quality improvement and implementation science research frameworks in efforts to enhance patient safety (CPSI, 2020). Additionally, there was a recent call for QIPS to be combined in clinical education (Wong et al., 2022). Currently there is no known collated body of literature which profiles stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research Frameworks) and guides on how these may be best utilised.” Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. National Academies Press; 2001. Canadian Patient Safety Institute. A Guide to Patient Safety Improvement: Integrating Knowledge Translation & Quality Improvement Approaches. Edmonton, Alberta; 2020 We have clarified our overall aim is identify stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks), and not necessarily hybrid approaches only, which are in their infancy. Additionally, we have clarified that the results of the scoping review will be used to develop a meta-framework, the methodology for which is beyond the parameters of the scoping review protocol. “The aim of this scoping review is to identify and describe the conceptual frameworks relating to stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks) in healthcare. The research questions guiding this review are: 1. What conceptual frameworks are available for Quality Improvement and/or Patient Safety Research and how have they been applied in healthcare? 2. How are the concepts of QI and patient safety research defined in available Quality Improvement and/or Patient Safety Research Frameworks? 3. What are the reported objectives of available Quality Improvement and/or Patient Safety Research frameworks? 4. What domains and sub-domains are addressed in available Quality Improvement and/or Patient Safety Research Frameworks? 5. What structure-, process- and outcome- related indicators are used in available Quality Improvement and/or Patient Safety Research Frameworks? 6. What criteria for research priorities have been established? 7. What research priorities have been established? Scoping review findings will be used to inform the development of a meta-framework that will be used to guide QI and patient safety research related priority setting, measurement and monitoring, implementation, and knowledge translation activities in Ireland.” Participatory Mechanisms for Knowledge User Engagement Moreover, while “knowledge user engagement” is emphasised, the protocol offers minimal discussion on the participatory mechanisms involved. The omission of concrete example regarding decision-making structures leaves the co-creation assertion somewhat unsupported. Response: Thank you for this observation. We have added the below paragraph to the section on knowledge-user engagement and co-creation. “The overall participatory mechanism for knowledge user engagement with the planned scoping review is the existing schedule of regular online meetings as part of EQUIPS Strand 2 work programme. The scoping review is a standing agenda item at these meetings, which are chaired by the EQUIPS Research Network Manager. The meetings are facilitated with the aim of giving equal voice to researchers and knowledge users. For example, using the meeting forum, knowledge users themselves continually decide how they would like to be included, and contribute to the review. Outputs from the Strand meetings are reported by the Network Manager to the wider network, including its steering committee, whom are responsible for ensuring that strand outputs are used to fulfil the network’s work programme”. Ethical Considerations Also, the authors state ethical approval is unnecessary yet moral considerations in stakeholder engagement and interpretation are overlooked parting the ethical structure incomplete Response: Thank you for this observation, we have expanded the ethical considerations and have included the below paragraph: “In accordance with JBI guidance 50 , there is no requirement to apply for research ethical approval for the scoping review. Knowledge users are being engaged to inform the process of how scoping review is done, and not as research participants. Nevertheless, as is best practice, ethical principles of beneficence and informed consent will be applied to the conduct of the scoping review. Knowledge users, have been informed during online Strand 2 meetings that they are free to share any relevant view and given the volunteer nature of their role in the study, are free to withdraw from participation in the scoping review team for any reason and without incurring any negative consequences from any of the individuals or organisations associated with the research.” Methodology Reviewers Equally, although dual independent reviewers are noted, key details about their training and calibration are left out this failure raises concerns regarding consistency in inclusion decisions and inter rater reliability. Response : Thank you for this observation. We have added the below to the methodology section. “Two reviewers will independently assess each of the retrieved records against eligibility criteria. To support inter-rater reliability, seven reviewers (SEM, JP, JMC, EOD, AVC, JAP, CMG) at the study selection stage comprise experienced researchers with PhDs in healthcare quality, human factors and/or health services research or equivalent experience. Titles and abstracts will be screened for relevance, followed by full-text review to examine if eligibility criteria are met. Disagreement among reviewers will be resolved by consulting a third reviewer (SEM plus one other reviewer) to reach consensus.” Additionally: “Working in teams of two across six reviewers (SEM, JP, EOD, AVC, JAP, CMG), two reviewers (with a balance of healthcare quality/human factors and health services research expertise) will use a piloted, standardised data extraction form, developed in Covidence, to independently extract data relevant to the scoping review aims (see Table 4 for draft template).” Data Extraction Template In addition, the draft extraction template is presented, though it is vague in relation to coding schemes and variable definitions, making it difficult to understand the way multi-domain data will be categorized. Response: Thank you for this observation. An updated draft extraction template is now presented, with better clarity and includes variable definitions where relevant. Please see Table 4 in the revised manuscript. Review Findings Furthermore, the review’s findings aim to contribute to a conceptual framework, but the process for developing this framework remains unaddressed, making it unclear whether it should be inductively derived or theoretically imposed . Response: Thank you for this observation. We have now clarified that our aim is to identify and describe the conceptual frameworks relating to stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks) in healthcare. While we indicate that the results will be used to contribute to a conceptual framework, describing the process for this is beyond the scope of the review protocol paper. However, we have added to the methodology section that the scoping review findings will be presented to stakeholders at a QI and Patient Safety Research Symposium and other for a. Here consultation about how the findings could be used to inform a framework for Irish context will take place. See paragraph below: “Scoping review findings will be presented at a dedicated QI and Patient Safety Research symposium at the RCSI University of Medicine & Health Sciences and other fora. Here consultation will take place with stakeholders (i.e. healthcare professionals, healthcare managers, researchers, academics, patient representatives, research funders, and EQUIPS members). Discussion will focus on how the findings may be used to develop a QI and Patient Safety Research Conceptual Framework and inform the prioritisation of research topics and methodologies within the context of the Irish healthcare system.” In addition, we have updated the title of the scoping review protocol to make this more clear. “Profiling and Mapping Quality Improvement and Patient Safety Research Frameworks: Protocol for a Scoping Review to Guide Integration” Covidence Meanwhile, C ovidence is mentioned, lacking elaboration on how data validation, version control and reviewer calibration will be managed raising concerns about internal consistency and data integrity. Response: Thank you for this observation. We have updated the data extraction section as below to address these concerns. “To support consistency of the process and version control, the extraction template will be finalised and agreed prior to its use it the study. Disagreement among reviewers will be resolved by a third reviewer. To maintain consistency, all consensus decisions will be led be author SEM with at least two other reviewers present.” Adherence to JBI and PRISMA-ScR Then, the adherence to JBI and PRISMA-ScR guidelines is outlined though procedural details on how these frameworks will be executed remain inadequately clarified. The shortcoming of explicit inclusion thresholds and screening examples impacts the review’s reproducibility, rendering it questionable. Subsequently, the research plans to retrieve multiple frameworks addressing similar concepts, yet a method for reconciling duplicates as well as overlaps is absent which could result in data redundancy, distorting the synthesis. Response: Thank you for this observation. We believe the inclusion of a detailed data extraction template addresses the concern about application of JBI and PRISMA-ScR guidelines. To address the issue of inclusion thresholds we have added the below statement under the study eligibility criteria “Inclusion thresholds include that papers must address one of the two central scoping review themes: (1) QI and/or patient safety research frameworks and (2) QI and/or patient safety research priorities”. To address the issue of duplicates, papers which address the same framework will be included as a supporting reference, but the framework will only be described once in the scoping review report. “Where multiple papers describe the same research frameworks, all papers will be included in the review as supporting references, with the research framework itself only being described once in the scoping review findings”. Contextual Relevance – Irish Healthcare System Finally, the Irish healthcare system is described in broad terms, without addressing system-specific factors that could influence the research, limiting its ability to provide contextually relevant recommendations. Response: Thank you for this observation which is well founded. As we have now revised the study aim (to produce a scoping review) over production of a conceptual framework, this critique means our scoping review findings ought to be contextualised with the context of the Irish healthcare system. Planned consultation with stakeholders at the QI and patient safety research symposium will enable this. We have updated the methodology as below: “Scoping review findings will be presented at a dedicated QI and Patient Safety Research symposium at the RCSI University of Medicine & Health Sciences and other fora. Here consultation will take place with stakeholders (i.e healthcare. professionals, healthcare managers, researchers, academics, patient representatives, research funders, and EQUIPS members) on how the findings may be used to develop a research conceptual framework and inform research prioritisation exercises within the context of the Irish healthcare system”. Thank you for time and expertise in providing the peer review. We have reflected on each of the comments and provide the below clarifications and revisions, which have strengthened and clarified the academic value of our planned study. Theoretical Rationale for Study Research Questions The paper aims to integrate quality improvement (QI) and patient safety (PS), though the scarcity of a clear theoretical model linking these concepts hinders the strength of the proposed meta-framework with insufficient explanation of their connection. Response: We have revised the study background to make clear the conceptual overlap between QI Research and Patient Safety Research and have clarified the study aims and objectives. We are aware that QI Research Frameworks exist in the literature, as do Patient Safety Research Frameworks. These are valid and are required to guide researchers in their fields. We have added a definition of a framework to the introductory paragraph: A framework is considered ‘a structure, overview, outline, system or plan consisting of various descriptive categories, e.g. concepts, constructs or variables, and the relations between them that are presumed to account for a phenomenon’ 1 Nilsen, P. Making Sense of Implementation Theories, Models, and Frameworks. In: Albers, B., Shlonsky, A., Mildon, R. (eds) Implementation Science 3.0. 2020. Springer, Cham. https://doi.org/10.1007/978-3-030-03874-8. We are also aware that both QI research and Patient Safety research address overlapping goals (i.e. contributing to knowledge to enhance safety), and while we are aware of some recent frameworks that guide both QI and Patient Safety Research (e.g. Canadian Patient Safety Institute (2020) A Guide to Patient Safety Improvement: Integrating Knowledge Translation & Quality Improvement Approaches), there is no systematic collation of such frameworks available from the literature that we could identify. The availability of existing frameworks like this strengthens our proposal to develop a meta-framework, which could be used partially or in-full dependent on the needs of end-users such as those within our diverse network. For example, researchers may take guidance from a full meta-framework or elements of it, dependent on their context or the aims of their study. For health professionals, there has been a call to integrate quality improvement and patient safety research in clinical education ( Wong et al., 2020) which a meta-framework could support . In essence, individual QI and Patient Safety Research Frameworks are still required, but since they are part of the knowledge generation and translation continuum that aims to improve safety, a meta-research framework is required to reflect and understand the co-occurring approaches to improving patient safety in practice. As such, the primary aim of this scoping review is to profile stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research Frameworks). Thereafter, at the end of the scoping review study, we will use this understanding to inform the development of a meta-framework. We appreciate this was not sufficiently clear in the original submission. We have added the below paragraph on the rationale for combining the QI and patient safety research frameworks, and have clarified our review aims and objectives. “ Rationale for combining Quality Improvement and Patient Safety Research Framework The US Institute of Medicine have long established patient safety, alongside timeliness, effectiveness, efficiency, equity and patient centredness, as a core goal of quality in healthcare (IOM, 2001). Since QI methodologies use data for diagnosing improvement opportunities in healthcare systems and for implementing and monitoring improvements in system performance, there are natural conceptual overlaps between the study of improvement and patient safety research. For example, in healthcare settings, QI methodology (e.g. PDSA) is regularly used to help implement, monitor, and adapt patient safety interventions (e.g. safe surgery checklist) over time with the goal of improving safety. At the same time, using routine and additional data sources, researchers examine implementation and effectiveness outcomes (e.g. compliance with safe surgery checklist and surgical outcomes) to inform decision-making about adoption of policies and practices. To reflect the multiple approaches to improving safety in practice, researchers require guidance about selecting evaluation foci and research methodology. For example, a recent Canadian Patient Safety Institute publication, offers guidance on how to combine quality improvement and implementation science research frameworks in efforts to enhance patient safety (CPSI, 2020). Additionally, there was a recent call for QIPS to be combined in clinical education (Wong et al., 2022). Currently there is no known collated body of literature which profiles stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research Frameworks) and guides on how these may be best utilised.” Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. National Academies Press; 2001. Canadian Patient Safety Institute. A Guide to Patient Safety Improvement: Integrating Knowledge Translation & Quality Improvement Approaches. Edmonton, Alberta; 2020 We have clarified our overall aim is identify stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks), and not necessarily hybrid approaches only, which are in their infancy. Additionally, we have clarified that the results of the scoping review will be used to develop a meta-framework, the methodology for which is beyond the parameters of the scoping review protocol. “The aim of this scoping review is to identify and describe the conceptual frameworks relating to stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks) in healthcare. The research questions guiding this review are: 1. What conceptual frameworks are available for Quality Improvement and/or Patient Safety Research and how have they been applied in healthcare? 2. How are the concepts of QI and patient safety research defined in available Quality Improvement and/or Patient Safety Research Frameworks? 3. What are the reported objectives of available Quality Improvement and/or Patient Safety Research frameworks? 4. What domains and sub-domains are addressed in available Quality Improvement and/or Patient Safety Research Frameworks? 5. What structure-, process- and outcome- related indicators are used in available Quality Improvement and/or Patient Safety Research Frameworks? 6. What criteria for research priorities have been established? 7. What research priorities have been established? Scoping review findings will be used to inform the development of a meta-framework that will be used to guide QI and patient safety research related priority setting, measurement and monitoring, implementation, and knowledge translation activities in Ireland.” Participatory Mechanisms for Knowledge User Engagement Moreover, while “knowledge user engagement” is emphasised, the protocol offers minimal discussion on the participatory mechanisms involved. The omission of concrete example regarding decision-making structures leaves the co-creation assertion somewhat unsupported. Response: Thank you for this observation. We have added the below paragraph to the section on knowledge-user engagement and co-creation. “The overall participatory mechanism for knowledge user engagement with the planned scoping review is the existing schedule of regular online meetings as part of EQUIPS Strand 2 work programme. The scoping review is a standing agenda item at these meetings, which are chaired by the EQUIPS Research Network Manager. The meetings are facilitated with the aim of giving equal voice to researchers and knowledge users. For example, using the meeting forum, knowledge users themselves continually decide how they would like to be included, and contribute to the review. Outputs from the Strand meetings are reported by the Network Manager to the wider network, including its steering committee, whom are responsible for ensuring that strand outputs are used to fulfil the network’s work programme”. Ethical Considerations Also, the authors state ethical approval is unnecessary yet moral considerations in stakeholder engagement and interpretation are overlooked parting the ethical structure incomplete Response: Thank you for this observation, we have expanded the ethical considerations and have included the below paragraph: “In accordance with JBI guidance 50 , there is no requirement to apply for research ethical approval for the scoping review. Knowledge users are being engaged to inform the process of how scoping review is done, and not as research participants. Nevertheless, as is best practice, ethical principles of beneficence and informed consent will be applied to the conduct of the scoping review. Knowledge users, have been informed during online Strand 2 meetings that they are free to share any relevant view and given the volunteer nature of their role in the study, are free to withdraw from participation in the scoping review team for any reason and without incurring any negative consequences from any of the individuals or organisations associated with the research.” Methodology Reviewers Equally, although dual independent reviewers are noted, key details about their training and calibration are left out this failure raises concerns regarding consistency in inclusion decisions and inter rater reliability. Response : Thank you for this observation. We have added the below to the methodology section. “Two reviewers will independently assess each of the retrieved records against eligibility criteria. To support inter-rater reliability, seven reviewers (SEM, JP, JMC, EOD, AVC, JAP, CMG) at the study selection stage comprise experienced researchers with PhDs in healthcare quality, human factors and/or health services research or equivalent experience. Titles and abstracts will be screened for relevance, followed by full-text review to examine if eligibility criteria are met. Disagreement among reviewers will be resolved by consulting a third reviewer (SEM plus one other reviewer) to reach consensus.” Additionally: “Working in teams of two across six reviewers (SEM, JP, EOD, AVC, JAP, CMG), two reviewers (with a balance of healthcare quality/human factors and health services research expertise) will use a piloted, standardised data extraction form, developed in Covidence, to independently extract data relevant to the scoping review aims (see Table 4 for draft template).” Data Extraction Template In addition, the draft extraction template is presented, though it is vague in relation to coding schemes and variable definitions, making it difficult to understand the way multi-domain data will be categorized. Response: Thank you for this observation. An updated draft extraction template is now presented, with better clarity and includes variable definitions where relevant. Please see Table 4 in the revised manuscript. Review Findings Furthermore, the review’s findings aim to contribute to a conceptual framework, but the process for developing this framework remains unaddressed, making it unclear whether it should be inductively derived or theoretically imposed . Response: Thank you for this observation. We have now clarified that our aim is to identify and describe the conceptual frameworks relating to stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks) in healthcare. While we indicate that the results will be used to contribute to a conceptual framework, describing the process for this is beyond the scope of the review protocol paper. However, we have added to the methodology section that the scoping review findings will be presented to stakeholders at a QI and Patient Safety Research Symposium and other for a. Here consultation about how the findings could be used to inform a framework for Irish context will take place. See paragraph below: “Scoping review findings will be presented at a dedicated QI and Patient Safety Research symposium at the RCSI University of Medicine & Health Sciences and other fora. Here consultation will take place with stakeholders (i.e. healthcare professionals, healthcare managers, researchers, academics, patient representatives, research funders, and EQUIPS members). Discussion will focus on how the findings may be used to develop a QI and Patient Safety Research Conceptual Framework and inform the prioritisation of research topics and methodologies within the context of the Irish healthcare system.” In addition, we have updated the title of the scoping review protocol to make this more clear. “Profiling and Mapping Quality Improvement and Patient Safety Research Frameworks: Protocol for a Scoping Review to Guide Integration” Covidence Meanwhile, C ovidence is mentioned, lacking elaboration on how data validation, version control and reviewer calibration will be managed raising concerns about internal consistency and data integrity. Response: Thank you for this observation. We have updated the data extraction section as below to address these concerns. “To support consistency of the process and version control, the extraction template will be finalised and agreed prior to its use it the study. Disagreement among reviewers will be resolved by a third reviewer. To maintain consistency, all consensus decisions will be led be author SEM with at least two other reviewers present.” Adherence to JBI and PRISMA-ScR Then, the adherence to JBI and PRISMA-ScR guidelines is outlined though procedural details on how these frameworks will be executed remain inadequately clarified. The shortcoming of explicit inclusion thresholds and screening examples impacts the review’s reproducibility, rendering it questionable. Subsequently, the research plans to retrieve multiple frameworks addressing similar concepts, yet a method for reconciling duplicates as well as overlaps is absent which could result in data redundancy, distorting the synthesis. Response: Thank you for this observation. We believe the inclusion of a detailed data extraction template addresses the concern about application of JBI and PRISMA-ScR guidelines. To address the issue of inclusion thresholds we have added the below statement under the study eligibility criteria “Inclusion thresholds include that papers must address one of the two central scoping review themes: (1) QI and/or patient safety research frameworks and (2) QI and/or patient safety research priorities”. To address the issue of duplicates, papers which address the same framework will be included as a supporting reference, but the framework will only be described once in the scoping review report. “Where multiple papers describe the same research frameworks, all papers will be included in the review as supporting references, with the research framework itself only being described once in the scoping review findings”. Contextual Relevance – Irish Healthcare System Finally, the Irish healthcare system is described in broad terms, without addressing system-specific factors that could influence the research, limiting its ability to provide contextually relevant recommendations. Response: Thank you for this observation which is well founded. As we have now revised the study aim (to produce a scoping review) over production of a conceptual framework, this critique means our scoping review findings ought to be contextualised with the context of the Irish healthcare system. Planned consultation with stakeholders at the QI and patient safety research symposium will enable this. We have updated the methodology as below: “Scoping review findings will be presented at a dedicated QI and Patient Safety Research symposium at the RCSI University of Medicine & Health Sciences and other fora. Here consultation will take place with stakeholders (i.e healthcare. professionals, healthcare managers, researchers, academics, patient representatives, research funders, and EQUIPS members) on how the findings may be used to develop a research conceptual framework and inform research prioritisation exercises within the context of the Irish healthcare system”. Competing Interests: No competing interests to disclose Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 11 Feb 2026 John McCaffrey , School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland 11 Feb 2026 Author Response Thank you for time and expertise in providing the peer review. We have reflected on each of the comments and provide the below clarifications and revisions, which have strengthened and ... Continue reading Thank you for time and expertise in providing the peer review. We have reflected on each of the comments and provide the below clarifications and revisions, which have strengthened and clarified the academic value of our planned study. Theoretical Rationale for Study Research Questions The paper aims to integrate quality improvement (QI) and patient safety (PS), though the scarcity of a clear theoretical model linking these concepts hinders the strength of the proposed meta-framework with insufficient explanation of their connection. Response: We have revised the study background to make clear the conceptual overlap between QI Research and Patient Safety Research and have clarified the study aims and objectives. We are aware that QI Research Frameworks exist in the literature, as do Patient Safety Research Frameworks. These are valid and are required to guide researchers in their fields. We have added a definition of a framework to the introductory paragraph: A framework is considered ‘a structure, overview, outline, system or plan consisting of various descriptive categories, e.g. concepts, constructs or variables, and the relations between them that are presumed to account for a phenomenon’ 1 Nilsen, P. Making Sense of Implementation Theories, Models, and Frameworks. In: Albers, B., Shlonsky, A., Mildon, R. (eds) Implementation Science 3.0. 2020. Springer, Cham. https://doi.org/10.1007/978-3-030-03874-8. We are also aware that both QI research and Patient Safety research address overlapping goals (i.e. contributing to knowledge to enhance safety), and while we are aware of some recent frameworks that guide both QI and Patient Safety Research (e.g. Canadian Patient Safety Institute (2020) A Guide to Patient Safety Improvement: Integrating Knowledge Translation & Quality Improvement Approaches), there is no systematic collation of such frameworks available from the literature that we could identify. The availability of existing frameworks like this strengthens our proposal to develop a meta-framework, which could be used partially or in-full dependent on the needs of end-users such as those within our diverse network. For example, researchers may take guidance from a full meta-framework or elements of it, dependent on their context or the aims of their study. For health professionals, there has been a call to integrate quality improvement and patient safety research in clinical education ( Wong et al., 2020) which a meta-framework could support . In essence, individual QI and Patient Safety Research Frameworks are still required, but since they are part of the knowledge generation and translation continuum that aims to improve safety, a meta-research framework is required to reflect and understand the co-occurring approaches to improving patient safety in practice. As such, the primary aim of this scoping review is to profile stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research Frameworks). Thereafter, at the end of the scoping review study, we will use this understanding to inform the development of a meta-framework. We appreciate this was not sufficiently clear in the original submission. We have added the below paragraph on the rationale for combining the QI and patient safety research frameworks, and have clarified our review aims and objectives. “ Rationale for combining Quality Improvement and Patient Safety Research Framework The US Institute of Medicine have long established patient safety, alongside timeliness, effectiveness, efficiency, equity and patient centredness, as a core goal of quality in healthcare (IOM, 2001). Since QI methodologies use data for diagnosing improvement opportunities in healthcare systems and for implementing and monitoring improvements in system performance, there are natural conceptual overlaps between the study of improvement and patient safety research. For example, in healthcare settings, QI methodology (e.g. PDSA) is regularly used to help implement, monitor, and adapt patient safety interventions (e.g. safe surgery checklist) over time with the goal of improving safety. At the same time, using routine and additional data sources, researchers examine implementation and effectiveness outcomes (e.g. compliance with safe surgery checklist and surgical outcomes) to inform decision-making about adoption of policies and practices. To reflect the multiple approaches to improving safety in practice, researchers require guidance about selecting evaluation foci and research methodology. For example, a recent Canadian Patient Safety Institute publication, offers guidance on how to combine quality improvement and implementation science research frameworks in efforts to enhance patient safety (CPSI, 2020). Additionally, there was a recent call for QIPS to be combined in clinical education (Wong et al., 2022). Currently there is no known collated body of literature which profiles stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research Frameworks) and guides on how these may be best utilised.” Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. National Academies Press; 2001. Canadian Patient Safety Institute. A Guide to Patient Safety Improvement: Integrating Knowledge Translation & Quality Improvement Approaches. Edmonton, Alberta; 2020 We have clarified our overall aim is identify stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks), and not necessarily hybrid approaches only, which are in their infancy. Additionally, we have clarified that the results of the scoping review will be used to develop a meta-framework, the methodology for which is beyond the parameters of the scoping review protocol. “The aim of this scoping review is to identify and describe the conceptual frameworks relating to stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks) in healthcare. The research questions guiding this review are: 1. What conceptual frameworks are available for Quality Improvement and/or Patient Safety Research and how have they been applied in healthcare? 2. How are the concepts of QI and patient safety research defined in available Quality Improvement and/or Patient Safety Research Frameworks? 3. What are the reported objectives of available Quality Improvement and/or Patient Safety Research frameworks? 4. What domains and sub-domains are addressed in available Quality Improvement and/or Patient Safety Research Frameworks? 5. What structure-, process- and outcome- related indicators are used in available Quality Improvement and/or Patient Safety Research Frameworks? 6. What criteria for research priorities have been established? 7. What research priorities have been established? Scoping review findings will be used to inform the development of a meta-framework that will be used to guide QI and patient safety research related priority setting, measurement and monitoring, implementation, and knowledge translation activities in Ireland.” Participatory Mechanisms for Knowledge User Engagement Moreover, while “knowledge user engagement” is emphasised, the protocol offers minimal discussion on the participatory mechanisms involved. The omission of concrete example regarding decision-making structures leaves the co-creation assertion somewhat unsupported. Response: Thank you for this observation. We have added the below paragraph to the section on knowledge-user engagement and co-creation. “The overall participatory mechanism for knowledge user engagement with the planned scoping review is the existing schedule of regular online meetings as part of EQUIPS Strand 2 work programme. The scoping review is a standing agenda item at these meetings, which are chaired by the EQUIPS Research Network Manager. The meetings are facilitated with the aim of giving equal voice to researchers and knowledge users. For example, using the meeting forum, knowledge users themselves continually decide how they would like to be included, and contribute to the review. Outputs from the Strand meetings are reported by the Network Manager to the wider network, including its steering committee, whom are responsible for ensuring that strand outputs are used to fulfil the network’s work programme”. Ethical Considerations Also, the authors state ethical approval is unnecessary yet moral considerations in stakeholder engagement and interpretation are overlooked parting the ethical structure incomplete Response: Thank you for this observation, we have expanded the ethical considerations and have included the below paragraph: “In accordance with JBI guidance 50 , there is no requirement to apply for research ethical approval for the scoping review. Knowledge users are being engaged to inform the process of how scoping review is done, and not as research participants. Nevertheless, as is best practice, ethical principles of beneficence and informed consent will be applied to the conduct of the scoping review. Knowledge users, have been informed during online Strand 2 meetings that they are free to share any relevant view and given the volunteer nature of their role in the study, are free to withdraw from participation in the scoping review team for any reason and without incurring any negative consequences from any of the individuals or organisations associated with the research.” Methodology Reviewers Equally, although dual independent reviewers are noted, key details about their training and calibration are left out this failure raises concerns regarding consistency in inclusion decisions and inter rater reliability. Response : Thank you for this observation. We have added the below to the methodology section. “Two reviewers will independently assess each of the retrieved records against eligibility criteria. To support inter-rater reliability, seven reviewers (SEM, JP, JMC, EOD, AVC, JAP, CMG) at the study selection stage comprise experienced researchers with PhDs in healthcare quality, human factors and/or health services research or equivalent experience. Titles and abstracts will be screened for relevance, followed by full-text review to examine if eligibility criteria are met. Disagreement among reviewers will be resolved by consulting a third reviewer (SEM plus one other reviewer) to reach consensus.” Additionally: “Working in teams of two across six reviewers (SEM, JP, EOD, AVC, JAP, CMG), two reviewers (with a balance of healthcare quality/human factors and health services research expertise) will use a piloted, standardised data extraction form, developed in Covidence, to independently extract data relevant to the scoping review aims (see Table 4 for draft template).” Data Extraction Template In addition, the draft extraction template is presented, though it is vague in relation to coding schemes and variable definitions, making it difficult to understand the way multi-domain data will be categorized. Response: Thank you for this observation. An updated draft extraction template is now presented, with better clarity and includes variable definitions where relevant. Please see Table 4 in the revised manuscript. Review Findings Furthermore, the review’s findings aim to contribute to a conceptual framework, but the process for developing this framework remains unaddressed, making it unclear whether it should be inductively derived or theoretically imposed . Response: Thank you for this observation. We have now clarified that our aim is to identify and describe the conceptual frameworks relating to stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks) in healthcare. While we indicate that the results will be used to contribute to a conceptual framework, describing the process for this is beyond the scope of the review protocol paper. However, we have added to the methodology section that the scoping review findings will be presented to stakeholders at a QI and Patient Safety Research Symposium and other for a. Here consultation about how the findings could be used to inform a framework for Irish context will take place. See paragraph below: “Scoping review findings will be presented at a dedicated QI and Patient Safety Research symposium at the RCSI University of Medicine & Health Sciences and other fora. Here consultation will take place with stakeholders (i.e. healthcare professionals, healthcare managers, researchers, academics, patient representatives, research funders, and EQUIPS members). Discussion will focus on how the findings may be used to develop a QI and Patient Safety Research Conceptual Framework and inform the prioritisation of research topics and methodologies within the context of the Irish healthcare system.” In addition, we have updated the title of the scoping review protocol to make this more clear. “Profiling and Mapping Quality Improvement and Patient Safety Research Frameworks: Protocol for a Scoping Review to Guide Integration” Covidence Meanwhile, C ovidence is mentioned, lacking elaboration on how data validation, version control and reviewer calibration will be managed raising concerns about internal consistency and data integrity. Response: Thank you for this observation. We have updated the data extraction section as below to address these concerns. “To support consistency of the process and version control, the extraction template will be finalised and agreed prior to its use it the study. Disagreement among reviewers will be resolved by a third reviewer. To maintain consistency, all consensus decisions will be led be author SEM with at least two other reviewers present.” Adherence to JBI and PRISMA-ScR Then, the adherence to JBI and PRISMA-ScR guidelines is outlined though procedural details on how these frameworks will be executed remain inadequately clarified. The shortcoming of explicit inclusion thresholds and screening examples impacts the review’s reproducibility, rendering it questionable. Subsequently, the research plans to retrieve multiple frameworks addressing similar concepts, yet a method for reconciling duplicates as well as overlaps is absent which could result in data redundancy, distorting the synthesis. Response: Thank you for this observation. We believe the inclusion of a detailed data extraction template addresses the concern about application of JBI and PRISMA-ScR guidelines. To address the issue of inclusion thresholds we have added the below statement under the study eligibility criteria “Inclusion thresholds include that papers must address one of the two central scoping review themes: (1) QI and/or patient safety research frameworks and (2) QI and/or patient safety research priorities”. To address the issue of duplicates, papers which address the same framework will be included as a supporting reference, but the framework will only be described once in the scoping review report. “Where multiple papers describe the same research frameworks, all papers will be included in the review as supporting references, with the research framework itself only being described once in the scoping review findings”. Contextual Relevance – Irish Healthcare System Finally, the Irish healthcare system is described in broad terms, without addressing system-specific factors that could influence the research, limiting its ability to provide contextually relevant recommendations. Response: Thank you for this observation which is well founded. As we have now revised the study aim (to produce a scoping review) over production of a conceptual framework, this critique means our scoping review findings ought to be contextualised with the context of the Irish healthcare system. Planned consultation with stakeholders at the QI and patient safety research symposium will enable this. We have updated the methodology as below: “Scoping review findings will be presented at a dedicated QI and Patient Safety Research symposium at the RCSI University of Medicine & Health Sciences and other fora. Here consultation will take place with stakeholders (i.e healthcare. professionals, healthcare managers, researchers, academics, patient representatives, research funders, and EQUIPS members) on how the findings may be used to develop a research conceptual framework and inform research prioritisation exercises within the context of the Irish healthcare system”. Thank you for time and expertise in providing the peer review. We have reflected on each of the comments and provide the below clarifications and revisions, which have strengthened and clarified the academic value of our planned study. Theoretical Rationale for Study Research Questions The paper aims to integrate quality improvement (QI) and patient safety (PS), though the scarcity of a clear theoretical model linking these concepts hinders the strength of the proposed meta-framework with insufficient explanation of their connection. Response: We have revised the study background to make clear the conceptual overlap between QI Research and Patient Safety Research and have clarified the study aims and objectives. We are aware that QI Research Frameworks exist in the literature, as do Patient Safety Research Frameworks. These are valid and are required to guide researchers in their fields. We have added a definition of a framework to the introductory paragraph: A framework is considered ‘a structure, overview, outline, system or plan consisting of various descriptive categories, e.g. concepts, constructs or variables, and the relations between them that are presumed to account for a phenomenon’ 1 Nilsen, P. Making Sense of Implementation Theories, Models, and Frameworks. In: Albers, B., Shlonsky, A., Mildon, R. (eds) Implementation Science 3.0. 2020. Springer, Cham. https://doi.org/10.1007/978-3-030-03874-8. We are also aware that both QI research and Patient Safety research address overlapping goals (i.e. contributing to knowledge to enhance safety), and while we are aware of some recent frameworks that guide both QI and Patient Safety Research (e.g. Canadian Patient Safety Institute (2020) A Guide to Patient Safety Improvement: Integrating Knowledge Translation & Quality Improvement Approaches), there is no systematic collation of such frameworks available from the literature that we could identify. The availability of existing frameworks like this strengthens our proposal to develop a meta-framework, which could be used partially or in-full dependent on the needs of end-users such as those within our diverse network. For example, researchers may take guidance from a full meta-framework or elements of it, dependent on their context or the aims of their study. For health professionals, there has been a call to integrate quality improvement and patient safety research in clinical education ( Wong et al., 2020) which a meta-framework could support . In essence, individual QI and Patient Safety Research Frameworks are still required, but since they are part of the knowledge generation and translation continuum that aims to improve safety, a meta-research framework is required to reflect and understand the co-occurring approaches to improving patient safety in practice. As such, the primary aim of this scoping review is to profile stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research Frameworks). Thereafter, at the end of the scoping review study, we will use this understanding to inform the development of a meta-framework. We appreciate this was not sufficiently clear in the original submission. We have added the below paragraph on the rationale for combining the QI and patient safety research frameworks, and have clarified our review aims and objectives. “ Rationale for combining Quality Improvement and Patient Safety Research Framework The US Institute of Medicine have long established patient safety, alongside timeliness, effectiveness, efficiency, equity and patient centredness, as a core goal of quality in healthcare (IOM, 2001). Since QI methodologies use data for diagnosing improvement opportunities in healthcare systems and for implementing and monitoring improvements in system performance, there are natural conceptual overlaps between the study of improvement and patient safety research. For example, in healthcare settings, QI methodology (e.g. PDSA) is regularly used to help implement, monitor, and adapt patient safety interventions (e.g. safe surgery checklist) over time with the goal of improving safety. At the same time, using routine and additional data sources, researchers examine implementation and effectiveness outcomes (e.g. compliance with safe surgery checklist and surgical outcomes) to inform decision-making about adoption of policies and practices. To reflect the multiple approaches to improving safety in practice, researchers require guidance about selecting evaluation foci and research methodology. For example, a recent Canadian Patient Safety Institute publication, offers guidance on how to combine quality improvement and implementation science research frameworks in efforts to enhance patient safety (CPSI, 2020). Additionally, there was a recent call for QIPS to be combined in clinical education (Wong et al., 2022). Currently there is no known collated body of literature which profiles stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research Frameworks) and guides on how these may be best utilised.” Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. National Academies Press; 2001. Canadian Patient Safety Institute. A Guide to Patient Safety Improvement: Integrating Knowledge Translation & Quality Improvement Approaches. Edmonton, Alberta; 2020 We have clarified our overall aim is identify stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks), and not necessarily hybrid approaches only, which are in their infancy. Additionally, we have clarified that the results of the scoping review will be used to develop a meta-framework, the methodology for which is beyond the parameters of the scoping review protocol. “The aim of this scoping review is to identify and describe the conceptual frameworks relating to stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks) in healthcare. The research questions guiding this review are: 1. What conceptual frameworks are available for Quality Improvement and/or Patient Safety Research and how have they been applied in healthcare? 2. How are the concepts of QI and patient safety research defined in available Quality Improvement and/or Patient Safety Research Frameworks? 3. What are the reported objectives of available Quality Improvement and/or Patient Safety Research frameworks? 4. What domains and sub-domains are addressed in available Quality Improvement and/or Patient Safety Research Frameworks? 5. What structure-, process- and outcome- related indicators are used in available Quality Improvement and/or Patient Safety Research Frameworks? 6. What criteria for research priorities have been established? 7. What research priorities have been established? Scoping review findings will be used to inform the development of a meta-framework that will be used to guide QI and patient safety research related priority setting, measurement and monitoring, implementation, and knowledge translation activities in Ireland.” Participatory Mechanisms for Knowledge User Engagement Moreover, while “knowledge user engagement” is emphasised, the protocol offers minimal discussion on the participatory mechanisms involved. The omission of concrete example regarding decision-making structures leaves the co-creation assertion somewhat unsupported. Response: Thank you for this observation. We have added the below paragraph to the section on knowledge-user engagement and co-creation. “The overall participatory mechanism for knowledge user engagement with the planned scoping review is the existing schedule of regular online meetings as part of EQUIPS Strand 2 work programme. The scoping review is a standing agenda item at these meetings, which are chaired by the EQUIPS Research Network Manager. The meetings are facilitated with the aim of giving equal voice to researchers and knowledge users. For example, using the meeting forum, knowledge users themselves continually decide how they would like to be included, and contribute to the review. Outputs from the Strand meetings are reported by the Network Manager to the wider network, including its steering committee, whom are responsible for ensuring that strand outputs are used to fulfil the network’s work programme”. Ethical Considerations Also, the authors state ethical approval is unnecessary yet moral considerations in stakeholder engagement and interpretation are overlooked parting the ethical structure incomplete Response: Thank you for this observation, we have expanded the ethical considerations and have included the below paragraph: “In accordance with JBI guidance 50 , there is no requirement to apply for research ethical approval for the scoping review. Knowledge users are being engaged to inform the process of how scoping review is done, and not as research participants. Nevertheless, as is best practice, ethical principles of beneficence and informed consent will be applied to the conduct of the scoping review. Knowledge users, have been informed during online Strand 2 meetings that they are free to share any relevant view and given the volunteer nature of their role in the study, are free to withdraw from participation in the scoping review team for any reason and without incurring any negative consequences from any of the individuals or organisations associated with the research.” Methodology Reviewers Equally, although dual independent reviewers are noted, key details about their training and calibration are left out this failure raises concerns regarding consistency in inclusion decisions and inter rater reliability. Response : Thank you for this observation. We have added the below to the methodology section. “Two reviewers will independently assess each of the retrieved records against eligibility criteria. To support inter-rater reliability, seven reviewers (SEM, JP, JMC, EOD, AVC, JAP, CMG) at the study selection stage comprise experienced researchers with PhDs in healthcare quality, human factors and/or health services research or equivalent experience. Titles and abstracts will be screened for relevance, followed by full-text review to examine if eligibility criteria are met. Disagreement among reviewers will be resolved by consulting a third reviewer (SEM plus one other reviewer) to reach consensus.” Additionally: “Working in teams of two across six reviewers (SEM, JP, EOD, AVC, JAP, CMG), two reviewers (with a balance of healthcare quality/human factors and health services research expertise) will use a piloted, standardised data extraction form, developed in Covidence, to independently extract data relevant to the scoping review aims (see Table 4 for draft template).” Data Extraction Template In addition, the draft extraction template is presented, though it is vague in relation to coding schemes and variable definitions, making it difficult to understand the way multi-domain data will be categorized. Response: Thank you for this observation. An updated draft extraction template is now presented, with better clarity and includes variable definitions where relevant. Please see Table 4 in the revised manuscript. Review Findings Furthermore, the review’s findings aim to contribute to a conceptual framework, but the process for developing this framework remains unaddressed, making it unclear whether it should be inductively derived or theoretically imposed . Response: Thank you for this observation. We have now clarified that our aim is to identify and describe the conceptual frameworks relating to stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks) in healthcare. While we indicate that the results will be used to contribute to a conceptual framework, describing the process for this is beyond the scope of the review protocol paper. However, we have added to the methodology section that the scoping review findings will be presented to stakeholders at a QI and Patient Safety Research Symposium and other for a. Here consultation about how the findings could be used to inform a framework for Irish context will take place. See paragraph below: “Scoping review findings will be presented at a dedicated QI and Patient Safety Research symposium at the RCSI University of Medicine & Health Sciences and other fora. Here consultation will take place with stakeholders (i.e. healthcare professionals, healthcare managers, researchers, academics, patient representatives, research funders, and EQUIPS members). Discussion will focus on how the findings may be used to develop a QI and Patient Safety Research Conceptual Framework and inform the prioritisation of research topics and methodologies within the context of the Irish healthcare system.” In addition, we have updated the title of the scoping review protocol to make this more clear. “Profiling and Mapping Quality Improvement and Patient Safety Research Frameworks: Protocol for a Scoping Review to Guide Integration” Covidence Meanwhile, C ovidence is mentioned, lacking elaboration on how data validation, version control and reviewer calibration will be managed raising concerns about internal consistency and data integrity. Response: Thank you for this observation. We have updated the data extraction section as below to address these concerns. “To support consistency of the process and version control, the extraction template will be finalised and agreed prior to its use it the study. Disagreement among reviewers will be resolved by a third reviewer. To maintain consistency, all consensus decisions will be led be author SEM with at least two other reviewers present.” Adherence to JBI and PRISMA-ScR Then, the adherence to JBI and PRISMA-ScR guidelines is outlined though procedural details on how these frameworks will be executed remain inadequately clarified. The shortcoming of explicit inclusion thresholds and screening examples impacts the review’s reproducibility, rendering it questionable. Subsequently, the research plans to retrieve multiple frameworks addressing similar concepts, yet a method for reconciling duplicates as well as overlaps is absent which could result in data redundancy, distorting the synthesis. Response: Thank you for this observation. We believe the inclusion of a detailed data extraction template addresses the concern about application of JBI and PRISMA-ScR guidelines. To address the issue of inclusion thresholds we have added the below statement under the study eligibility criteria “Inclusion thresholds include that papers must address one of the two central scoping review themes: (1) QI and/or patient safety research frameworks and (2) QI and/or patient safety research priorities”. To address the issue of duplicates, papers which address the same framework will be included as a supporting reference, but the framework will only be described once in the scoping review report. “Where multiple papers describe the same research frameworks, all papers will be included in the review as supporting references, with the research framework itself only being described once in the scoping review findings”. Contextual Relevance – Irish Healthcare System Finally, the Irish healthcare system is described in broad terms, without addressing system-specific factors that could influence the research, limiting its ability to provide contextually relevant recommendations. Response: Thank you for this observation which is well founded. As we have now revised the study aim (to produce a scoping review) over production of a conceptual framework, this critique means our scoping review findings ought to be contextualised with the context of the Irish healthcare system. Planned consultation with stakeholders at the QI and patient safety research symposium will enable this. We have updated the methodology as below: “Scoping review findings will be presented at a dedicated QI and Patient Safety Research symposium at the RCSI University of Medicine & Health Sciences and other fora. Here consultation will take place with stakeholders (i.e healthcare. professionals, healthcare managers, researchers, academics, patient representatives, research funders, and EQUIPS members) on how the findings may be used to develop a research conceptual framework and inform research prioritisation exercises within the context of the Irish healthcare system”. Competing Interests: No competing interests to disclose Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 18 Aug 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 4 5 Version 3 (revision) 28 Apr 26 Version 2 (revision) 11 Feb 26 read read read Version 1 18 Aug 25 read read Olalekan John Okesanya , Neuropsychiatric Hospital, Aro, Nigeria Adam B Sutherland , University of Bradford, Bradford, UK Kassu Jilcha , Addis Ababa University, Addis Ababa, Ethiopia Mary Lavelle , Queen's University Belfast, Belfast, UK Anthony J Montgomery , Northumbria University Newcastle, Newcastle, UK Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Montgomery A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 01 Apr 2026 | for Version 2 Anthony J Montgomery , Northumbria University Newcastle, Newcastle, England, UK 0 Views copyright © 2026 Montgomery A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I had the benefit of reading the reviews of three previous reviewers and the response of the authors. It's obvious that the authors have addressed the many technical questions posed by the previous reviewers. Therefore, I will comment on some of the conceptual issues. The basic idea to conduct a scoping review on the research frameworks that guide patient safety and QI research is a worthy one. I am very happy to approve this study, and the following comments should be considered as suggestive, not obligatory. 1. It would be helpful for the reader to understand why a scoping review is the best way forward. I assume the scoping review approach reflects the fact that the area is heterogeneous and a little 'scattered', but it would be helpful to comment on this a little. 2. Some examples of the research frameworks that already exist would be helpful for the reader. Also, a 'tighter' definition of what is meant by a research framework would be helpful. It sounds a little generic at the moment. For example, what is not a research framework? Will the authors be using inductive/abductive methods to delineate what research frameworks exist? 3. The research aims are mostly clear. I was just wondering with regard to the first aim, how the authors meant by 'what conceptual frameworks are available' - what is meant by 'available'? 4. The authors intend to develop a meta-framework, but does this not depend on the quality of the frameworks in existence? For example, if the scoping review finds that the majority of frameworks are poorly described and vague - why try to make a meta-framework? 5. The constant use of and/or needs to be clarified a little. For example, what happens if they find many examples of QI that are not directly focused on patient safety issues? I hope my comments have been helpful. As I said, the idea and method are sound, and it will be interesting to see how the authors deal with the heterogeneous nature of the information that they find. Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise Patient safety research, occupational health, burnout, emotional labour, psychological safety. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (1) Author Response 28 Apr 2026 John McCaffrey, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland I had the benefit of reading the reviews of three previous reviewers and the response of the authors. It's obvious that the authors have addressed the many technical questions posed by the previous reviewers. Therefore, I will comment on some of the conceptual issues. The basic idea to conduct a scoping review on the research frameworks that guide patient safety and QI research is a worthy one. I am very happy to approve this study, and the following comments should be considered as suggestive, not obligatory. Authors' response : Thank you very much for the peer review of our scoping review protocol paper. We appreciate the very helpful suggestions around conceptual issues and have responded to these below and incorporated edits in the paper. 1. It would be helpful for the reader to understand why a scoping review is the best way forward. I assume the scoping review approach reflects the fact that the area is heterogeneous and a little 'scattered', but it would be helpful to comment on this a little . Authors' response : Thank you for this helpful suggestion, we have added the below comment to the introductory section: "A scoping review is the most suitable approach, as it enables the collation, description, and synthesis of information from multiple heterogeneous fields that contribute to the study of QI and patient safety." 2. Some examples of the research frameworks that already exist would be helpful for the reader. Also, a 'tighter' definition of what is meant by a research framework would be helpful. It sounds a little generic at the moment. For example, what is not a research framework? Will the authors be using inductive/abductive methods to delineate what research frameworks exist? Authors' response : Thank you for this helpful suggestion. We have now specified what we mean exactly by a QI and patient safety research framework. In the introduction, we have added: "A framework is defined as ‘a structure, overview, outline, system or plan consisting of various descriptive categories, e.g. concepts, constructs or variables, and the relations between them that are presumed to account for a phenomenon’. 1 Therefore we define a QI and patient safety research framework as a set of categories and relations which describe the research process leading to the production of generalisable new knowledge about QI and patient safety." In relation to examples of research frameworks, we are reluctant to put potential findings in the scoping review protocol. However, we have in the existing manuscript, given two examples. To make these more explicit, we highlighted these to the reader a bit more, with the below edits: "In the early 2000s, the World Health Organisation (WHO) published the Patient Safety Research Cycle which outlined the core research functions of patient safety research. These were 1) measuring harm, 2) understanding the causes of harm, 3) identifying locally affordable solutions, 4) evaluating impact and 5) translating evidence into safer care. 31 This is perhaps the most well-known Patient Safety Research Framework, and functions to guide the foci of researchers’ attention worldwide. For example, a recent Canadian Patient Safety Institute publication, offers guidance on how to combine knowledge translation, quality improvement and implementation science research frameworks, such as the Capability Opportunity and Motivation Model of Behaviour in efforts to enhance patient safety. 50 Such a framework could address a recent call for combining QI and PS in clinical education 51 and is likely a good example of what could be applied as hybrid research framework, due to its potential to guide the research process and inform knowledge on quality improvement and patient safety." In response to your helpful suggestion, we have now clarified in the methods section, that we will use both deductive and inductive methods approach to delineate what research frameworks exist. We have added the below to the methods section: "The approach to data extraction will be both deductive and inductive, with some open text extraction options included to enable the collection of concepts and information which may not have been anticipated at the outset." 3. The research aims are mostly clear. I was just wondering with regard to the first aim, how the authors meant by 'what conceptual frameworks are available' - what is meant by 'available'? Authors' response : Thank you for this query. By available, we mean, what frameworks ‘exist’? To be more clear, we have removed the word ‘available’ the list of objectives. For example, the first objective now reads: 1. What conceptual frameworks exist to guide Quality Improvement and/or Patient Safety Research and how have they been applied in healthcare? 4. The authors intend to develop a meta-framework, but does this not depend on the quality of the frameworks in existence? For example, if the scoping review finds that the majority of frameworks are poorly described and vague - why try to make a meta-framework? Authors' response : Thank you for this question. This in an important consideration and we cannot pre-empt the findings of the scoping review or what other data sources may be required. This is a good reason why the development of the meta-framework does not form part of the scoping review aims and objectives itself. As indicated in the aims and objectives section, the primary aim of the scoping review itself is to profile existing frameworks. To make this more clear, we have added to the aims and objectives section: "The actual development of the meta-framework does not form part of the scoping review protocol. The development of the framework will take place in the follow-on phase of this research, as part of EQUIPS Research Network programme of work." 5. The constant use of and/or needs to be clarified a little. For example, what happens if they find many examples of QI that are not directly focused on patient safety issues? Authors' response : The use of ‘and/or’ is simply to denote that we are profiling a mixed array of frameworks, some may deal with QI or Patient Safety alone, some may deal with both. If we find a QI research framework that is not directly focussed on patient safety issues, that will form part of our findings. It could be that is focussed on other relevant issues that may be indirectly supportive of patient safety research, for example, methodologies for studying how improvement happens. This is explicit in the existing first sentence of the aims and objectives section: "The aim of this scoping review is to identify and describe the conceptual frameworks relating to stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks) in healthcare." I hope my comments have been helpful. As I said, the idea and method are sound, and it will be interesting to see how the authors deal with the heterogeneous nature of the information that they find. Authors' Response : Thank you View more View less Competing Interests None to disclose reply Respond Report a concern Montgomery AJ. Peer Review Report For: Development of a Quality Improvement and Patient Safety Research Conceptual Framework to Inform Research Priorities for the Irish Healthcare System: Protocol for a Scoping Review [version 1; peer review: 2 not approved] . HRB Open Res 2025, 8 :92 ( https://doi.org/10.21956/hrbopenres.15774.r54050) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-92/v2#referee-response-54050 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Lavelle M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 01 Apr 2026 | for Version 2 Mary Lavelle , Queen's University Belfast, Belfast, Northern Ireland, UK 0 Views copyright © 2026 Lavelle M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for the opportunity to review this paper. The topic is important, and the scoping review has the potential to offer valuable insights for those working both clinically and from a research perspective within healthcare settings, both in Ireland and beyond. It is clear that the authors have made substantial revisions in response to earlier reviewer comments, and these changes have appreciably strengthened both the manuscript and the methodological description. At this stage, I have only one remaining query. Will the proposed meta‑framework be presented as part of this review article? If so, it would be helpful to include additional detail on the planned process for co‑creating this framework, including how the development steps will be operationalised. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise Patient safety and health services research. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 28 Apr 2026 John McCaffrey, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland Thank you for your peer review and positive comments on our manuscript. In response to your query, we will not be including the proposed meta-framework as part of the scoping review article. To make this more clear, we have added the below statement at the end of the aims and objectives section: The actual development of the meta-framework does not form part of the scoping review protocol. The development of the framework will take place in the follow-on phase of this research, as part of EQUIPS Research Network programme of work View more View less Competing Interests None to disclose reply Respond Report a concern Lavelle M. Peer Review Report For: Development of a Quality Improvement and Patient Safety Research Conceptual Framework to Inform Research Priorities for the Irish Healthcare System: Protocol for a Scoping Review [version 1; peer review: 2 not approved] . HRB Open Res 2025, 8 :92 ( https://doi.org/10.21956/hrbopenres.15774.r53513) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-92/v2#referee-response-53513 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Jilcha K. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 04 Mar 2026 | for Version 2 Kassu Jilcha , Addis Ababa University, Addis Ababa, Ethiopia 0 Views copyright © 2026 Jilcha K. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The study topic is highly relevant to the health sector, and I appreciate the focus on "Profiling and Mapping Quality Improvement and Patient Safety Research Frameworks: Protocol for a Scoping Review to Guide Integration." This work has the potential to serve as a valuable resource for health researchers and healthcare sectors alike. However, there are several areas where the protocol could be strengthened to enhance its scientific rigor and clarity. Protocol Structure and Presentation: A well-defined structure is essential for study protocols. The protocol should include a clear Abstract that summarizes the background, objectives, methodology, and anticipated implications, along with appropriate keywords. The Introduction should clearly present the concepts of quality improvement and patient safety, highlighting how these elements can be integrated to enhance patient health outcomes. It should also address the role of health professionals in maintaining quality while providing clinical services and cite recent studies to substantiate these ideas. Literature Review and Conceptual Framework: Following the Introduction, a comprehensive Literature Review section should address the specific objectives and research questions while identifying literature gaps. Importantly, this section should culminate in the development of a conceptual framework that currently appears to be missing from the protocol. This framework will be essential for guiding the scoping review methodology. Methodology Clarity: The Research Methodology section should comprehensively describe all study areas, including data sources, selection criteria, search strategies, tools to be used for data extraction and quality assessment, and data analysis techniques. This level of detail is crucial for ensuring the protocol's reproducibility and rigor. Overall Assessment: The protocol would benefit from more detailed and substantive content throughout, with clear delineation between sections using appropriate headings (Abstract, Introduction, Literature Review, Methodology, and Conclusion). This will help guide readers through the proposed study and facilitate understanding of how the integration of quality improvement and patient safety will be systematically explored. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Occupational safety and health, ergonomics, Quality I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 28 Apr 2026 John McCaffrey, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland Thank you for your peer review of our scoping review protocol. We agree that the rationale for, and objectives of, the study are clearly described; that the study design is appropriate for the research question, and that sufficient details of the methods are provided to allow replication by others. Therefore we agree with your quantitative assessment, but is was mainly unclear how your qualitative assessment matched to this. Nevertheless, we have replied to the qualitative comments, and this supported the revised version. Please see below responses to comments provided Protocol Structure and Presentation: The manuscript meets with requirements for structuring and describing scoping review protocols (as per JBI guidelines), and we disagree that any further amendments are needed, as the suggestions have already been met. For example, we have covered abstract, title, keywords, introduction, aims/objectives, methods (eligibility criteria, information sources, search strategy, data management, data extraction, data analysis and presentation, knowledge user engagement and co-creation), dissemination. These are all required by JBI standards, and are more reproducible and supportive of researchers than the generic Abstract, Introduction, Literature Review, Methodology, and Conclusion suggested. A heading ‘Literature Review’ is not recommended by JBI, as this would be more substantial than what would be expected for a scoping protocol, particularly when the scoping review itself, once completed, is a form of literature evidence synthesis. Literature Review and Conceptual Framework: Thank you for your comments on this. We have already included sufficient background literature in the introductory section, as per JBI guidelines for scoping review protocols. We have included definition of terms, why the research is needed, and what the gaps are. In response to your comments, we have added a specific statement on why a scoping review is indicated, to enhance clarity: A scoping review is the most suitable approach, as it enables the collation, description, and synthesis of information from multiple heterogeneous fields that contribute to the study of QI and patient safety. In response to your comments, we have clarified that the development of the conceptual framework does not form part of the scoping review aims and objectives. As per the aims and objectives, we aim to profile existing frameworks, and the development of the framework will form part of the next phase of the research. We have added the below statement: The actual development of the meta-framework does not form part of the scoping review protocol. The development of the framework will take place in the follow-on phase of this research, as part of EQUIPS Research Network programme of work. Methodological Clarity : As per your quantitative assessment, and the reviewers 4 and 5, it is obvious the methodological clarity. Your qualitative comments formed a helpful checklist, but these elements – “data sources, selection criteria, search strategies, tools to be used for data extraction and quality assessment, and data analysis techniques” were included in the paper reviewed. Overall Assessment: We agree with the overall quantitative assessment, as per the qualitative comments, we are satisfied that we have structured the protocol headings are per the well-established and internationally accepted and commonly used, JBI guidelines. View more View less Competing Interests None to disclose. reply Respond Report a concern Jilcha K. Peer Review Report For: Development of a Quality Improvement and Patient Safety Research Conceptual Framework to Inform Research Priorities for the Irish Healthcare System: Protocol for a Scoping Review [version 1; peer review: 2 not approved] . HRB Open Res 2025, 8 :92 ( https://doi.org/10.21956/hrbopenres.15774.r53664) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-92/v2#referee-response-53664 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Sutherland A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 08 Jan 2026 | for Version 1 Adam B Sutherland , University of Bradford, Bradford, England, UK 0 Views copyright © 2026 Sutherland A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thanks so much for the opportunity to review this paper, which I have read with interest. My interest comes from your position of attempting to tie together safety science with implementation science. I am in agreement with the previous reviewer that this has not been achieved. Theoretical Grounding The manuscript is weakened by only offering a superficial theoretical exploration of the differences and alignments between improvement science and safety science. One of your review questions (Nr 5) is framed in Donabedian's "Structure-Process-Outcome" structure but there has been no exploration of this as a fundamental principle of quality improvement. Furthermore there has been no attempt to link improvement and safety science principles, which weakens the structure of your proposed analytical approach as it is unclear how you are going to ensure theoretical alignment between the concepts and the future framework you intend to develop. End User Involvement A core principle of scoping review methodology is the involvement of service users in the creation of the review and its questions. There is only a fleeting reference to service user involvement in the manuscript and I see no service users represented in the author list. I am very strongly on the opinion that where patient safety is involved, patients must be part of the research journey from start to end and this should be reconsidered. Search Strategy I've taken some time to look at your search strategies and have concerns that some of the terms you have used may skew your search results. I see behavioural science and implementation science included, human factors and sociotechnical systems but these are all very different concepts. Again,this is related to the lack of theoretical grounding of the proposal. I also wonder about the feasibility of this review. Notwithstanding the theoretical weaknesses I can imagine that the initial search strategies will yield many hundreds of thousands of titles that require screening, and there may be insufficient resource available for this in the methods. Data extraction I think a bit more information is needed for the readers to understand what is meant by "QI/PS-R Focus" and "QI/PS-R Definitions" - perhaps this just relates to the theoretical positions taken? How will extractors manage those studies that report BOTH QI and PS factors? I would fully expect that there would be substantial overlap between patient safety and quality improvement. You would need to separate the two concepts and demonstrate how they align (or indeed sit in tension) Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Partly Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise Human Factors; Patient Safety I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (1) Author Response 11 Feb 2026 John McCaffrey, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland Thanks so much for the opportunity to review this paper, which I have read with interest. My interest comes from your position of attempting to tie together safety science with implementation science. I am in agreement with the previous reviewer that this has not been achieved. Response: Thank you for this observation. Please see reply to reviewer 1. Overall, we have updated the scoping review aims to profiling QI Research Frameworks, Patient Safety Research Frameworks, and Frameworks which may already combine QI and Patient Safety as part of an overall research framework. The paper title has been reorientated to reflect the aims of the scoping review and not a planned application of the findings, i.e. the development of a conceptual framework. “Profiling and Mapping Quality Improvement and Patient Safety Research Frameworks: Protocol for a Scoping Review to Guide Integration Theoretical Grounding The manuscript is weakened by only offering a superficial theoretical exploration of the differences and alignments between improvement science and safety science . Response: The paper has incorporated an additional paragraph on the rationale for combining QI and patient safety research frameworks as below. Since part of our data extraction concerns how frameworks define QI and/or patient safety research, the scoping review findings with further detail difference and alignments between these. “ Rationale for combining Quality Improvement and Patient Safety Research Framework The US Institute of Medicine have long established patient safety, alongside timeliness, effectiveness, efficiency, equity and patient centredness, as a core goal of quality in healthcare (IOM, 2001). Since QI methodologies use data for diagnosing improvement opportunities in healthcare systems and for implementing and monitoring improvements in system performance, there are natural conceptual overlaps between the study of improvement and patient safety research. For example, in healthcare settings, QI methodology (e.g. PDSA) is regularly used to help implement, monitor, and adapt patient safety interventions (e.g. safe surgery checklist) over time with the goal of improving safety. At the same time, using routine and additional data sources, researchers examine implementation and effectiveness outcomes (e.g. compliance with safe surgery checklist and surgical outcomes) to inform decision-making about adoption of policies and practices. To reflect the multiple approaches to improving safety in practice, researchers require guidance about selecting evaluation foci and research methodology. For example, a recent Canadian Patient Safety Institute publication, offers guidance on how to combine quality improvement and implementation science research frameworks in efforts to enhance patient safety (CPSI, 2020). Additionally, there was a recent call for QIPS to be combined in clinical education (Wong et al., 2022). Currently there is no known collated body of literature which profiles stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research Frameworks) and guides on how these may be best utilised.” One of your review questions is framed in Donabedian's "Structure-Process-Outcome" structure but there has been no exploration of this as a fundamental principle of quality improvement. Response : Thank you for this observation. An explanation of Donabedian’s Structure-Process-and Outcome Quality Framework is now provided in the introductory text. Additionally, examples of structures, processes and outcomes are now provided in the study data extraction table (Table 3) in the manuscript, and as identified below (4.12 – 4.14). “Fifty identified research priorities for developed countries are detailed in WHO reports 32 . These were summarised using Donabedian’s structure, process and outcome quality framework to identify research areas that were the results or consequences of care (outcomes), due to resourcing and organisational arrangements (structures) or influenced by the delivery of care (processes). It was expected that further knowledge in these substantial knowledge gaps would contribute to improving patient safety (WHO, 2008) . Priorities for developed countries like Ireland focused on the underlying processes and organisational factors that lead to unsafe care, the cost-effectiveness of risk-reducing strategies, and the development of better safety indicators 32” 4.12 Were structural indicators established? (i.e. building blocks of care, e.g. buildings, staff, equipment, policies) 4.13 Were process indicators established? (i.e. management, organisational, and clinical processes, e.g. use of checklists) 4.14 Were outcome indicators established? (i.e. outcomes of care, e.g. adverse events) World Alliance for Patient Safety. Summary of the Evidence on Patient Safety: Implications for Research. Geneva: World Health Organization, 2008 Furthermore, there has been no attempt to link improvement and safety science principles, which weakens the structure of your proposed analytical approach as it is unclear how you are going to ensure theoretical alignment between the concepts and the future framework you intend to develop. Response : Thank you for this observation. A table (Table 1) outlining similarities and differences across principles of quality improvement, quality improvement research and patient safety research has been included in the introductory section. Completion of the scoping review, profiling the frameworks, will identify within existing frameworks where synergies across aims, methodology and outcome are, and where there are opportunities for integration. “For illustration and reflecting the literature above, Table 1, details multiple similarities and differences across QI, QI research and Patient Safety research. To reflect these multiple approaches and interdependencies in improving safety in practice, researchers require guidance about selecting evaluation foci and research methodology”. End User Involvement A core principle of scoping review methodology is the involvement of service users in the creation of the review and its questions. There is only a fleeting reference to service user involvement in the manuscript and I see no service users represented in the author list. I am very strongly on the opinion that where patient safety is involved, patients must be part of the research journey from start to end and this should be reconsidered. Response: Thank you for this observation. EQUIPS has a small but growing number of patient partners and collaborates regularly with other patient organisations (e.g., Patients for Patient Safety Ireland). All patient partners were invited to participate in scoping review development and we anticipate they will continue to play an active role in further stages of this research. Authors are listed according to the International Committee of Medical Journal Editors (ICMJE) Recommendations. Please see reply to Reviewer 1 above. More detail has been added on sharing of findings: “Scoping review findings will be presented at a dedicated QI and Patient Safety Research symposium at the RCSI University of Medicine & Health Sciences and other fora. Here, consultation will take place with stakeholders (i.e. healthcare professionals, healthcare managers, researchers, academics, patient representatives, research funders, and EQUIPS members). Discussion will focus on how the findings may be used to develop Quality Improvement and Patient Safety Research Conceptual Framework and inform the prioritisation of research topics and methodologies within the context of the Irish healthcare system”. Search Strategy I've taken some time to look at your search strategies and have concerns that some of the terms you have used may skew your search results. I see behavioural science and implementation science included, human factors and sociotechnical systems but these are all very different concepts. Again, this is related to the lack of theoretical grounding of the proposal. Response : Thank you for this observation. We have clarified we are profiling stand-alone and or integrated QI and Patient Safety Frameworks, and have provided more theoretical grounding, I think these address the concerns. Moreover, details of expertise supporting the project are more clearly outlined, and this should instil confidence that papers addressing the theoretical aims of the study will be included. I also wonder about the feasibility of this review. Notwithstanding the theoretical weaknesses I can imagine that the initial search strategies will yield many hundreds of thousands of titles that require screening, and there may be insufficient resource available for this in the methods. Response: We are confident in the feasibility of the review, given our aim to profile research frameworks, specifically. Data extraction I think a bit more information is needed for the readers to understand what is meant by "QI/PS-R Focus" and "QI/PS-R Definitions" - perhaps this just relates to the theoretical positions taken? How will extractors manage those studies that report BOTH QI and PS factors? I would fully expect that there would be substantial overlap between patient safety and quality improvement. You would need to separate the two concepts and demonstrate how they align (or indeed sit in tension) Response: Thank you for this observation. I think this had been addressed by our clarification of aims. Please see reply to reviewer 1 above and below We have clarified our overall aim is identify stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks), and not necessarily hybrid approaches only, which are in their infancy. Additionally, we have clarified that the results of the scoping review will be used to develop a meta-framework, the methodology for which is beyond the parameters of the scoping review protocol. “The aim of this scoping review is to identify and describe the conceptual frameworks relating to stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks) in healthcare. The research questions guiding this review are: 1. What conceptual frameworks are available for Quality Improvement and/or Patient Safety Research and how have they been applied in healthcare? 2. How are the concepts of QI and patient safety research defined in available Quality Improvement and/or Patient Safety Research Frameworks? 3. What are the reported objectives of available Quality Improvement and/or Patient Safety Research frameworks? 4. What domains and sub-domains are addressed in available Quality Improvement and/or Patient Safety Research Frameworks? 5. What structure-, process- and outcome- related indicators are used in available Quality Improvement and/or Patient Safety Research Frameworks? 6. What criteria for research priorities have been established? 7. What research priorities have been established? Scoping review findings will be used to inform the development of a meta-framework that will be used to guide QI and patient safety research related priority setting, measurement and monitoring, implementation, and knowledge translation activities in Ireland.” View more View less Competing Interests No competing interests to disclose reply Respond Report a concern Sutherland AB. Peer Review Report For: Development of a Quality Improvement and Patient Safety Research Conceptual Framework to Inform Research Priorities for the Irish Healthcare System: Protocol for a Scoping Review [version 1; peer review: 2 not approved] . HRB Open Res 2025, 8 :92 ( https://doi.org/10.21956/hrbopenres.15586.r51963) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-92/v1#referee-response-51963 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Okesanya O. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 22 Nov 2025 | for Version 1 Olalekan John Okesanya , Neuropsychiatric Hospital, Aro, Nigeria 0 Views copyright © 2025 Okesanya O. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The paper suffers from multiple deficiencies, as mentioned below, which diminish its academic value. The paper aims to integrate quality improvement (QI) and patient safety (PS), though the scarcity of a clear theoretical model linking these concepts hinders the strength of the proposed meta-framework with insufficient explanation of their connection. Moreover, while “knowledge user engagement” is emphasised, the protocol offers minimal discussion on the participatory mechanisms involved. The omission of concrete example regarding decision-making structures leaves the co-creation assertion somewhat unsupported. Also, the authors state ethical approval is unnecessary yet moral considerations in stakeholder engagement and interpretation are overlooked parting the ethical structure incomplete. Equally, although dual independent reviewers are noted, key details about their training and calibration are left out this failure raises concerns regarding consistency in inclusion decisions and inter rater reliability. In addition, the draft extraction template is presented, though it is vague in relation to coding schemes and variable definitions, making it difficult to understand the way multi-domain data will be categorized. Furthermore, the review’s findings aim to contribute to a conceptual framework, but the process for developing this framework remains unaddressed, making it unclear whether it should be inductively derived or theoretically imposed. Meanwhile, covidence is mentioned, lacking elaboration on how data validation, version control and reviewer calibration will be managed raising concerns about internal consistency and data integrity. Then, the adherence to JBI and PRISMA-ScR guidelines is outlined though procedural details on how these frameworks will be executed remain inadequately clarified. The shortcoming of explicit inclusion thresholds and screening examples impacts the review’s reproducibility, rendering it questionable. Subsequently, the research plans to retrieve multiple frameworks addressing similar concepts, yet a method for reconciling duplicates as well as overlaps is absent which could result in data redundancy, distorting the synthesis. Finally, the Irish healthcare system is described in broad terms, without addressing system-specific factors that could influence the research, limiting its ability to provide contextually relevant recommendations. Is the rationale for, and objectives of, the study clearly described? No Is the study design appropriate for the research question? No Are sufficient details of the methods provided to allow replication by others? No Are the datasets clearly presented in a useable and accessible format? No Competing Interests No competing interests were disclosed. Reviewer Expertise IoT, Health care, AI and Cloud I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (1) Author Response 11 Feb 2026 John McCaffrey, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland Thank you for time and expertise in providing the peer review. We have reflected on each of the comments and provide the below clarifications and revisions, which have strengthened and clarified the academic value of our planned study. Theoretical Rationale for Study Research Questions The paper aims to integrate quality improvement (QI) and patient safety (PS), though the scarcity of a clear theoretical model linking these concepts hinders the strength of the proposed meta-framework with insufficient explanation of their connection. Response: We have revised the study background to make clear the conceptual overlap between QI Research and Patient Safety Research and have clarified the study aims and objectives. We are aware that QI Research Frameworks exist in the literature, as do Patient Safety Research Frameworks. These are valid and are required to guide researchers in their fields. We have added a definition of a framework to the introductory paragraph: A framework is considered ‘a structure, overview, outline, system or plan consisting of various descriptive categories, e.g. concepts, constructs or variables, and the relations between them that are presumed to account for a phenomenon’ 1 Nilsen, P. Making Sense of Implementation Theories, Models, and Frameworks. In: Albers, B., Shlonsky, A., Mildon, R. (eds) Implementation Science 3.0. 2020. Springer, Cham. https://doi.org/10.1007/978-3-030-03874-8. We are also aware that both QI research and Patient Safety research address overlapping goals (i.e. contributing to knowledge to enhance safety), and while we are aware of some recent frameworks that guide both QI and Patient Safety Research (e.g. Canadian Patient Safety Institute (2020) A Guide to Patient Safety Improvement: Integrating Knowledge Translation & Quality Improvement Approaches), there is no systematic collation of such frameworks available from the literature that we could identify. The availability of existing frameworks like this strengthens our proposal to develop a meta-framework, which could be used partially or in-full dependent on the needs of end-users such as those within our diverse network. For example, researchers may take guidance from a full meta-framework or elements of it, dependent on their context or the aims of their study. For health professionals, there has been a call to integrate quality improvement and patient safety research in clinical education ( Wong et al., 2020) which a meta-framework could support . In essence, individual QI and Patient Safety Research Frameworks are still required, but since they are part of the knowledge generation and translation continuum that aims to improve safety, a meta-research framework is required to reflect and understand the co-occurring approaches to improving patient safety in practice. As such, the primary aim of this scoping review is to profile stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research Frameworks). Thereafter, at the end of the scoping review study, we will use this understanding to inform the development of a meta-framework. We appreciate this was not sufficiently clear in the original submission. We have added the below paragraph on the rationale for combining the QI and patient safety research frameworks, and have clarified our review aims and objectives. “ Rationale for combining Quality Improvement and Patient Safety Research Framework The US Institute of Medicine have long established patient safety, alongside timeliness, effectiveness, efficiency, equity and patient centredness, as a core goal of quality in healthcare (IOM, 2001). Since QI methodologies use data for diagnosing improvement opportunities in healthcare systems and for implementing and monitoring improvements in system performance, there are natural conceptual overlaps between the study of improvement and patient safety research. For example, in healthcare settings, QI methodology (e.g. PDSA) is regularly used to help implement, monitor, and adapt patient safety interventions (e.g. safe surgery checklist) over time with the goal of improving safety. At the same time, using routine and additional data sources, researchers examine implementation and effectiveness outcomes (e.g. compliance with safe surgery checklist and surgical outcomes) to inform decision-making about adoption of policies and practices. To reflect the multiple approaches to improving safety in practice, researchers require guidance about selecting evaluation foci and research methodology. For example, a recent Canadian Patient Safety Institute publication, offers guidance on how to combine quality improvement and implementation science research frameworks in efforts to enhance patient safety (CPSI, 2020). Additionally, there was a recent call for QIPS to be combined in clinical education (Wong et al., 2022). Currently there is no known collated body of literature which profiles stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research Frameworks) and guides on how these may be best utilised.” Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. National Academies Press; 2001. Canadian Patient Safety Institute. A Guide to Patient Safety Improvement: Integrating Knowledge Translation & Quality Improvement Approaches. Edmonton, Alberta; 2020 We have clarified our overall aim is identify stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks), and not necessarily hybrid approaches only, which are in their infancy. Additionally, we have clarified that the results of the scoping review will be used to develop a meta-framework, the methodology for which is beyond the parameters of the scoping review protocol. “The aim of this scoping review is to identify and describe the conceptual frameworks relating to stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks) in healthcare. The research questions guiding this review are: 1. What conceptual frameworks are available for Quality Improvement and/or Patient Safety Research and how have they been applied in healthcare? 2. How are the concepts of QI and patient safety research defined in available Quality Improvement and/or Patient Safety Research Frameworks? 3. What are the reported objectives of available Quality Improvement and/or Patient Safety Research frameworks? 4. What domains and sub-domains are addressed in available Quality Improvement and/or Patient Safety Research Frameworks? 5. What structure-, process- and outcome- related indicators are used in available Quality Improvement and/or Patient Safety Research Frameworks? 6. What criteria for research priorities have been established? 7. What research priorities have been established? Scoping review findings will be used to inform the development of a meta-framework that will be used to guide QI and patient safety research related priority setting, measurement and monitoring, implementation, and knowledge translation activities in Ireland.” Participatory Mechanisms for Knowledge User Engagement Moreover, while “knowledge user engagement” is emphasised, the protocol offers minimal discussion on the participatory mechanisms involved. The omission of concrete example regarding decision-making structures leaves the co-creation assertion somewhat unsupported. Response: Thank you for this observation. We have added the below paragraph to the section on knowledge-user engagement and co-creation. “The overall participatory mechanism for knowledge user engagement with the planned scoping review is the existing schedule of regular online meetings as part of EQUIPS Strand 2 work programme. The scoping review is a standing agenda item at these meetings, which are chaired by the EQUIPS Research Network Manager. The meetings are facilitated with the aim of giving equal voice to researchers and knowledge users. For example, using the meeting forum, knowledge users themselves continually decide how they would like to be included, and contribute to the review. Outputs from the Strand meetings are reported by the Network Manager to the wider network, including its steering committee, whom are responsible for ensuring that strand outputs are used to fulfil the network’s work programme”. Ethical Considerations Also, the authors state ethical approval is unnecessary yet moral considerations in stakeholder engagement and interpretation are overlooked parting the ethical structure incomplete Response: Thank you for this observation, we have expanded the ethical considerations and have included the below paragraph: “In accordance with JBI guidance 50 , there is no requirement to apply for research ethical approval for the scoping review. Knowledge users are being engaged to inform the process of how scoping review is done, and not as research participants. Nevertheless, as is best practice, ethical principles of beneficence and informed consent will be applied to the conduct of the scoping review. Knowledge users, have been informed during online Strand 2 meetings that they are free to share any relevant view and given the volunteer nature of their role in the study, are free to withdraw from participation in the scoping review team for any reason and without incurring any negative consequences from any of the individuals or organisations associated with the research.” Methodology Reviewers Equally, although dual independent reviewers are noted, key details about their training and calibration are left out this failure raises concerns regarding consistency in inclusion decisions and inter rater reliability. Response : Thank you for this observation. We have added the below to the methodology section. “Two reviewers will independently assess each of the retrieved records against eligibility criteria. To support inter-rater reliability, seven reviewers (SEM, JP, JMC, EOD, AVC, JAP, CMG) at the study selection stage comprise experienced researchers with PhDs in healthcare quality, human factors and/or health services research or equivalent experience. Titles and abstracts will be screened for relevance, followed by full-text review to examine if eligibility criteria are met. Disagreement among reviewers will be resolved by consulting a third reviewer (SEM plus one other reviewer) to reach consensus.” Additionally: “Working in teams of two across six reviewers (SEM, JP, EOD, AVC, JAP, CMG), two reviewers (with a balance of healthcare quality/human factors and health services research expertise) will use a piloted, standardised data extraction form, developed in Covidence, to independently extract data relevant to the scoping review aims (see Table 4 for draft template).” Data Extraction Template In addition, the draft extraction template is presented, though it is vague in relation to coding schemes and variable definitions, making it difficult to understand the way multi-domain data will be categorized. Response: Thank you for this observation. An updated draft extraction template is now presented, with better clarity and includes variable definitions where relevant. Please see Table 4 in the revised manuscript. Review Findings Furthermore, the review’s findings aim to contribute to a conceptual framework, but the process for developing this framework remains unaddressed, making it unclear whether it should be inductively derived or theoretically imposed . Response: Thank you for this observation. We have now clarified that our aim is to identify and describe the conceptual frameworks relating to stand-alone QI Research Frameworks, Patient Safety Research Frameworks, and hybrid approaches (QI and Patient Safety Research, QIPS-R, Frameworks) in healthcare. While we indicate that the results will be used to contribute to a conceptual framework, describing the process for this is beyond the scope of the review protocol paper. However, we have added to the methodology section that the scoping review findings will be presented to stakeholders at a QI and Patient Safety Research Symposium and other for a. Here consultation about how the findings could be used to inform a framework for Irish context will take place. See paragraph below: “Scoping review findings will be presented at a dedicated QI and Patient Safety Research symposium at the RCSI University of Medicine & Health Sciences and other fora. Here consultation will take place with stakeholders (i.e. healthcare professionals, healthcare managers, researchers, academics, patient representatives, research funders, and EQUIPS members). Discussion will focus on how the findings may be used to develop a QI and Patient Safety Research Conceptual Framework and inform the prioritisation of research topics and methodologies within the context of the Irish healthcare system.” In addition, we have updated the title of the scoping review protocol to make this more clear. “Profiling and Mapping Quality Improvement and Patient Safety Research Frameworks: Protocol for a Scoping Review to Guide Integration” Covidence Meanwhile, C ovidence is mentioned, lacking elaboration on how data validation, version control and reviewer calibration will be managed raising concerns about internal consistency and data integrity. Response: Thank you for this observation. We have updated the data extraction section as below to address these concerns. “To support consistency of the process and version control, the extraction template will be finalised and agreed prior to its use it the study. Disagreement among reviewers will be resolved by a third reviewer. To maintain consistency, all consensus decisions will be led be author SEM with at least two other reviewers present.” Adherence to JBI and PRISMA-ScR Then, the adherence to JBI and PRISMA-ScR guidelines is outlined though procedural details on how these frameworks will be executed remain inadequately clarified. The shortcoming of explicit inclusion thresholds and screening examples impacts the review’s reproducibility, rendering it questionable. Subsequently, the research plans to retrieve multiple frameworks addressing similar concepts, yet a method for reconciling duplicates as well as overlaps is absent which could result in data redundancy, distorting the synthesis. Response: Thank you for this observation. We believe the inclusion of a detailed data extraction template addresses the concern about application of JBI and PRISMA-ScR guidelines. To address the issue of inclusion thresholds we have added the below statement under the study eligibility criteria “Inclusion thresholds include that papers must address one of the two central scoping review themes: (1) QI and/or patient safety research frameworks and (2) QI and/or patient safety research priorities”. To address the issue of duplicates, papers which address the same framework will be included as a supporting reference, but the framework will only be described once in the scoping review report. “Where multiple papers describe the same research frameworks, all papers will be included in the review as supporting references, with the research framework itself only being described once in the scoping review findings”. Contextual Relevance – Irish Healthcare System Finally, the Irish healthcare system is described in broad terms, without addressing system-specific factors that could influence the research, limiting its ability to provide contextually relevant recommendations. Response: Thank you for this observation which is well founded. As we have now revised the study aim (to produce a scoping review) over production of a conceptual framework, this critique means our scoping review findings ought to be contextualised with the context of the Irish healthcare system. Planned consultation with stakeholders at the QI and patient safety research symposium will enable this. We have updated the methodology as below: “Scoping review findings will be presented at a dedicated QI and Patient Safety Research symposium at the RCSI University of Medicine & Health Sciences and other fora. Here consultation will take place with stakeholders (i.e healthcare. professionals, healthcare managers, researchers, academics, patient representatives, research funders, and EQUIPS members) on how the findings may be used to develop a research conceptual framework and inform research prioritisation exercises within the context of the Irish healthcare system”. View more View less Competing Interests No competing interests to disclose reply Respond Report a concern Okesanya OJ. Peer Review Report For: Development of a Quality Improvement and Patient Safety Research Conceptual Framework to Inform Research Priorities for the Irish Healthcare System: Protocol for a Scoping Review [version 1; peer review: 2 not approved] . HRB Open Res 2025, 8 :92 ( https://doi.org/10.21956/hrbopenres.15586.r50211) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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