Honing design to improve from one build to the next

In the first half of a two-part article, Consultant Medical Microbiologist, Dr Michael Weinbren, head of Estates Risk and Environment at Belfast Health and Social Care Trust, George McCracken, Susanne Lee of independent microbiology consultancy, Leegionella, and Consultant Microbiologist at NHS Greater Glasgow and Clyde, Dr Teresa Inkster, argue that ensuring patient safety in new healthcare facilities requires a markedly different approach to design and construction. They advocate ‘no longer blindly following guidance’, designing with patient safety uppermost, heeding lessons from past projects – and especially unsuccessful ones, and ‘front-loading’ projects at concept stage with risk identification and consideration.

While dangers are recognised on the construction site, a safety culture for occupants about to enter a new building is conspicuous by its absence. The risks emanating from design, construction, and commissioning of a new healthcare facility where the occupants are particularly vulnerable is causing death and patient harm on a scale of magnitude higher than on the construction site, yet this largely goes unrecognised. This is evidenced by the multitude of reports documenting patient infections from the built environment. The situation is further complicated by the very fabric of our hospital buildings driving antimicrobial resistance – the legacy of which threatens the future existence of many of the modern developments in medicine.

Building occupant safety resides in a bygone era lacking a health and safety culture, although perversely the concept of the built environment affecting occupant safety dates back to Florence Nightingale. When projects go wrong it is very easy to blame a particular group of individuals, but in most instances, this would be totally incorrect. Understanding the basis for the failures is key to improving patient safety. The New Hospital Programme (NHP) is in a privileged position to implement unprecedented change to improve patient safety and change the way the construction industry works. This article examines why this should be the case, and the requirement for change.