MJ Medical

Patient safety case


One of our Senior Consultants, Kate Bradley, recently undertook some research into considering issues of patient safety when planning and designing new healthcare facilities. The findings of her paper are summarised below.


It is estimated that around 10% of patients admitted to NHS hospitals have experienced a patient safety incident (National Patient Safety Agency, 2004). Of these incidents, research has found that 19 per cent resulted in moderate harm, six per cent in permanent harm and eight per cent resulted in death (Vincent et al, 2001). The building of any new hospital is an opportunity to improve patient safety, however it also has the potential to introduce new and potentially significant patient safety risks. When these reports were written the government introduced Private Finance Initiative (PFI) and Local Improvement Finance Trust (LIFT) to facilitate the replacement of a dilapidated NHS estate. There were limited publications at this time recommending improvements to patient safety through the built environment, for example Design for Patient Safety report (Design Council, 2003).

Following the Francis report (Francis, 2013) and the Berwick Report (Berwick, 2013) the government commitment to improving patient safety has been reinvigorated. However this focuses on clinical safety improvements rather than the built environment. With the Naylor Report (Naylor, 2017) recommending capital investment in the healthcare estate it is important to ensure that improving patient safety in the built environment is also reinvigorated. In this research we considered two key questions: how important is patient safety when designing the built environment, and what are the benefits of planning for patient safety?


In 2017 MJ Medical undertook a literature review of current patient safety guidance, research and reports on the topic of designing for patient safety. The literature review was an international approach covering any areas associated with designing for patient safety except mental and behavioural health as they are a separate specialism. The purpose of the review was to recommend an approach to focus improvements in the built environment, reducing the potential for human error, especially in the delivery of care and incorporate features that will promote positive patient outcomes and wellbeing.

Key findings

The National Patient Safety Agency was a key source of information and a particular area of focus was the original patient safety case (NPSA, 2006) following the National Patient Safety Agency (NPSA) visit to St Joseph’s Hospital, Wisconsin, USA in 2005. This was the first hospital in the USA to be designed for patient safety. An appendix from this report was a patient safety insert that the NPSA had drawn up for the inclusion in a Final Invitation to Negotiation (FITN) for the design of a new hospital. This proposed a risk assessment process throughout the course of the project and beyond, including during construction to review and manage the risks being introduced by the project.

The Centre for Health Design (CHD) in America has published a number of studies related to the topics identified as a theme for designing for patient safety. The CHD has also developed a Safety Risk Assessment (SRA) for healthcare facility environments (The Centre for Health Design, 2015). This is a tool for assessing some key themes associated with improving patient safety during the design of a project and links to the FITN documents issued by the Department of Health.

The literature review identified a wide variety of built environment theme’s covering a range of topics. The diagram below identifies the key themes which were evaluated as part of this work and the level of research identified during this study against each theme.


The findings of the literature review were summarised into a Patient Safety Case. This is an evidence based specification outlining some key criteria as part of the briefing process. The Patient Safety Case identifies the evidence-base that is available to support designing for patient safety and quality. The improvements which have been identified are shown to improve patient outcomes and safety, promote healing, increase patient satisfaction, and in some instances, reduce cost. The patient safety case also identifies the link between staff satisfaction with the built environment and general well-being and job satisfaction which has an indirect impact on patient care.

The case is not intended to be limiting or restrictive to these topics, it seeks to encourage patient safety as the philosophy of the building.

The literature review identified two possible opportunities for designing for patient safety, one is the use of an output based specification (the Patient Safety Case) and the other the use of a risk management process. The purpose of the literature review was to produce a patient safety case which would be used in health facility developments to raise the profile for designing healthcare environments for patient safety.


Berwick, D., 2013. A promise to learn – a commitment to act, London: The Stationary Office.

Design Council, 2003. Design for Patient Safety, London: Department of Health.

Francis, R., 2013. Report of the Mid Staffordshire NHS Foundation Trust Public Enquiry, London: The Stationary Office.

National Patient Safety Agency, 2004. s.l.: Department of Health.

Naylor, S. R., 2017. NHS Property and Estate; Why the state matters for patients, s.l.: Department of Health .

NPSA, 2006. St Joseph’s: Hospital design for patient safety. Learning from a visit to St Joseph’s Hospital, West Bend, London: National Patient Safety Agency.

The Centre for Health Design, 2015. [Online] Available at: https://www.healthdesign.org/sra
[Accessed 05 September 2017].

Vincent et al, 2001. Adverse events in British hospitals: preliminary retrospective record review, s.l.: s.n.