SAFER HOSPITALS D xx
Group competence consists of assembling all the necessary competences at the appropriate time to make the required decisions. This requires both technical expertise – for example, in designing a safe water system – and the relevant expertise relating to the patient group for whom the facility is being designed. However, several serious pitfalls can arise when
attempting to achieve this. First, it is common for individuals to be appointed based
On commissioning of a new water system, high microbial counts were detected despite microbial point of entry filtration and use of chlorine dioxide from outset of wetting the system. The reason for the high counts is illustrated in the above images. The components at the periphery of the water system were coated in a yellow material (see red arrows) on TMVs (left image) and TMV strainers (right image). Forensic analysis showed this to be what is commonly found in fire boarding. It is thought that dust from cutting the fire boarding in the project had entered the water system during construction. In a similar incident, fibre glass particles from pipe insulation entered the water system due to cutting the insulation on pipes over an open water tank.
Dame Judith Hackitt, is widely regarded as a blueprint for transforming the construction industry.5 Originally, the government asked Dame Judith Hackitt
to produce a report focused specifically on cladding. However, recognising the deeper systemic causes of the tragedy, she refused to limit the scope of the review. Her argument was that focusing solely on cladding would address only one symptom of a much broader problem. Within months, another tragedy caused by a different issue could occur. Instead, she emphasised that whether the failure involved a high-rise residential building, a supermarket, or a hospital, the underlying root causes were largely the same. Three key recommendations from the report are listed
below: 1. The future safety of the occupants of the building under construction must be placed at the forefront of any project or programme.
Dr Michael Weinbren
Dr Michael Weinbren is a consultant medical microbiologist and infection control doctor. He has an interest in the built environment, particularly with regard to infection prevention and control and healthcare water and wastewater systems. Dr Weinbren is currently employed as the specialist advisor microbiology to the New Hospital programme.
2. A risk-based approach is therefore required to identify the various hazards to which future occupants may be exposed, so that the necessary mitigations can be implemented to ensure their safety.
3. All the essential elements of good governance – including accountability, responsibility, training, auditing, and related processes – must be established across all stakeholders involved in the project.
A risk-based approach Until now, much of the industry has been driven primarily by compliance with guidance. A risk-based approach is different, although the two are not mutually exclusive. Guidance will always be required, but what changes is the way it is applied. Central to a risk-based approach is competence.
Competence may be defined as ‘the combination of training, skills, experience and knowledge that a person possesses, and their ability to apply these to perform a task safely’.
Both individual and group competence are required.
38 Health Estate Journal April 2026
on hierarchy or job title rather than competence. One example is the appointment of infection control personnel. Few would dispute that infection control knowledge is essential. However, through no fault of their own, many infection control professionals have received little or no training in the built environment. Despite this, they are sometimes appointed to project groups where they may not be able to contribute effectively to discussions about design. For this reason, precisely defining the competence required is essential. The perception of competence can vary among stakeholders; for example, some, including chief executives, may assume that architects and design teams possess all the expertise required to construct a safe hospital. In practice, however, this assumption does not reflect the complexity involved.
Modern healthcare design: increasing complexity Historically, the location of a clinical hand-wash station might have been determined primarily by aesthetic considerations. This should no longer be acceptable. Not only can unnecessary placement create risk, but incorrect placement can make the difference between life and death for a patient. This requires additional expertise to be involved in the decision-making process. Similarly, a design team may be asked to produce a water system, which they will undoubtedly do by following existing guidance. However, if asked to design a safe water system, they may not know where to begin as risks can differ based on setting and a multidisciplinary assessment is often required. These examples are not intended to reflect negatively
on architects or design teams. Rather, they illustrate that the increasing complexity of modern healthcare design requires a multidisciplinary approach from the very beginning of a project. Examples of this approach include the following:
1. The inclusion of drain inspection manholes within clinical areas results in safety risks and operational disruption when blockages happen. When design reaches an advanced stage, or worse, when works have started on site, it will be almost impossible to mitigate these risks without substantial financial cost. Having the Infection control teams, as part of a multi-disciplinary approach, assess the risks at the early stages of the design process is straightforward and essential but is often overlooked.
2. In a modern hospital with 100 per cent single room occupancy, the associated ensuite bathroom design can be extremely challenging. To create space costs money, and all efforts are made to conserve this where possible. However, to ‘squeeze everything in’ will only present a variety of safety risks for future occupants, given, for example, that shower drains are now recognised as potential sources of transmission of wastewater organisms when placed conventionally. Space constraints result in there being no safe location for the placement of the shower drain. Again, this potential failure can be mitigated by engaging individuals with the appropriate expertise within a multi- disciplinary forum at the inception of the project. 3. Ensuring the appropriate room ventilation is another
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