SAFER HOSPITALS
area of risk to occupants that is not fully understood by design professionals. It is essential that project ventilation safety groups are integrated from the inception of the design with the full range of required range of competencies being present from the beginning. Guidance in this field is easily misinterpreted. If appropriate expertise is involved from the outset, late and costly rectifications would not be required.
Guidance and compliance versus a risk-based approach Guidance and compliance have a long track record of failure across a number of industries. As stated in the Hackitt Report, the blind following of guidance is not compatible with modern construction. Guidance and compliance can blind users to unidentified risks and can stifle innovation. What is required instead is a mature use of guidance. A multidisciplinary, competent group should use guidance as a reference point, but their primary responsibility is to think critically and identify all potential risks. Where no mitigation currently exists, the group must
develop appropriate solutions. Where mitigations are described in guidance, but the group identifies more effective solutions, these should be adopted. This does not give anyone carte blanche to do whatever
they wish. Where deviations from guidance occur, a documented risk assessment must demonstrate why the deviation is justified. Such deviations are, in essence, enhancements to the safety of future occupants, and are fundamentally different from derogations, which are often perceived as cost-cutting measures that compromise safety. Transitioning to a risk-based approach – when
If implemented correctly, improvements in design and practice could significantly enhance patient outcomes while simultaneously helping to preserve the effectiveness of antibiotics for the future.
implemented correctly – enhances the safety of future occupants while also saving time and money. However, for many organisations this shift can be challenging, as their primary focus has traditionally been compliance. Many buildings in which serious failures have occurred were fully compliant with guidance. Compliance does not necessarily equate to safety. A clear example of this was North Staffordshire Hospital.6
The hospital was compliant with key
performance indicators issued by the Healthcare Commission. Unfortunately, none of these indicators related directly to patient safety. This was reflected in poor patient outcomes, despite the hospital being approved by the Commission. Lastly a risk-based approach requires the risk to be
shared across the various stakeholders. Loading all the risks onto the construction company is unacceptable and will not work – either the construction company will walk away from the project or will raise the costs but will not know the solutions. Greater detail of how by setting up project specific safety groups, the risks can be shared across
April 2026 Health Estate Journal 39
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