DESIGN & CONSTRUCTION
n Manufacturers Products need to be safe, reliable, readily decontaminated, installed correctly, and readily maintained. This may sound simple, but when dissected, is complex. Any product going into a water system must be free of contamination – the practice of water testing components is highly dangerous (nearly bringing cardiac surgery globally to a standstill), and must be stopped or mitigated against in a demonstrably effective manner. Product safety is complex – and while manufacturers’ instructions may appear exhaustive, they do not highlight the ‘critical control points’ which are essential to get right if the equipment is to be installed correctly and safely for the patient. The provision of training material which aids the correct installation of equipment should also be evaluated as part of the product. The role of manufacturers in this process should not be seen in isolation from that of procurement.
n Procurement Procurement has a pivotal role to play in driving improvements in equipment design, and thereby patient safety, but to date in many areas this is mostly lacking. Avoidable harm is currently allowed to compromise patient safety. From discussions with manufacturers it is clear that they rarely receive feedback on what works and what doesn’t with their products. The NHS is in a unique position to drive the change. The uniqueness comes from the NHS – in contrast to most other healthcare models – being a network, with the potential to harness feedback on products on a large scale. Additionally, not only does the NHS require better, safer designs, but it also needs new, innovative products in response to recently recognised issues. The role of procurement in delivering
patient safety is greatly misunderstood. Supplier and supply chain engagement at an early stage are vital to ensure that everyone understands the importance of their contribution to patient safety. This engagement is also important to ensure that projects are ‘de-risked’ – by helping those involved know how they will be supported in delivering a safe environment. This greater understanding will provide a substantial element of cost control to each project.
n Producers of guidance A key question for the producers of guidance is what is their goal? Is the goal to produce guidance for the sake of producing guidance, or to inform the audience sufficiently to achieve the requisite goal? Guidance does not preclude the need for training. Issuing guidance without ensuring that the relevant training facilities exist has, and
32 Health Estate Journal March 2024
Figure 5: Where is risk introduced in a new-build project? At the centre of the image is the healthcare facility, with its complement of doctors and nurses. Damage to patient safety may traditionally be thought of as originating from the staff in the immediate environment. What this image is demonstrating is that the further away a stakeholder is from the healthcare facility, the greater the harm that can be inflicted. The Figure does not, however, consider the impact on patients and cost to human life.
will continue to, affect patient safety. For example, when the update to HTM 04-01 was produced in 2012, no one would dispute the role of Infection Control as part of a multidisciplinary team to ensure water safety. However, no prior or subsequent training was available to Infection Control teams. Consequently, many infection control specialists are part of Water Safety Groups, but bring no added value to the table, because through no fault of their own they have not been able to acquire the necessary training. The way guidance is used, as already highlighted, needs to be rapidly addressed – it is an adjunct, not something to be followed blindly, and does not replace the need for a risk-based approach, combined with assembling the requisite expertise to deliver patient safety.
n The NHS
An organisation with a memory was a report of an expert group on learning from adverse events in the NHS chaired by the Chief Medical Officer first published in 2000. In many ways this report was ahead of its time. A similar safety culture needs to be developed in recognition of the risks posed within and from the built environment. The NHS is responsible for building large numbers of healthcare premises, perhaps more than any other body globally. The current cost of failure relating to the built environment is unknown, but is likely to be in the order of billions of pounds. This does not consider the unnecessary loss of life, increased length of stay, avoidable use of antibiotics, and spread of antimicrobial resistance within healthcare facilities. The NHS has the opportunity to develop a unique safety culture for healthcare construction and maintenance which operates off the near misses; to date this approach has never been harnessed within this sector, unlike the airline industry.
Not straightforward A hospital new-build is described as a ‘once-in-a-lifetime opportunity’ for individuals. The working life of a hospital is around 30 years, so rebuilding a new facility is likely to only happen once during a career. Few, if any, therefore, are prepared for the process, which is nothing less than an onslaught. As a Chief Executive one might expect the process to be analogous to purchasing a new car, i.e. one simply needs to get a company in which designs and builds new hospitals. This is far from the case. While ratings exist for items costing only a pound, there is little to guide the purchaser who is about to spend the best part of a billion pounds on a new healthcare facility. The best one gets is that these companies have built hospitals beforehand, but there is often no way of establishing if these were successful. It is essential that the NHS Trust’s Chief Executive and Board understand how risk is readily introduced into a project, which can destabilise a safe outcome. The Board needs to move from facilitating such a project to taking control. Architects, design teams, and construction companies will do whatever they are told, and equally want a successful outcome. However if instruction/guidance is not specific, they will proceed in their own way often unaware of the risk. Why should they be aware of the risk, when most others involved in process are not?
Reference 1 Building a Safer Future: Independent Review of Building Regulations and Fire Safety: Final Report. May 2018.
http://tinyurl.com/ybywvrdm
n April’s HEJ will include the concluding part of this article.
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