Abstract

The pandemic and the breakdown it caused presents an opportunity and an obligation to re-evaluate healthcare design and operations, with an eye towards building a more resilient healthcare delivery system, capable not only of achieving safer routine care but also of maintaining high safety levels and staff wellness in times of disasters and emergencies.

A change in outcomes – clinical or experiential – requires a major shift in the culture of healthcare. This is particularly important owing to the way that healthcare creates anxiety in both patients and staff, threatens everyone’s psychological safety, and contributes to staff burnout. Creating salutogenic environments that promote health and wellbeing, as well as a supportive culture, can help promote healing for the patient and nurture staff.

To drive change, we need highly effective processes for co-creating design and for truly understanding what patients, staff and communities value. We must continue this process beyond completion of the hospital building itself. This ambition means rethinking how the organisation and the wider system functions, and how its internal and external systems and relationships operate. We must identify and rewrite many of the current underlying design principles, cultural norms, and other practices that dictate how hospitals operate and how patients and staff experience them. Digital technology, new building design based around sound human factors, and changes in the operating rules for services can all help support this transformation.

Senior executives and boards of directors in healthcare systems today feel overwhelmed by an onslaught of urgent priorities: quality; equity; preparedness; supply-chain shortages; new payment models; staff burnout; and decarbonisation, to name a few. They may not welcome the duty to push patient and staff safety back to strategic prominence. Nevertheless, “first do no harm”, including to our healthcare staff, remains a sacred obligation for all in healthcare, and success requires “constancy of purpose for improvement”. Without renewed board and executive leadership and accountability for safety, and without concerted, persistent investment in developing new approaches that permit the delivery of safe and equitable care across the healthcare continuum, during both normal and extraordinary times, millions upon millions of patients, families, and healthcare staff will pay the price for inaction.