Design for Patient Safety: Creating significant professional, cultural and commercial impact through innovative design in a range of health care settings
Submitting InstitutionRoyal College of Art
Unit of AssessmentArt and Design: History, Practice and Theory
Summary Impact TypeSocietal
Research Subject Area(s)
Medical and Health Sciences: Public Health and Health Services
Language, Communication and Culture: Other Language, Communication and Culture
Summary of the impact
Design research at the Royal College of Art (RCA) has pioneered projects
and studies developing a design-led, systems-based approach to improve
patient safety in hospital and mobile healthcare. It has led a
multidisciplinary culture in which designers, clinicians, psychologists
and business specialists collaborate in development projects. This new
approach to Design for Patient Safety has had a profound impact on
understanding public service provision, on practice and policy, and has
realised commercial benefit.
Research in Design for Patient Safety, carried out at the RCA by the
Helen Hamlyn Centre for Design (HHCD) in partnership with the universities
of Surrey and Cambridge, resulted in the publication of the Design for
Patient Safety report in 2003 [s3.1]. Co-author of the report, Professor
Roger Coleman, co-directed the HHCD. The authors criticised design
management practices in the NHS and called for a system-wide, design-led
approach to improve patient experience. The report advocated designers as
having a central role to play in improving healthcare, and was endorsed in
a foreword by the Chief Medical Officer, Sir Liam Donaldson [s3.1]. This
endorsement enabled HHCD researchers Thea Swayne, Sally Halls and Sarah
Gottlieb to undertake a series of projects with the National Patient
Safety Agency (NPSA), from 2005-9.
Beginning in 2006 with A Guide to the Graphic Design of Medication
Packaging [s3.2], the NPSA and HHCD produced guidance publications to
assist designers, manufacturers and procurers in improving designs for the
frontline of healthcare provision. Further publications in the series
covered the graphic design of injectable medicines and packaging of
single-use medical devices.
The methodologies were refined by HHCD researchers Grace Davey, Gianpaolo
Fusari, Halls, Maja Kecman, Yusuf Muhammad and Karina Torlei during a
series of patient safety projects with the Department of Health and the
Design Council [s3.3]. Design Bugs Out (2009) resulted in designs that are
easier to clean and less likely to trap bacteria. Design for Patient
Dignity (2010) resulted in innovative products and systems to improve
dignity in the patient experience. Reducing Violence and Aggression in
A&E adopted design principles to reduce violence in the emergency
Ed Matthews, Fusari and Jonathan West at HHCD built on these foundations
through a dedicated Health & Patient Safety research lab, achieving
genuine interdisciplinary collaboration, and helping major research
projects achieve significant impact in two key areas: ambulances and
mobile healthcare; and patient safety in the hospital environment.
The ambulance research began with the NPSA study Future Ambulances in
2006, which found a lack of consistency in equipment and vehicles,
identifying nine problem areas for design intervention. This led to the
Smart Pods project (EPSRC, 2007-9), which explored a new system of
vehicles, equipment and operations management to reduce unnecessary
A&E admissions. Matthews, Fusari, Muhammad and Rob Thompson redesigned
the ambulance interior and built a mobile demonstrator unit [s3.4].
Patient safety in the hospital environment was addressed via research
with the Sorrell Foundation to improve the patient experience in London
hospitals (Critical Points 2004-5) and with Imperial College to improve
the resuscitation trolley (2006-8) [s3.5]. This culminated in a landmark,
three-year multidisciplinary project, Designing Out Medical Error (DOME)
(EPSRC, 2008-2011), undertaken by Professor Jeremy Myerson (PI), Matthews,
West and Davey, researching how design can reduce medical error on
surgical wards [s3.6], leading to several design outputs already
commercially available or undergoing clinical trials. The appointment of
procurement, design, medical and risk managers to the DOME Advisory Board
helped achieve greater impact by assisting the adoption of the project
outputs in the NHS.
In 2013, the Health & Patient Safety research lab is one of three
priority areas for the HHCD and forms the basis of the RCA's leadership of
the HELIX Centre for Design in Healthcare (HEFCE Catalyst Fund 2013).
References to the research
The high quality of the cited research, including DOME, is evidenced by
international awards for both research and design (Core77 Research &
Strategy Award Pro Runner-Up, and International Design & Health
Academy Award Winner, International Research Project category). The
Redesigning the Emergency Ambulance: Improving Mobile Emergency Healthcare
project won a Silver IDEA in the category of Research for the 2012
International Design Excellence Awards, run by the Industrial Designers
Society of America, as well as Design of the Year (Transport category)
2012 at the UK Design Museum. Research in HHCD receives funding from RCUK,
EU, charitable trust and other funders who undertake peer review and award
on the strength of research excellence commensurate with 3* and 4* levels.
All URLs last accessed: 22/11/13.
3.1) Buckle, P., Clarkson, P.J., Coleman, R., Lane, R., Stubbs, D., Ward,
J., Jarrett, J. & Bound J. (2003), Design for Patient Safety (London:
Department of Health).
3.4) Matthews, E. et al. (2011), `Patient safety: Redesigning the
emergency ambulance', World Health Design, Oct 2011: 46-50.
3.6) West, J., Davey, G., Anderson, A., Matthews, E. and Myerson, J.
(2012), `Designing out medical error (DOME): Establishing an evidence base
to design products and equipment that better support surgical wards',
World Health Design, 5(4), 48-55.
Details of the impact
Building on the 2003 Design for Patient Safety report, a number of
research projects at the RCA have had extensive impact on professional
stakeholders and the wider public.
Understanding public service provision
It is estimated that one in ten hospital patients suffer some form of
unintended harm, at huge cost to the NHS (WHO 2013). This situation is due
in large part to traditional, discipline-specific approaches to design for
patient safety. By researching and piloting a new multidisciplinary
process through the EPSRC-funded DOME study and others, and by widely
disseminating that process, the RCA research as cited in Section 2 has
contributed significantly to improving awareness and understanding the
importance of the ways in which a key public service — healthcare — is
The DOME project was widely disseminated to professional and public
audiences via international symposia (including a 90-minute workshop at
the world's largest patient safety conference, ISQua, 2010, and a keynote
at The King's Fund annual conference 2011, London) and media coverage
(including a feature on the BBC Health website <http://www.bbc.co.uk/news/health-16812134>).
Five design innovations arising from the project were showcased in a
touring exhibition funded by the European Commission, which visited the
RCA Galleries, the Royal College of Surgeons Hunterian Museum, London and
the Pontio Centre, University of Bangor, North Wales. Thought leaders and
policymakers attended the private views and accompanying presentations.
The impact on the awareness of the importance of design for patient safety
is evident in an editorial article in the world-renowned journal The
Lancet: `The DOME project suggests a pragmatic approach to care that is
efficient, patient-centred, safe and — in its own way — beautiful' [s5.1].
The Director of Museums and Archives at the Royal College of Surgeons
confirmed that the exhibition engaged stakeholders and the public in
future directions for surgery [s5.2].
A similar strategy was adopted for the redesign of the emergency
ambulance, undertaken in collaboration with Imperial College, the
University of the West of England, London Ambulance Service and NHS
London. A full-size mobile demonstrator unit embodying research principles
was selected and exhibited by the Design Museum as one of its Designs of
the Year (2012). International media coverage for the project channelled
vehicle manufacturer and healthcare provider interest to aid the
translation into commercial reality. The BBC2 Culture Show (average
800,000 viewers) covered work at HHCD, using the project as an exemplar.
There was also coverage on BBC London News and BBC World Health Show. This
media coverage guaranteed public understanding of the importance of design
for patient safety [s5.3].
The Design Bugs Out (2009), Design for Patient Dignity (2010), and
Reducing Violence and Aggression in A&E (2011) projects have all
affected various elements of public health service provision. They also
received extensive media coverage, opened national debate about our health
system and were widely adopted. The A&E violence solutions are
currently being piloted by three UK health trusts [s5.4], and a design to
improve the practice of regularly changing cannulae to reduce infections
is widely available [s5.5].
Impact on practice and policy
A series of publications (from 2006 onwards) detailing best practice in
the design of healthcare graphics, packaging and equipment was produced
with the NPSA. These provided clear guidance to healthcare bodies
including the Department of Health and primary care trusts, winning a
Design Management Europe Award for `best management of design in a public
or non-profit organisation' [s5.6].
Beneficiaries include the design community (giving unambiguous and
detailed guidance), procurement (articulating their requirements) and
staff and patients (improving patient safety). An independent review of
the NPSA's medication outputs (carried out by York Health Economics
Consortium) stated that `The design recommendations for packaging are
attributed with having made a significant contribution to safer dispensing
and administration' [s5.7].
The RCA's multidisciplinary approach to patient safety has sought to
involve business and suppliers at the earliest stages of development.
Research as cited in Section 2 has had commercial impact, creating a
revenue stream for manufacturers, eg a central design output of the DOME
project is the CareCentre, a bedside design containing equipment needed to
improve safety and hygiene. UK manufacturer Bristol Maid was involved in
the latter stages of the research and now produces and sells the
CareCentre, in use in UK hospitals [s5.8]. Clinical trials have shown that
the design improves the quality and safety of care on the front line
[s5.9]. Bristol Maid saw the value of opening up a new market and entered
the design into the Building Better Healthcare Awards, receiving
nominations in two categories.
Bristol Maid is also commercialising the HHCD's redesign of the hospital
resuscitation trolley, the Resus:station. This has been through a clinical
trial funded by the Wellcome Trust and has been proven to enhance clinical
performance when attending a cardiac arrest [s5.10]. Manufacturers have
also been closely involved with the Design Bugs Out and ambulance redesign
projects — and the business of extracting economic value from the research
Sources to corroborate the impact
Copies of all sources to corroborate the impact are available from the
HEI upon request. All URLs last accessed: 22/11/13. All URLs last
5.1) The Royal College of Surgeons Hunterian Museum exhibition and the
article in The Lancet, Vol. 379 (18 February 2012): <http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673612602554.pdf>.
5.2) Letter from the Director of Museums and Archives, The Royal College
of Surgeons Hunterian Museum (28 February 2013).
5.3) Redesigning the Emergency Ambulance: media coverage (2012) included
BBC Culture Show (9 March 2012); BBC World Health Show <http://vimeo.com/39057179
; and BBC London News <http://vimeo.com/39057178>.
5.4) Feedback from Newham Hospital on merits of the Reducing Violence and
Aggression in A&E project.
5.6) Design Management Europe Award 2008: <http://www.dmeaward.com/portfolio/national-
- for-patient-safety/> (and 2007 Honourable Mention:
5.7) Lowson, K., Lanshear, A., Weingart, S. (2009), National Reporting
and Learning Service — Review of the Outputs of the Safer Medication Team
(York Health Economics Consortium), xiii, section 4.6.42.
5.8) DOME CareCentre:
5.9) Anderson, O., Briggs, M., West, J., Vincent, C.A., Hanna, G.B.
(2012), `The CareCentre:™ A cluster-randomised crossover clinical trial',
British Journal of Surgery, 99 (Suppl. 6), 52. Oral presentation to the
Association of Surgeons of Great Britain and Ireland, Liverpool, UK, 11
5.10) Resus:station trolley trials: Paper has not yet been published, but
the abstract is in three publications: Resuscitation (impact factor 4.29),
Circulation (impact factor 10.89) and Anaesthesia (impact factor 3.01).