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Lucy Harding is a Patient Safety Partner at North London NHS Foundation Trust, where she has also been a patient and Peer Support Worker.   In this reflective piece, Lucy shares her insights around how design in healthcare can impact patient safety. She draws on her professional background and lived experience of inpatient mental health care as an autistic person, to highlight the critical relationship between design and emotional safety. *Content warning: references to suicidality and self-harm.  I have a particular interest in how the physical environment shapes emotional regulation, sensory experience, and feelings of safety. As an autistic person, I also value sensory design and service accessibility, and I’m passionate about creating therapeutic spaces that genuinely support recovery. Design is a core component of patient safety My interest comes from experiencing first-hand how profoundly the built environment can affect emotional state, distress levels, and the ability to feel safe and engage in treatment. Poorly designed wards can feel chaotic, overwhelming, and sometimes frightening. My experience of patient involvement in co‑production projects, from artwork to furniture selection, helped me realise that design isn’t superficial; it’s a core component of patient safety and experience. As an autistic person, sensory design is very important to me, and I’ve experienced how unmet sensory needs can escalate distress. These experiences have made me want to advocate for safer and more therapeutic environments. Seeing the transformative impact of thoughtful design for mental health —such as improved acoustics, better lighting, and more predictable, calming spaces— has shown me how design can actively support or hinder safety. How the environment can impact patient safety Environments that feel like containment: institutional or outdated spaces can make people feel unsafe, watched, or confined. People should have access to outdoor spaces and fresh air, but not every mental health ward provides immediate access (eg. many wards require leave from hospital to be agreed by a care team, as there are not gardens designed into the ward environment). Sensory overload: harsh lighting, echoing voices in corridors, and unpredictable multi‑use spaces can heighten distress, especially for autistic people and those with experiences of trauma. There were times I had no control over sensory input as a patient, and this felt extremely destabilising and made me unsafe. I disengaged with and resisted treatment, and I self-harmed. The National Autistic Society reports that the average length of stay for autistic people in mental health hospital is 4.6 years, which is a considerably long time.[1] The Assuring Transformation dataset can help ICBs to look at where inequalities are for autistic people without LD in comparison to the general population.[2] I am curious about how much building design contributes to this inequity (rather than the clinical care provided). Lack of temperature control: wards that become extremely hot or cold can make rooms unsafe both physically and emotionally. Hot rooms feel stuffy and uninviting to use, both for staff and patients. High temperatures can make me feel more irritable and less rational. Many psychiatric medications also impact body temperature regulation. As temperatures are rising globally, improving ventilation and prioritising resources for this is becoming more essential. Poor acoustic design: noise and echoing make communication difficult, increasing misunderstandings and conflict. Lack of safe respite spaces: without somewhere quiet to withdraw, people may seek unsafe alternatives. I hid on my windowsill often as a patient, escaping observations and noise – but being unseen for two hours was a risk, and I wasn’t always keeping myself safe. Old buildings and shared facilities: shared bathrooms and dormitory bedrooms, and a lack of purpose-use ward spaces can create conflict, distress, and act as a barrier to treatment being therapeutic. Designing ensuite bedrooms, creating dedicated rooms for therapy, group activities, and quiet/sensory rooms can make a difference to how safe a ward feels. When design supports safety An example of a positive design change I experienced was the installation of a sound‑absorbing panel at an inpatient mental health service. It made a noticeable difference- reducing echoing and softening the overall noise level, which helped communication feel calmer and more respectful. This kind of acoustic improvement reduces the intensity and unpredictability of sounds on a ward. Also, seeing our photographs on the wall made me, as a patient, feel safe, heard, and included. Connecting with others through art and design ultimately lifted me out of a state of intense suicidality and depression. That lens has led me to be very passionate about design being directly connected to patient safety. Challenges and barriers Key challenges and barriers to designing healthcare environments in ways that support patient safety: Budget constraints: sensory‑friendly or trauma‑informed design is often seen as optional rather than essential. Legacy buildings: older wards may be structurally unsuitable for modern design standards. Competing priorities: safety is often interpreted narrowly (eg ligature reduction, or a reduction in a particular category of reported incidents) rather than holistically, which can overshadow sensory and emotional safety. Lack of awareness: designers and decision‑makers may not fully understand sensory needs or lived experience perspectives. Operational pressures: busy wards can deprioritise environmental improvements or require more focus and time than ward staffing allows. Limited co‑production: without meaningful involvement from service users, important design needs can be overlooked. These barriers mean that environments sometimes prioritise containment over comfort, despite evidence that therapeutic design improves safety. Considerations for safer design Co‑production from the start: involve service users, carers, and staff in every stage of design—not just as a consultation step. Sensory‑informed design: consider lighting, acoustics, temperature, predictability, and access to quiet spaces. Flexibility and choice: offer different types of spaces for different needs—calming rooms, social areas, private space, and low‑stimulus zones. Accessibility as standard: such as acoustic design for autistic people, people with hearing impairments, and sensory processing differences. Trauma‑informed principles: prioritise dignity, autonomy, and emotional safety. Feedback loops: continue involving patients after the building opens to refine and improve the environment. Final reflections Feeling safe is not the same as being objectively safe, and both matter equally in mental health settings. Design should never be an afterthought: it is a therapeutic intervention in its own right. When we create environments that respect sensory needs, reduce distress, and promote autonomy, we support recovery and reduce risk. Co‑production with patients isn’t just good practice, it’s essential for designing spaces that truly work for the people who use them. References 1. National Autistic Society. Number of autistic people in mental health hospitals: latest data. June 2025. Accessed online 13/15/26. 2. NHS England. The Assuring Transformation dataset (Table 3, column F&G: average length of stay for autistic patients without a learning disability). March 2026. Accessed online 13/05/26.

Patient falls are a significant concern in healthcare settings, often leading to severe injuries, prolonged hospital stays and increased healthcare costs. The importance of fall prevention extends beyond patient safety—it reduces hospital liability, enhances patient outcomes and improves overall healthcare efficiency. By proactively assessing and addressing fall risks, healthcare providers can significantly lower the incidence of falls, ensuring a safer environment for patients. Given the aging population and increasing chronic disease burden, fall prevention remains a top priority in improving patient care and quality of life. This blog from Augustine Kumah, Deputy Quality Manager at The Bank Hospital, Accra, Ghana, explores the significance of fall risk assessment, its implementation and its role in reducing fall-related incidents in healthcare settings. Introduction Falls among patients, particularly in healthcare facilities, remain a pressing concern worldwide. These incidents not only lead to injuries, prolonged hospital stays and increased healthcare costs, but can also have lasting psychological impacts on patients. Preventing patient falls necessitates a multifaceted approach, with fall risk assessment at its core.[1] Understanding the impact of patient falls Patient falls are defined as unintentional descents to the ground that occur in healthcare facilities, including hospitals, nursing homes and rehabilitation centres. According to the World Health Organization (WHO), falls are the second leading cause of unintentional injury deaths globally, with older adults being most at risk.[2] In healthcare facilities, the consequences of falls extend beyond physical injuries; they also affect a patient’s confidence, independence, and quality of life. The financial burden of falls on healthcare systems is substantial. Costs include direct expenses such as treatment for fall-related injuries and indirect costs like litigation, reputation damage and loss of trust. Additionally, healthcare providers experience emotional distress and professional repercussions when preventable falls occur under their watch. Hence, fall prevention is not just a patient safety priority but also an ethical obligation and a cost-saving measure. The role of fall risk assessment Fall risk assessment is a systematic process to identify patients at risk of falling. Healthcare providers can implement targeted interventions to mitigate these risks by evaluating intrinsic and extrinsic factors. Intrinsic factors include age, medical history, mobility impairments and cognitive status, while extrinsic factors encompass environmental hazards, medication side effects and inadequate assistive devices. Risk assessment tools, such as the Morse Fall Scale, Hendrich II Fall Risk Model and STRATIFY Risk Assessment Tool have been widely used. These tools provide a structured approach to assess risk levels and guide preventative measures. However, their effectiveness depends on accurate application and regular updates based on patient conditions. Implementing effective fall risk assessments To maximise the efficacy of fall risk assessments, healthcare facilities must adopt evidence-based strategies and integrate them into their workflows. Key steps include: Standardised assessment protocols: Developing and adhering to standardised protocols ensures consistency in evaluating fall risks across different departments and shifts. Protocols should specify the frequency of assessments, criteria for reassessment and documentation requirements. Staff training: Comprehensive training programme for healthcare workers are essential to enhance their competency in conducting fall risk assessments. Training should cover assessment tools, recognition of risk factors and communication of findings to the care team. Patient and family education: Involving patients and their families in fall prevention efforts fosters a collaborative approach. Educating them about potential risks and preventive measures empowers them to contribute to safety. Technology integration: Advanced technologies such as wearable sensors, predictive analytics and electronic health records (EHRs) can augment traditional fall risk assessments. For instance, sensors can monitor patient movements and alert staff to potential falls, while EHRs can flag high-risk patients for closer observation. Challenges in implementing fall risk assessments Despite its benefits, implementing fall risk assessments is not without challenges. Common barriers include: Resource constraints: Limited staffing, time pressures and inadequate funding can hinder comprehensive risk assessments. Overburdened staff may struggle to prioritise fall prevention alongside other responsibilities. Inconsistent application: Variability in applying risk assessment tools can lead to inaccurate results. Subjective judgment, incomplete data collection and lack of protocol adherence contribute to inconsistencies. Resistance to change: Resistance from staff and administrators to adopt new practices or technologies can impede the integration of fall risk assessments into routine care. Patient non-compliance: Some patients may resist interventions such as bed alarms, mobility aids or supervision, increasing their risk of falling. Strategies to overcome the challenges To address these challenges, healthcare facilities can adopt the following strategies: Leadership support: Strong leadership commitment is crucial to allocating resources, establishing accountability and creating a safety culture. Interdisciplinary collaboration: Engaging multidisciplinary teams, including nurses, physicians, physical therapists and pharmacists, ensures a holistic approach to fall risk assessment and prevention. Continuous Quality Improvement: Regular audits, feedback sessions and performance evaluations help identify gaps in fall prevention efforts and drive improvements. Tailored interventions: Personalising interventions based on individual patient needs and preferences increases their acceptability and effectiveness. Conclusion Preventing patient falls requires a proactive and comprehensive approach, with fall risk assessment as a foundational element. Healthcare facilities can significantly reduce fall-related incidents and their associated consequences by identifying at-risk individuals and implementing tailored interventions. However, the success of fall prevention efforts hinges on overcoming implementation challenges through leadership support, interdisciplinary collaboration and continuous improvement. As healthcare systems evolve, leveraging technology and prioritising patient-centred care will be instrumental in advancing fall risk assessments. By embracing these advancements, healthcare providers can create safer environments that uphold all patients' dignity, independence, and well-being. References The Joint Commission. Fall Reduction Program - Definition and Resources, 28 August 2017 WHO. Falls Factsheet. World Health Organization, 26 April 2021.