A Journey through the cheese

So last week I discussed a little about the swiss cheese model and how i felt that, due to the complex nature of healthcare enviromentments, the model proposed by James Reason in 1990 was too simplistic, and that the estates in which healthcare is delivered is far more like a bubbling fondue.

This week I have been exploring the cheese. I have been looking at the different levels of decision making and their potential latent impact months and years after a decision is taken, and how it might lead to an active error, harming a patient.

Latent defects are 'baked in' to buildings and environements right from the point they are designed and constructed. How decisions were made 10, 50 or, in some cases i am sorry to say, 100 years ago are affecting how we deliver healthcare in the 21st century.

Almost 35% of all healthcare buildings in the acute sector were built 50 years ago or more (17% more than 70 years). Nobody designing a building that long ago could have possibly imagined how far healthcare has advanced and how complex it has become, or indeed how their building needed to have change to keep pace.

As we design buildings today for the NHS we need to be mindful that what we design could be still in use for generations to come. New healthcare facilities need to flexible and adaptable, giving future generations of healthcare workers the opportunities to minimise the impacts of their aged estate on the patients of tomorrow.