Patient safety by design: a systems approach to preventing harm

Despite decades of awareness, avoidable harm remains one of the most persistent and troubling challenges in healthcare. Patients expect safe, effective and compassionate care, yet too often systems respond only after something has gone wrong. In my view, this reactive approach is no longer sufficient, and it risks undermining trust, outcomes and sustainability across health systems.

Patient safety is not a niche issue or an operational afterthought. It is fundamental to quality care, workforce wellbeing and public confidence. Globally, the scale of unintended harm remains unacceptably high, even though a significant proportion is preventable. The question is not whether we know enough to act, but whether we are willing to change how safety is designed, governed and delivered.

The limits of reacting after the event

Healthcare has made important progress in recent years, with stronger reporting mechanisms, national strategies and greater openness about harm. But too often, safety improvement is still driven by incidents rather than anticipation. Investigations take place once harm has occurred, lessons are identified, yet the same issues recur elsewhere.

Other safety-critical sectors rely on Safety Management Systems: structured, system-wide frameworks that identify risk early, embed safety into design and culture, and promote continuous learning. Healthcare, by contrast, has yet to adopt this thinking consistently or at scale.

A call for a systems-based approach to safety

This gap was the starting point for Patient Safety System Foundations: A Call for Action, a report developed by the ABHI Patient Safety Group in collaboration with the charity Patient Safety Learning. Rather than focusing on individual failures or isolated interventions, the report sets out what “good” looks like when patient safety is embedded across the entire system.

It recognises that safety is shaped not just by clinical practice, but by leadership, culture, data, regulation, workforce conditions and, crucially, how technology is designed and implemented. Importantly, it places patients and families at the centre, recognising their experiences as essential sources of insight rather than passive outcomes of care.

The report also aligns closely with current reform agendas, including the growing emphasis on prevention, digital transformation and care closer to home. If health systems are to change how and where care is delivered, safety cannot be retrofitted afterwards; it must be designed in from the start.

Why healthtech matters to patient safety

In my opinion, the HealthTech sector has a critical, and sometimes under-recognised, role to play in this shift. HealthTech companies already work within highly regulated environments, managing risk across product design, manufacturing, implementation and post-market surveillance. Many are deeply familiar with human factors, usability, data analysis and continuous improvement.

Yet industry is still too often positioned as something to be managed, rather than as a partner in safety. This is a missed opportunity. When effectively embedded, HealthTech can support safer pathways, reduce variation, enable better use of data and help staff work more safely as well as more efficiently.

Crucially, this is not about promoting individual technologies. It is about recognising that how systems are designed, including the technologies within them, fundamentally shapes safety outcomes. A system that values learning, transparency and collaboration will use innovation differently from one driven purely by short-term cost or compliance.

Safety, culture and the workforce

Another theme that cannot be ignored is the relationship between patient safety and workforce safety. Burnout, understaffing and fear of speaking up all increase the risk of harm. A culture that assigns blame rather than seeks understanding discourages learning and drives problems underground.

HealthTech organisations have experience of operating just cultures, supporting staff to raise concerns and using data to identify risk trends early. Sharing this expertise, and learning in return from healthcare professionals and patients, is an essential part of building safer systems.

Equity also matters. Evidence shows that avoidable harm does not affect all patients equally. Bias in design, access barriers and poor communication can all compound risk for already marginalised groups. Designing for safety must therefore mean designing for inclusion, ensuring that technologies, pathways and information work for diverse populations.

Moving forward together

Patient safety cannot be delivered by one group alone. Regulators, policymakers, providers, patients and industry all have distinct responsibilities, but none can succeed in isolation. What is needed is a shared commitment to systems thinking, underpinned by trust, transparency and a willingness to learn.

From my perspective, the most important shift is cultural. We must move from asking who is at fault to asking what in the system allowed this to happen. That change creates space for collaboration rather than defensiveness, and for improvement rather than repetition.

If we are serious about reducing avoidable harm, safety must become a design principle, not a retrospective fix. HealthTech has a vital role to play in that journey as a partner in building safer, more resilient health systems for patients and professionals alike.