Governing patient safety: strengthening infection control and medication safety

Funded by the National Institute for Health Research

Key contact: Professor Naomi Fulop 

Project team: Professor Naomi Fulop, Dr Angus Ramsay, Dr Simon Turner


This programme of work examines the governance arrangements used by hospitals to manage healthcare acquired infections and medication errors. Drawing on case studies of different English NHS Trusts, the projects examine the organisational structures and processes used by the hospitals to improve the governance of patient safety. The research programme aims to identify ways of improving the systems observed through a range of desk-based and empirical research activities:

  • Reviewing past research examining how hospitals manage healthcare acquired infections (e.g. MRSA) and medication errors;
  • Conducting mapping exercises to show how the Trusts are organised to support effective management of healthcare acquired infections and medication errors;
  • Exploring how internal factors (e.g. key events in the Trusts’ history, senior hospital staff) and external factors (e.g. government targets, newspaper reports) influence these structures and processes;
  • Conducting interviews with staff and non-participation observation within the hospital environment to gain a richer understanding of how these structures and processes work;
  • Co-developing and testing interventions in consultation with the Trusts in order to improve these structures and processes.

Why is this important?

By establishing what internal and external factors influence governance of patient safety – e.g. if government policy that identifies a particular risk to patient safety strengthens governance arrangements around that risk – we aim to support the development of new, effective methods for local service managers, and policy makers for the wider NHS, to help enable hospitals to provide safer care.


Interviews have been conducted with managers, doctors, nurses, pharmacists, and infection control team members, along with people with an interest in or experiences of the Trusts’ approaches to managing healthcare acquired infections and medication errors (commissioners of services, government agencies, and special interest groups).

A PhD studentship in Improvement Science funded by The Health Foundation will commence in autumn 2014. The PhD will involve use of ethnographic methods to analyse how specific medication safety cultures develop in a variety of clinical contexts based on differences in professional culture.


  • Detailed descriptions of the governance arrangements for controlling healthcare acquired infections and medication errors at Trust level
  • Maps of the key internal and external influences on these governance structures
  • Interventions to support or improve these structures and evaluation of these interventions.


Turner, S., Higginson, J., Oborne, C. A., Thomas, R. E., Ramsay, A. I., Fulop, N. J. (2014). Codifying knowledge to improve patient safety: A qualitative study of practice-based interventions. Social Science & Medicine, 113, 169-176  doi:10.1016/j.socscimed.2014.05.031.

Ramsay A, Turner S, Cavell G, Oborne CA, Thomas RE, Cookson G, Fulop NJ. (2013). Governing patient safety: lessons learned from a mixed methods evaluation of implementing a ward-level medication safety scorecard in two English NHS hospitals, BMJ Quality and Safety doi:10.1136/bmjqs-2012-001730.

Turner, S., Ramsay, A., & Fulop, N. (2013). The role of professional communities in governing patient safety. Journal of Health Organization and Management, 27.4, 527-543.

 Ramsay, A. Magnusson, C. Fulop, N (2010) The relationship between external and local governance systems: the case of Health Care Associated Infections and Medication Errors in one NHS Trust. Quality and Safety in Healthcare doi:10.1136/qshc.2009.037473. PubMed