Reducing falls in elderly care and across the hospital

The journey –

The project aimed to reduce inpatient falls across eight elderly care and acute medical wards. Nationally over 200,000 falls are reported each year in the NHS and are a major issue in a range of health and social care settings, both NHS and non-NHS.

The initiative has focussed on what happens to patients for the first few days in hospital. With an increasing national focus on dementia and frailty the team believes that reducing falls will become a major challenge in delivering compassionate care.  The cost of failing to address the issue in terms of cost and reputation is an additional driver.



In the eight wards covered by the initial phase, falls were reduced by 32{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b} in twelve months.  Following this success a trust-wide initiative replicated the activity, achieving a reduction across the trust of 17{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b}. The original eight wards, with minimal additional input, are still improving at a faster rate than the rest of the trust and have reduced their rate by a further 31{79f878acaa41f375dcd804cc8c058b5459a5482f20a3b9f87269b26c8734749b}.  These results indicate that a focus on the behaviour and habits of individual practitioners is the way to make change sustainable and continuous.

In 2012 the trust was shortlisted for the BMJ Safety /Improvement Award.


Patient setting

In-patient   X Out-patient Community based
Mental health Chronic illness Cross-systems


Clinical area

Staying healthy Maternity and newborn Children and young people Acute care   X
Planned care Mental health Long-term conditions End of life


Information, tools and techniques used

The first phase, which took a conventional approach to service improvement (training, action plans, guidelines, meetings etc) was abandoned after 9 months as no improvements had been made.  Phase 2 focussed on the concepts of emergent design, followership and imitation, producing outstanding results.

Over the past 3 years the team has moved from a position of thinking that safety is a product of resilient processes to thinking that safety is something that emerges out of imitating safe behaviours.



Brighton and Sussex University Hospitals NHS Trust.



Phase 1 started in June 2009 and the project is still ongoing.


Contact details and further information

Mark Renshaw, Deputy Chief of Safety, Brighton and Sussex University Hospitals NHS Trust:

Paula Tucker, Head of Nursing Patient Safety, Brighton and Sussex University Hospitals NHS Trust:

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