Safer hospitals mean better-protected patients, an engaged workforce and better clinical measurement. Safety improvements cannot be achieved without sustained local and clinical engagement.

The Health Foundation's safer patients initiative demonstrates what can be achieved and what it takes to achieve it.

Our work with the Institute for Healthcare Improvement shows that care systems are too complicated for staff simply to know intuitively what works. A positive change in one step may have a negative effect elsewhere.

Meanwhile, a top-down approach of targets and reporting systems may lead to improvements in some areas, but not better quality across the board.

The four hospital sites involved in the initiative receive support through organisational assessment; access to expertise on change management, improvement and measurement; site visits; and learning events. They share findings in a virtual community that allows them to post monthly progress reports and share learning.

They are also working with leadership development consultants to improve the way teams interact and help hospital leaders prioritise

After almost two years' work the trusts are reporting impressive progress in reducing adverse events and mortality, decreasing the number of hospital-acquired infections and prescribing errors, and improving medicines management.

The findings suggest that what works for one hospital may not be immediately successful for another. Sustainable improvements in safety can only be achieved through a planned, systematic approach, flexible enough to cope with local variation. Testing out local solutions and involving staff in decisions about the best way to improve safety helps to engage the workforce.

The second phase of the initiative will involve up to 20 more hospitals. As a small charity of limited resources but big ambitions, we would like to see every hospital in the UK involved.

Now is the time for the government to think about how and when this could be done.

Stephen Thornton is chief executive of the Health Foundation