Co-designing patient safety solutions: from participation to safety capability

Purpose of review Co-design is increasingly promoted as essential to improving patient safety, yet its contribution is often framed as engagement but rarely as a core safety design function. Over the past 18 months, a growing body of empirical work has applied co-design in high-risk safety domains, introduced stronger governance arrangements, and moved beyond local projects toward system-level redesign. This Current Opinion review synthesizes these recent developments to clarify how co-design is evolving, what mechanisms appear safety relevant, and where limitations in translation and evaluation remain. Recent findings The recent literature converges around four interrelated themes. First, co-design is increasingly applied in safety-critical junctions such as diagnostics, transitions of care, medicines, and incident investigations. Second, governance and power-sharing arrangements are emerging as central mechanisms for safety co-design, particularly in contexts marked by inequity, mistrust, or cumulative harm. Third, several studies highlight the importance of continuity across design, implementation, and evaluation phases, with breaks in this chain posing risks to safety co-design intent and fidelity. Finally, there is growing attention to scaling co-designed interventions from local initiatives to national programs. Evaluation of effectiveness remains limited especially at scale. Summary Collectively, these findings suggest that the field is maturing from viewing co-design as a participatory activity to understanding it as an operational safety capability. For clinical practice, this implies that co-design must be embedded through explicit governance, sustained participation across phases, and clear implementation pathways to ensure it effectively contributes to harm reduction. For research, future progress depends on more disciplined evaluation designs that legitimate lived experience as safety evidence alongside clinical data, and that assess whether co-designed interventions reliably function as intended within complex health systems.