Doing the math in your head – risk assessments in your own house

By Steve MacArthur, Hospital Safety Consultant

Lately it seems that I’ve been running into risk assessments that “feel” more like incomplete thoughts in that all the risks within the assessed environment are not represented. Certainly, there will always be an ebb and flow to the risk continuum, but (at least to my mind) even if a risk is abated to the extent possible, if you don’t continue to acknowledge the risk (and the abatement), then you run the risk (small pun intended) of having a surveyor yip because you didn’t identify the risk or appropriately manage the risk past the initial point of identification (that’s a lot of “risk” right there).

Particularly when it comes to managing risks in the behavioral health environment, what is of greatest importance is to tell the story of how this “at risk” patient population is being appropriately protected (ostensibly from themselves). And, generally, much like back in grade school, you need to be able to show your “work” on the “board”. You cannot expect someone who’s never been in your “space” to be able to draw all the lines and conclusions that might come as second nature to the folks that inhabit the environment. So, please make sure that your risk assessment reflects the entire journey—it will be easier come survey if it does. There are no incidental or minor mitigation strategies—everything builds towards the whole and the goal is keeping the patient safe.

I cannot recall for certain if I've shared this with you, but there is an updated edition (the 27th!) of the New York State Office of Mental Health Patient Safety Standards, Materials and Systems Guidelines ( As you have no doubt learned over the past couple of years, the ligature resistant manufacturing consortium is very busy churning out new products (would that we could go back in time and buy stock in some of these companies) and it is a full-time job keeping track of what works and, perhaps most importantly, what doesn’t work.

The “beauty” of the New York materials is that there is clear indication of what doesn’t work in certain instances and why that might be the case. I have a sneaking suspicion that this may supplant the Design Guide for the Built Behavioral Environment as the “go to” resource, but that doesn’t mean you won’t find it useful right now.

About the Author: Steve MacArthur is a safety consultant with The Greeley Company in Danvers, Mass. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is contributing editor for Healthcare Safety Leader. Contact Steve at