Introducing the worser case scenarios…

By Steve MacArthur, Hospital Safety Consultant

As we open up the risk assessment process to the outpatient behavioral health environments, the question becomes how much risk can there be to identify as a going concern?

I’ve been thinking about this a fair amount over the last couple of weeks and it occurred to me that probably the most useful approach might be to look at these environments as they would function in a worst case scenario—that is, when someone who’s been in the outpatient setting and doing fine suddenly takes a turn and presents themselves as a risk for self-harm or harm to others.

If you think about it, that’s really the scenario that would put the most stressors on the environment. I’m sure the clinicians in the audience would have a better sense than I of the likelihood of someone really making that kind of turn. And no doubt there are protocols in place for managing those patients in crisis.

But in walking through this process in my head, it makes me wonder this: If you don’t have a “safe room” (and I’m certainly not advocating that you designate one), you need to be able to provide some place to manage someone in crisis while you engage the overarching protocols—getting them to a crisis unit or an ED or whatever.

To that end, I would ask you to think about where such an individual could be safely managed—is it an office or a consult room? Or somewhere else?

Every environment has its unique qualities and I do think it makes more sense to push on the crisis process than to focus solely on what would happen under “normal” circumstances. As with a lot of these things, it’s not so much about regulatory compliance as it about providing the safest possible environment for all patients—the ones who are doing OK as well as the ones who are in crisis.

About the Author: Steve MacArthur is a safety consultant with Chartis Clinical Quality Solutions (formerly known as 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