Mac’s Safety Space: Baking management plans and holiday cookies

After binging the latest season of The Great British Baking Show, it occurred to me that there are (or can be) various levels of precision that must manifest themselves in various creative endeavors—even those relating to compliance. Setting aside my absolute feelings regarding the regulatory mandate to maintain written management plans for various physical environment functions (for the uninitiated, those would be: safety, security, hazardous materials & wastes, fire, medical equipment, utility systems), my pondering—prompted by our friends in Chicago issuing new and revised Emergency Management requirements aimed at settings outside of hospitals (more on the specifics next week)—turned to the nature of how one manages the physical environment plan across a complex healthcare system. What we usually end up with is the management plan dichotomy of “cookie-cutter” solutions in the monolithic management of programs versus a more customized, site-specific management of programs.

The dichotomy comes from something of a disconnect in that (in the parlance of baking) in order to precisely parcel out identical end products, the cookie-cutter approach makes abundant sense, but when applied to things that are not cookies (like management plans), there is a patina of “short cut” that is difficult to escape, particularly when you have a persnickety surveyor in the mix. I know that uniformity can sometimes work against compliance as it “extends” beyond the four walls of your facility, but sometimes you have to provide a solid foundation in order to promote flexibility in the field. Large healthcare organizations tend not to be particularly nimble, so you want to allow for some variation of practice. That’s why rounding is so important—you want the folks managing the environment to understand the rationale for what we’re asking them to do—compliance rarely manifests itself in the absence of understanding. That said, who has the time to manage specific plans for each care location unless you have a single starting point that outlines the administrative/programmatic considerations and then maybe customization “lives” in policies and procedures for each site, etc.

As we enter the season of annual evaluation (for those of you who observe the calendar year), as you look at the scope and effectiveness of your various programmatic elements, I would encourage you to include a specific assessment of the methodology through which (by which?) you are managing the entirety of the program (e.g., monolithic management plans, site specific management plans, a hybrid of the two) and make an absolute determination whether that methodology is promoting the effective management of the physical environment in all care settings.

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