Mac’s Safety Space: Compliance versus convenience—what’s the winning combination?

When you look at a lot of the “traditional” conditions that end up presenting during survey—propped doors, unsecured or improperly segregated gas cylinders, obstructed access to emergency equipment, sometimes even corridor clutter—the root cause often comes down to it being more convenient to sacrifice compliance (only for a moment, mind you, we were going to take care of that before you saw it). At this point in the history of the physical care environment, I don’t know that preventing these types of practices requires any additional education than what has already been provided (excepting, of course, orientation—more on that in a moment). It’s not that folks don’t know they’re not supposed to do this stuff; these are pretty well-established compliance “gaps.” As I think about it, this also can extend into the infection control realm (e.g., storage under sinks, uncovered linen, mixing soiled and clean storage). There are many, many ways that you can stub your toe on the compliance chair leg.

I also know that there is a parallel “tradition” that usually manifests itself as tasking department managers with correcting the issue(s) identified on their unit, following any rounding on said unit(s). But the question I keep coming back to relates to the persistence of so many of these types of findings during surveys—as much as 90% of survey findings through the first half of 2023—to what extent is anyone evaluating the effectiveness of this as a compliance strategy? The follow-up being: is this even resolvable or is it just the “cost of doing business?”  Certainly, we tend to focus our energies on the bigger picture stuff, such as managing the risks associated with behavioral health patients, ensuring perioperative environments are appropriately maintained, etc. But what about using the rounding process as a way to facilitate compliance as opposed to the healthcare safety equivalent of writing a parking ticket? Sure, it’s a violation at the root, but what caused it to happen? Is there an operational challenge that can’t be otherwise met without running afoul of the safety police? Do we ever ask a department manager or line staff, “how would you do it?”

I can’t help but think that increasing the level of collaboration/facilitation in these processes would yield some benefit, even if it’s only awareness. Too often, rules and regulations, without an understanding of the context, are just something to be worked around. Maybe we could work through this together…

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