Mac’s Safety Space: Fables of the preconstruction risk assessment

By Steve MacArthur, Hospital Safety Consultant

A fairly brief entry this week: Summer scorching seems to be the rule rather than the exception, of late, so blathering on in my usual fashion seems somehow over-indulgent.

Now that all is (presumably) moving towards whatever normalcy is going to be within our grasp (I suspect it will take a little time to figure out what that even means), I wanted to loop back on what could be a critical process as we start to build (both literally & figuratively) into the future: The preconstruction risk assessment (PCRA) process.

As you no doubt know by now, the folks at the American Society for Health Care Engineering (ASHE) have published an updated version of the time-honored Infection Control Risk Assessment created way back at the turn of the century (or as I like to say, the early aughts – you can find the historical version here: and the updated version here:

One of the things I periodically bump into is the notion of the PCRA  as a “one and done” activity, which I often find (as a single point in time) doesn’t account for the evolution (or mutation) of risks over the course of a construction or renovation project. Sometimes risks change before the project even gets “out of the blocks.”

In most, if not all, construction/renovation projects there is an “arc” of activities with different (and sometimes disparate) levels of risk—if you don’t periodically revisit the assessment to validate that all the initial assumptions are present, as significant as you imagined, etc., you might be in a position in which the protective measures (whatever they might be) do not match up with the risks requiring management.

There have certainly been any number of instances in which a historical risk assessment is requiring protective measures (say, for example, HEPA filtration of the construction space) and the project is nearly complete (ceilings and finishes are in, minimal generation of dust, etc.) that go well beyond the existing risks.

Think about having a regular process in place for review of construction/renovation activities, including reviews of existing PCRA’s (and yes, I know the “P” stands for “pre,” but I prefer to think of that as a shortening of the word “preventative” as opposed to the “before” synonym). If you’re interested, there was a really good article published in Healthcare Facilities Management magazine back in March 2023. It really does a good job at outlining the process and the importance of the component parts – check it out:

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