Mac’s Safety Space: How do you risk assessment?

By Steve MacArthur, Hospital Safety Consultant

If I have learned nothing over the course of the last little while (there are rumors that I am approaching 50 years in healthcare—rumors I roundly dispute, despite my having worked in healthcare since 1978), it is that the administration of the risk assessment process in any organization is as close to an essential undertaking as any I can think of (beyond “compliance” as a process).

At the ASHE conference there was one session that was set up as something of a debate on the merits of operational considerations versus compliance, with the notion that there is something of an adversarial aspect to that relationship (I was almost going to call it a dichotomy, but I really think that operations and compliance are two sides of the same coin). There was a little bit of back and forth between the opposing “teams,” but it struck me that, at the end of the day, you really can’t have effective operations that are not “built” around compliance—to my mind they are inextricably linked.

That said, I’d like to welcome you to what I think will be a series (intermittent—I’m not going to gush these out all at once) of blog posts that discuss those moments where operations and compliance are somehow… severed? Torn asunder? My general euphemism for the classic “gap” between compliance and operations is that of the “unauthorized field modification”—door stops, obstructed building emergency equipment, conversions of spaces from one purpose to another without letting anyone know, etc.

Clearly, as we’ve noted in the past, a lot of these are born of convenience or trying to get a design feature to do what makes sense from an operations standpoint (why would you design a door arrangement in, for example, a radiology procedure room that doesn’t have an accommodation for moving a stretcher in and out of the space—nobody wants to fight those doors with a patient on a stretcher!) There are risks associated with anything you might do (or not)—how does one effectively empower point of care/point of service staff to “come clean” when there are operational considerations that are not being met?

I think, to a fair degree, it comes down to outreach, with a healthy dose of education, but some part of me wants to dig in a little deeper on this subject, particularly as it informs any organization’s risk assessment processes (I think it’s safe to say that there are probably any number of RA processes that can be invoked at any given time). The power of the RA process is in how closely one can come to a standardized way of dealing with this stuff (preferably one that can exist in perpetuity) and using that standard to keep operations and compliance on the same page.

As a closing thought, it’s times like these in which I miss the “old days” when folks could weigh in on the webpage for each post—I always enjoyed seeing the immediate feedback and I suspect the notion of operational compliance challenges might bring some interesting real-world examples. If you should have an operational compliance issue with which you are feeling challenged, I would encourage you to let me know, which you can do by e-mailing me at or—whichever is easiest for you to copy and paste. I would love to hear from you and I promise I will make it worth your while.

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