Mac’s Safety Space: Safety risk inclusivity – Doing the math in your head

By Steve MacArthur, Hospital Safety Consultant

I’ve bumped into a couple of survey findings over the last little while that I wanted to chat about. While the topics are not exactly the same (ligature risks versus medical equipment risks), there are some instructive aspects that revolve around the practical application of the risk assessment process.

In general, as there is very little specificity of direction in how one might manage risks in one’s organization, you get to plot your own course. Where that course can get a little wayward is in those instances when either the slow march of time, or the comings and goings of folks involved in the process, result in the memorialization of initial assessments, etc., into being nothing more than a set of blurry expectations, the genesis of which have become obscured over time (so, blurred blurriness).

For example, the management of manual blood pressure cuffs, as a function of inclusion (or not) in the medical equipment inventory. These devices have been around for rather a long time (and used to be quite a challenge when they contained mercury, but that was a while ago—hopefully!) and the decision to include or not include these devices in the medical equipment inventory was probably made somewhere around that rather a long time ago. So, if a surveyor were to ask staff why the manual blood pressure cuff wasn’t included in the medical equipment inventory (if that is the case, which it was in this example), what would/should the response be?

At what point does one need to go back and look at all the risk-based determinations of the past on the off chance that a question like this is raised during survey? I’m sure someone, at some point, made the determination, but that was probably—how many years ago?

I was at a conference, oh, a hundred years or so ago, and the rhetorical question was raised relative to what merits the need for an “official” risk assessment. The all-too-hyperbolic response (which, in candor, was all mine) was “everything,” but it does seem that there is a movement afoot in the surveyor ranks to try to identify processes that have been in place so long that the results of any risk assessment are likely fossilized or to find conditions or practices for which risk assessments have not been “officially” documented.

I suppose, to a degrees, this is an extension of the use of IFU’s as a means of generating findings—there are certain structures/strictures that are useful in determining how one might manage a risk, but it’s starting to seem like a case of the tail wagging the elephant in that the results of managing the risk(s) are not sufficient evidence that the risk is being managed appropriately (for some reason, ligature risks seem to be a case in point).

We can always do better and we can always learn from unanticipated (and, in some instances, un-anticipatable) events and it’s very much how we learn and improve. That’s the continuum that matters most.

It just reminds me too much of being called to the board during math class—the results are only acceptable when you do the work on the board.

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