Mac's Safety Space: Risk assessments and the lessons of the past

By Steve MacArthur, Hospital Safety Consultant

In my mind’s eye, I always think that I’ve covered certain topics in posts gone by (and I suspect this is one of those recurring risk assessment themes), but some things just don’t seem to go away.

This post is mostly a consideration of how everything you’ve ever seen, every survey finding that’s ever been cited, every condition or practice identified during safety tours, surveillance rounds, fire drills, MBWA (managing by walking around) sessions—this is all data that can (and probably will) allow you to catch a glimpse of the future. While the phrase “there is nothing new under the sun” can be interpreted as a railing against the boredom of every day existence, it also serves as a mantra of sorts when one considers the implications of the past as a predictor of the future. Of course, there’s always the dynamic of surprise (you ain’t seen nothing yet), but a robust process for keeping your finger on the pulse of the physical environment is an essential component of “normal” operations and will help reduce those pesky repeat offenders and their practices of noncompliance recidivism.

But, what do you look for? In looking back over the past few years (perhaps even more than a few), that’s the question that I hear most frequently. And my automatic response is that I don’t look “for” anything as much as I look “at” everything. If you open your sense to the entirety of the environment, non-compliance tends to make itself known, though sometimes you have to slow down enough for that transformation to occur. I like to tell folks that, as a surveyor, I am never more dangerous than when I am standing still, because that’s when I can best “see” the stuff that’s out of place—stains, damage to surfaces, dust, conditions that folks are walking right by every day. I’ll use the classic example of the stained ceiling tile; they typically don’t just happen, but are the result of a process, perhaps a leaking pipe, roof, etc. Some folks are good at “seeing” those things; and other folks are good at seeing those things and then reporting them! But think of the last time a stained (or damaged) ceiling tile was identified during rounds, or even a survey, there’s no way to know how many folks walked by the condition, but (unless it is in the most isolated space in your organization) somebody did. This goes back to the “nothing new” mantra—it’s all happened before (maybe not at the level of “Groundhog Day,” though there are certain things).

The point I’m getting to is this: go back and look at your last survey results. Did you have any findings in the more critical areas of whatever matrix might be in the mix? What did you do to fix those issues, or, more importantly, what did you include in the corrective action plan that you submitted to the regulatory body of your choice? Do you know if the fixes identified post-survey are being sustained? Did you use those findings as a guide to what might fall out in your next survey? I submit to you that if you look carefully at what you’ve experienced in the past (especially the areas of greater risk) and focus where you are with those findings in relation to compliance, you can avoid any number of headaches in the survey process. Sure, a surveyor might find that funky one-off whatever it might be the day of survey, but if you zoom in on the stuff you know has already happened (at least once), then maybe, just maybe, you can get ahead of the game.

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