Everyone’s a risk wrangler

It seems that every week when I look for topics upon which to pontificate, I periodically try to find things that don’t (necessarily) focus on the whole risk assessment thing and I have come to the inescapable conclusion (took me long enough!) that there is virtually no topic that we can discuss that doesn’t fold back into the realm of the assessment and management of risk.

To be honest, I have no idea why I even thought for a moment that something else could be at work. I think it may go back to when I asked the (somewhat rhetorical) question as to whether one would have to do a risk assessment for “everything” and was informed by a representative from our friends in Chicago that risk assessments were not required (admittedly, this was rather a long time ago—on the order of a decade or so), but if you want to identify the “hub” (or, I daresay, the “big toe”) of the management of the physical environment, it is the risk assessment process.

Having said that, as I am wont to do, I try to collect interesting articles that I encounter and there were a couple of posts relating to designing behavioral health facilities that I thought made some good points. The first post (https://www.linkedin.com/pulse/common-mistakes-designing-psychiatric-hospitals-sivakumar-murugesan/?trk=articles_directory) won me over in the first sentence, with the observation that “there is no one-size-fits-all solution.”

This observation (one with which I wholeheartedly agree) is kind of the tipping point when it comes to survey findings. Oftentimes surveyors are looking for something in particular when it comes to design and protection so when they encounter something they’ve never seen before, so it can be a hard sell for an organization to provide sufficient data to support that the approaches, etc., are, in fact, effectively managing the risks associated with behavioral health patients.

It seems like not having reportable events (successful attempts at harm or near misses) isn’t enough data to support the effectiveness of the program—you have to be able to “show your work” in ensuring the safety of these at-risk patient populations.

There are a few items to consider outlined in the June 2022 issue of Perspectives:

• Conducting audits to determine the rates at which staff are completing the screening process as required by your policy;
• Implementing a process to routinely monitor staff performance of one-to-one observation to ensure practices are in compliance with your policies and procedures;
• Confirming that patients at high risk are place in a safe environment or placed in a one-to-one and that environmental risk assessments are completed as required;
• Tracking the timeliness and completeness of suicide risk assessments to ensure that they are regularly being performed in alignment with your policy.

A lot of this comes down to the clear identification of risks in the environment as the starting point—it is very difficult to educate line staff to the “dangers” of the environment unless you clearly identify those risks. And that identification must take into account the various levels of risk in the environment (there is really no way to build an environment to a single risk level); and for that task, I think you’ll find the information here to be very instructive: https://www.linkedin.com/pulse/guidelines-varying-levels-precautions-while-designing-murugesan/. It is not just about how we’ve managed risk in the past—it’s as much about how we are going to manage risks now and forever.

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 stevemacsafetyspace@gmail.com.