A portion of the physical environment is invisible
Lately, I’ve been doing a lot work that involves above-the-ceiling inspections, so I’ve been spending a fair amount of time in “backstage” areas. As my knees will tell you (as they have been reminding me), climbing ladders and poking one’s head above the ceiling is an arduous task—one for which there is a certain reluctance to engage. And, with the burgeoning use of containment carts to ensure that infection control protections are included in the inspection process, there is that additional “barrier” to prioritizing this activity. I know for myself that, if I’m engaged in a “straight” regulatory rehearsal, I tend to try and limit the amount of above-the-ceiling inspections (in general, I really hate the idea of having a facilities support person following me around with a ladder) to the last day of the inspection visit and, if I see enough issues in the readily accessible backstage areas (e.g., utility spaces, IT/telecom closets, mechanical spaces, etc.), I am content to make the general observation that the issues (e.g., firestopping, wires on sprinkler piping, open junction boxes, etc.) are sufficiently widespread to represent a survey vulnerability, so sometimes the ladders don’t come out.
As a general point, I am pretty confident that if I start cracking ceiling tiles, there will be deficiencies of some kind; while there may be spaces that are in good shape, there are invariably opportunities to improve above the ceiling in every organization—it just depends on how much you want to look.
The equation we discussed last week involved the participation of frontline folks to assist in identifying environmental deficiencies, but the places we’re discussing now are more or less invisible to all but a few folks. The accessible backstage areas (as noted above, and I’m sure you can add some spots to the list) are occupied periodically and you definitely want to get the folks in those spaces to be on the lookout for deficiencies, so we’re back to the finders and fixers, though in this case the finders and fixers might be the same person.
The space that’s really intriguing me is the space that has to be actively inspected—the space above the ceiling. In newer buildings (and bless you if you have one of those), there tends to be a little more space above the ceiling, which allows for a couple of things: room to have “stuff” and have it be installed in a manner that promotes compliance, but also room to see stuff that might not be quite in compliance. In older facilities, it can be a whole other world: odd-sized ceiling tiles; ceiling tile systems that are not easily accessed or require a tool with which to gain access; ceiling tiles over which cabling, conduiting, ductwork, etc. is squeezed in so tightly that the tiles are impossible to remove, and then, if you can get the ceiling to shift enough to stick your head up into the space, there’s so much material that you can’t see more than an inch or two in any direction.
So, particularly with the “older building” folks, but this could be anyone—how do you plan your above-the-ceiling inspections? Do you somehow mark the ceiling tiles (or ceiling locations) that provide enough of a “view” to be worth checking again? Do you use your HVAC as-builts to determine where the ductwork is and stay away from those locations? Or, do you adopt a random approach to the inspections? I know some folks contract out the above-the-ceiling inspection process; if so, do you specify a minimum number of above-the-ceiling locations? Do you work with the vendor to identify the “good” ceiling tiles? It tends not to be the most efficient of processes—anyone have any “tricks” or innovations to increase the efficiencies or is it just one more pain in the neck?
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.