Risk – A Four Letter Word You Should Mention

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An article I recently read discussed risk assessments in hospitals for items from infections to patient records. It was interesting how interwoven these assessments and processes were to provide checks and balances for patient care and safety. This made me think a little more about the physical environment and how we as healthcare facility experts review the risks of our facilities. One of the underlying principles of being a facility manager or engineer is mitigating risk in the designs, commissioning and operation of hospital facilities. Energy systems are particularly critical since the impact everything in a hospital. Can you imagine running your hospital without electricity and how long could you operate beyond the mandatory 96 hours?

Most everyone agrees that energy is the lifeblood of any facility. Without energy in its many forms, whether electricity, natural gas, water or steam, life safety would be at risk. This is exactly why the Joint Commission standards reference utilities in any risk assessment. This is especially evident in the risk analysis for utility systems (EC 02.05.01) standards. But how much deeper are you looking into the energy delivery process of your facility.

I recall a time when many years past when my company had a main transformer fail. You can imagine the difficulty that this failure caused in our facility. Thankfully it was a manufacturing environment and not healthcare but it made us take a critical look at not only our preventive but also our predictive maintenance processes. While I am not suggesting that your hospital’s specific program is insufficient, I am advocating the premise that it is good to review even the best programs with a critical eye to seek validation and possible areas of improvement.

For instance, our event spurred us to review our arc flash testing program. We found that the changes in our facility, which were minor in nature, suggested that we increase the frequency of our testing to 3 years as opposed to the 5 year requirement. With all of the changes in a hospital system, is your time schedule appropriate? Could you use prediction techniques instead of time to determine the optimum timing for maintenance to be performed? Perhaps one area of the facility needs attention on a different time schedule than others. A critical review of current and past practices is a key to ensuring reliability. Our review also showed us the number of changes in the distribution system but really didn’t fully connect the implications until they were all placed in a time sequence for us to see.

Keeping a historical and easy to digest image of changes was also an output of our review. We used a facility plan and color coded (by year) pins to place in areas of change. It’s a simplistic but it sure helped us to see our actions. How do you quickly reference the changes (large and small) in the distribution system in your facility?hallway

So knowing the time and frequency of changes in the system will lead to a better assessment and analysis of the risks in that system. Moving forward, this is becoming much more automated. Through the use of Building Analytics a manager can now have continuous commissioning and fault detection & diagnostics (you may have seen this mentioned as FDDI) operating on a 24 hour per day basis. The beauty of Building Analytics is that it can tie together a host of system using the building automation, meter data management, distribution system control and other facility management systems into a format that provides fault indication, prediction and business costs for the existing state of operation. Using such a system allows for risk assessment on a continuous basis. You also benefit from the ability to prioritize resources to address the most critical issues on a tactical level while planning the strategic level initiatives to mitigate existing and future risks. This is a wonderful development for the healthcare facility manager.

Our parents taught us not to use “four” letter words, but risk is a four letter word that we should be using continuously while finding ways to make it smaller in our operation. Using critical analysis such as arc flash studies and Building Analytics should turn big RISK into a smaller manageable risk for our healthcare facilities.

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