With the continued high rate of harm in hospitals, design professionals must be alert to assessing risk potential in their design projects. This case study article describes two examples of how risk assessments have been used in hospital design projects. Hospital A is a replacement critical access hospital with a total capacity of 25 beds accommodating medical/surgical, critical care, and obstetric patients. Hospital B is a rural integrated hospital and clinic with a phased replacement project with 50 beds.

For Hospital A, the author conducted a current state workflow assessment at the start of pre-design that involved individual interviews and observation. Opportunities for improvement were documented and prioritized based on workflow issues with a space impact. The location of the intensive care unit was identified as a top priority. With differing opinions about the location of this high-risk patient care area, the author recommended the Failure Modes and Effects Analysis (FMEA) process for risk assessment.

For Hospital B, during the occupancy planning phase, the author conducted Lean A3 problem-solving training, then individual interviews with hospital leadership to assess their problem-solving process. The lab leadership interviews identified a workflow challenge created by design decisions that needed resolution prior to occupancy. The problem concerned the high-risk handling of frozen specimens and, again, the author recommended the FMEA process.

In both cases, participants uncovered key areas of risk enabling them to take the necessary next steps, demonstrating how the FMEA process can inform facility design decisions. For Hospital A, it resulted in locating the ICU adjacent to the medical/surgical unit and not the emergency department. For Hospital B, it resulted in transporting specimens from the operating room to pathology via pneumatic tube instead of physically walking the long distance. Both hospitals were faced with decisions that involved potential delays in patient care and the FMEA structured conversations generated solutions focused on safely integrating operations and the physical environment. The FMEA process brought clarity in situations in which the solutions were not obvious and there were differing opinions.

Edited abstract from “Risk Assessment as Standard Work in Design," by Patricia W. Morrill, PMP, EDAC. To access the entire report, click here to subscribe to the The Health Environments Research and Design (HERD) Journal. The HERD Journal, a sister publication to Healthcare Design, is an interdisciplinary, peer-reviewed journal whose mission is to enhance the knowledge and practice of evidence-based healthcare design by disseminating research findings, discussing issues and trends, and translating research to practice.