Risk, or the possibility of an adverse action occurring, exists in every system whether the system is mechanical, electrical, human or something else.

In his book The Unknown Known: A Memoir, Donald Rumsfeld stated: “There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don’t know. But there are also unknown unknowns. There are things we don’t know we don’t know.”

Assessing risk is a key component of determining what is known and unknown. A risk assessment, a process to identify potential hazards and analyze the potential impact of these hazards, can help to provide guidance in the risk assessment process and is required by Section 4.2, Risk Assessment, of the National Fire Protection Association’s NFPA 99, Health Care Facilities Code. The American Society for Health Care Engineering’s NFPA 99-2012 Risk Assessment Tool has been developed to help staff comply with the risk-based, patient-focused approach required by NFPA 99.

The tool recommends three steps be taken prior to completing the assessment. First, a multidisciplinary team that has knowledge of the facility’s space use, patient care services, clinical practices and other areas as appropriate should be established. The multidisciplinary team significantly affects the “unknown unknowns,” because involving multidisciplinary experts provides greater understanding and decision-making.

Second, it is recommended that the team become familiar with the risk category definitions within NFPA 99. These definitions provide the patient focus necessary within the risk assessment tool. Finally, the team should be familiarized with the ways in which system and equipment operability can affect patient safety. 

These three steps will allow the team to better assess the systems and equipment and their impact on building occupants. 

As the American Society for Health Care Risk Management states, risk assessments are vital to advance safe and trusted health care. Following an established process with a multidisciplinary team to assess risk will help to reduce adverse actions from occurring, helping to optimize the health care physical environment.