Governing healthcare electrical risks

A workable approach is to treat electrification as a managed program aligned to plan-do-check-act principles and accreditation methodology.

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Electrification is reshaping hospital infrastructure and workflows, bringing new ignition sources, high-energy battery hazards and utility-grade systems into environments with low tolerance for disruption.

This article summarizes the risk profile and outlines a practical governance model aligned with, but not exclusive to, DNV Healthcare USA Inc.’s National Integrated Accreditation for Healthcare Organizations^® accreditation framework and the International Organization for Standardization’s ISO 9001 plan-do-check-act (PDCA) principles.

It can help facilities managers remain safe, resilient and survey ready.

Electrification risk profile

Electrification in healthcare is no longer limited to back-of-house projects. It is increasingly visible at public entrances (e.g., electric vehicle (EV) charging), embedded in daily clinical work (e.g., battery-powered carts and devices), and central to resilience strategies (e.g., on-site energy storage and microgrids). These benefits are real, but they also broaden the hospital hazard profile.

Hospitals are uniquely sensitive to disruption. Patient acuity, limited mobility, oxygen use and dependence on continuous utilities mean that an event can become a patient safety emergency. In addition, risk often accumulates quietly through informal practices, such as charging clusters in offices or storerooms and unmanaged power use, until a near-miss forces attention.

Electrification crosses traditional boundaries. Facilities may own EV supply equipment (EVSE) and infrastructure, biomedical engineering may own clinical carts and device fleets, information technology (IT) may own battery-backed communications and endpoints, materials management may purchase replacement packs and security may be first to notice damage or unsafe charging behavior. Risk often concentrates at campus interfaces, entrances and valet zones, parking structures near air intakes and loading docks, where “temporary” charging becomes permanent, so siting, operating rules and visible oversight matter as much as electrical installation.

Lithium-ion battery (LIB) failures are not theoretical. Thermal runaway may present as heat, smoke and off-gassing before visible flame, and it can escalate rapidly once initiated. Most events begin as routine abnormalities — a device that runs hotter than usual, a swollen pack, a charger that smells “electrical” or a damaged cable — so governance should focus on preventing common precursors, enabling early reporting and ensuring a coordinated response posture. Common risks and mitigations include:

• Clinical cart and charger hazards. Regulators have reported overheating, smoke and fires involving batteries used in mobile medical carts and their chargers. A practical risk posture is to treat cart batteries and charging equipment as utility-like assets, emphasizing use of approved batteries and chargers, periodic inspections for damage and overheating indicators, defined replacement intervals and integration with the preventive maintenance program. This should align with the organization’s risk mitigation strategy and process.
• EVSE site and operations risks. EV charging expands the risk boundary beyond the building. Siting near emergency access routes, air intakes or critical utility infrastructure can create disproportionate operational consequences if a vehicle fire occurs nearby. Even when installation meets code, organizations still need operating rules for reporting damage, maintaining clear space and monitoring public charging areas.
• Battery energy storage systems (BESS) utility-grade hazards. Large BESS incidents have underscored how thermal runaway can generate flammable off-gases and how operational complexity can cascade into major disruption. For hospitals, the transferable lesson is life-cycle governance, including requiring appropriate listing and testing evidence, defining monitoring and alarm response expectations, controlling configuration changes and coordinating pre-incident planning with the authority having jurisdiction and local fire authorities.
• Informal charging cluster dangers. Fire services across the country have reported growth in LIB fires associated with consumer mobility devices and charging practices, with many incidents occurring during charging and spreading quickly when devices are near combustibles. Hospitals face an analogous risk when multiple batteries and chargers accumulate in offices or storerooms for convenience. The mitigation is largely behavioral and environmental, including designated charging rooms or lockers, limits on quantities, consistent housekeeping and routine rounding that treats charging areas like any other safety-sensitive space.

What makes these events different in healthcare is not only ignition but also consequence management. Smoke migration can trigger unit disruption, life safety system responses and rapid decisions about patient movement. Consequently, electrification risk should be integrated into the environment of care program and emergency preparedness planning, including coordination with local fire authorities for EVSE locations and any planned BESS installations.

A survey-ready model

A workable approach is to treat electrification as a managed program aligned to ISO 9001 PDCA principles and DNV’s accreditation methodology. This means defining scope (e.g., EVSE, device batteries/chargers and any BESS) and documenting a risk assessment that identifies credible hazards and exposure pathways, then mapping controls across prevention, detection and response with clear ownership and measurable evidence.

One way to operationalize PDCA is to assign electrification owners for each asset class and require the same management plan elements used elsewhere, including scope and inventory, roles and responsibilities, inspection and maintenance, training, incident reporting and a defined review cadence. This turns electrification into a managed system that can be audited and improved.

Most organizations do not need a new committee but a clear integration point. EVSE and BESS align with utilities management and emergency management; clinical carts and device batteries align with medical equipment management and infection prevention and housekeeping practices; and campuswide charging behaviors align with environment of care rounding and policy enforcement.

The key is to make electrification visible in the same dashboards and management review structures leadership trusts through the following steps:

1. Define the asset and use case, including what is deployed, where and who uses it.
2. Identify credible failure modes (e.g., electrical fault, overheating/thermal runaway, smoke migration, blocked access routes and monitoring failure).
3. Map exposure pathways and operational consequences (e.g., patients, staff, egress, air handling, utilities and downtime).
4. Inventory existing controls and evaluate gaps (e.g., design features, policies, rounding, preventive maintenance, training and response plans).
5. Assign owners, timelines and evidence, and review performance through drills, near-miss trending and management review.

Prevention focuses on the decisions that shape risk before anything goes wrong, including EVSE siting that protects emergency access, air intakes and critical building features; standardization of approved chargers and battery packs; designated charging and storage locations sized for the real device load; and clear rules that prevent ad-hoc power use. Prevention also includes life-cycle controls that are easy to overlook, such as replacing aging battery packs on a schedule, removing damaged packs from service and ensuring vendors do not substitute “equivalent” batteries or chargers without review.

Detection relies on routine oversight and unambiguous escalation. For EVSE, this may include periodic inspections, rapid repair of damaged connectors and cables, and a way for security or valet staff to report problems. For internal charging areas, it includes rounding that looks for overloaded outlets, blocked egress, damaged packs and chargers operating in unsuitable locations. The goal is to convert observations into managed work, tickets, device swaps and service calls before they become events.

Response translates hazards into coordinated preparedness. Role-based training should clarify who isolates equipment, who notifies whom and which situations require escalation to incident command or external responders. Drills and tabletop exercises should include realistic constraints such as smoke migration, unit relocation considerations and public-area EVSE incidents that may affect access routes. A strong response posture also includes post-event learning, including near-miss reporting; after-action review; and updates to purchasing standards, siting criteria or training based on what the organization observed.

Procurement and receiving

Procurement is the earliest control point to prevent unmanaged electrification risk. Hospitals can define “electrification-controlled items” in the procure-to-pay workflow so purchases route through the right reviewers (i.e., biomedical, facilities/engineering and safety/emergency management, as appropriate) and restrict buying to approved models and vendors. Receiving then becomes a documented acceptance step, confirming compatibility and condition and preventing high-risk charging equipment from being drop-shipped directly to units without oversight.

Many hospitals can enable this without a major IT project by using existing fields and routing rules, including category flags, deliver-to requirements and reviewer assignments. Requisitions that include key terms (e.g., battery pack, charger, charging cabinet, EVSE and energy storage) can be routed for technical review and required to specify an equipment owner and intended deployment location.

Procurement controls also are where organizations can prevent so-called “silent substitutions” that increase risk, including aftermarket batteries, unapproved chargers or vendor changes made during supply shortages. Facilities managers should define which substitutions require review and ensure receiving and biomedical/facilities acceptance checks verify compatibility and listings before the equipment is released for use.

Equally important, procurement and receiving should feed an inventory location of record. Fixed assets (e.g., EVSE, charging rooms and BESS) typically live in the facilities’ computerized maintenance management system (CMMS)/enterprise asset management (EAM) system with maintenance plans and documentation. Clinical carts and device fleets typically live in the biomedical inventory system with battery type, charger type and replacement intervals. Items are not truly controlled unless they can be located; therefore, moves should trigger location updates as they do for IT assets.

Implementation roadmap

A practical first milestone is to eliminate the most common high-consequence failure modes, including unknown battery stockpiles and untracked installation of EVSE or charging rooms. The second milestone is to make the program auditable by creating a location-of-record and evidence trail that can be reviewed by leaders and surveyors.

For example, in the first 90 days, facilities managers can focus on governance fundamentals by defining scope and ownership, setting simple rules that staff can follow and implementing oversight that is sustainable. They must engage facilities, biomedical, security, supply chain, safety and emergency management, and unit leadership early so controls match real workflows rather than idealized ones.

Actions include publishing designated charging and storage locations and explicitly prohibiting ad-hoc charging in combustible storage areas; creating an electrification risk register (e.g., EVSE, device batteries/chargers and any BESS) with owners and reviewing the cadence; implementing a receiving/acceptance step for electrification-controlled items and requiring an equipment owner and location on requisitions; establishing a location-of-record in the CMMS/EAM for facilities and a biomedical inventory, and defining how moves/relocations are updated; and training key roles on early warning signs, reporting paths and escalation, and including an electrification scenario in a drill or tabletop.

A functioning system

Survey readiness is demonstrated through evidence of a functioning system, including a documented risk assessment; controls mapped to hazards; training and competency; inspection, maintenance and monitoring records; and continuous improvement through near-miss trending, corrective actions and review.

It often is easiest to manage as an evidence package that a leader can assemble quickly and that includes a documented risk assessment covering EVSE, lithium-ion charging/storage/disposal and any BESS, with a defined review cadence; siting criteria and operating rules communicated to staff and contractors; inventory and location-of-record for key assets and charging areas, with assigned owners; preventive maintenance schedules and completed work orders aligned to manufacturer instructions; training and competency records along with drill and tabletop documentation that includes electrification scenarios; and near-miss and incident review, corrective actions and management review outputs demonstrating continuous improvement.

The path forward

Electrification can strengthen resilience and support sustainability goals, but it must be governed as a high-consequence risk domain. Ultimately, the path forward is practical — define what is in scope, decide who owns it, make controls visible in daily operations and use PDCA to keep the program effective as technologies and patterns evolve. 

About this article

This article was contributed to Health Facilities Management by DNV Healthcare USA Inc.

Scott Mason, CHOP, HCC, is executive director of business development and sales for life sciences – healthcare accreditation, certifications and training at DNV Healthcare USA Inc. He can be reached at scott.mason@dnv.com.

Related article // Groups focus on battery safety

According to a National Institute of Standards and Technology paper, “Understanding the Risk of Lithium-Ion Battery Fires,” lithium-ion battery (LIB) fires are a growing problem that extend across an LIB’s life cycle. But data on such fires is fragmented and mostly incomplete. Much of the data comes from secondary sources, making the identification of LIB fires difficult.

The National Fire Protection Association (NFPA) is in the process of developing NFPA 800, Battery Safety Code, a new, comprehensive standard to address the entire life cycle of batteries. NFPA 800 is aimed to fill gaps in existing standards (like NFPA 855, Standard for the Installation of Stationary Energy Storage Systems) to mitigate fire and explosion risks across diverse battery usage.

In coordination with this effort, the American Society for Health Care Engineering (ASHE) has established a work group to develop practical, risk-based recommended practices for hospitals to align guidance with codes and standards (including NFPA 800) and make sure solutions support both patient care and day-to-day hospital operations.

The ASHE Battery Safety Task Group will focus on identifying, assessing and mitigating risks; the development of practical, risk-based recommended practices; and alignment with existing and developing codes and standards.

While battery safety is a growing concern, facilities that stay appraised of continuing development of battery safety standards and establish programs to properly manage the potential risks will be able to continue to safely use LIBs. 

Related article by Jonathan Flannery, MHSA, CHFM, FASHE, FACHE, senior associate director of regulatory affairs at the American Society for Health Care Engineering.