The Facility Guidelines Institute’s (FGI) Guidelines for Design and Construction requires healthcare organizations to develop a safety risk assessment to identify and mitigate hazards and risks of adverse events for patients, staff, and visitors. The Center for Health Design has a free tool to help guide you through the process.

The Safety Risk Assessment (SRA) toolkit, funded through a multiyear grant from the Agency for Healthcare Quality and Research and created by safety risk experts, outlines a proactive process for architects, designers, healthcare organizations, and safety advocates to follow. It’s designed to prompt discussion and encourage multidisciplinary teams to use an evidence-based design approach to identify solutions to six safety issues: infection, falls, medication errors, security risks, injuries of behavioral health, and patient handling concerns.

The toolkit should be utilized as early in the design process as possible to help guide decisions and is created in a way that doesn’t require users to have previous SRA knowledge or experience. Short tutorial videos, a user guide, and a section on frequently asked questions and answers are also included online.

Getting started
There are four basic steps to follow when using the toolkit:
• Begin by creating a profile that includes information about the project scope, safety areas to consider, and project team collaborators, including subject matter experts, frontline caregivers, administrators, designers, architects, engineers, and other stakeholders. This profile becomes the project “home page.” It can be used to provide documentation to an authority having jurisdiction for project approvals and houses links to many outside resources such as FGI’s Patient Handling and Movement Assessment white paper and its Design Guide for the Built Environment of Behavioral Health Facilities.
• Next, enter historical safety data (such as the number of specific infections in a unit or fall incidents) to help identify where problems may exist and establish any trends that might be considered. This information can be entered using an organization’s existing numeric format for collecting and reporting or via narrative.
• The Safety Alignment Tool will then assess safety issues within the context of larger organizational objectives and quality improvement processes. This process helps outline where an organization may need some additional work on improving safety and provides an opportunity to align project objectives with strategic objectives for safety. These items can serve as an action list for the administrative team and can be marked as “in progress,” “not started,” or “well developed.”
• In the final stage, design considerations for the six safety areas are looked at together, individually, or by building component (such as unit or room layout). These factors aren’t a checklist but a prompt for discussion so teams can decide whether an item is applicable to a project and then assign a high-level risk estimate, cost magnitude, and priority level. Rationale statements are also added here to help teams understand why a consideration might be important as well as any trade-offs or additional benefits that might be realized.

Next steps
Many project design choices are influenced by the care model, operational policies and procedures, the staff, patients (and their family/visitors), and the built environment. Therefore, it’s important that all stakeholders have a voice in identifying the optimal solutions for any given project. What works for one project or organization may be vastly different for another.

The bottom line is that the SRA isn’t about checking off everything you’ve done and acing the test. It’s about proactively considering the implications of design and creating solutions that have been developed in a thoughtful manner.

For more information, visit the Safety Risk Assessment toolkit on The Center’s website at

Ellen Taylor, PhD, AIA, MBA, EDAC, is vice president for research at The Center for Health Design. She can be reached at