“Life is messy and full of compounding consequences.” Although environmental law professor Sanne Knudsen was writing about the cumulative public health risk of exposure to chemicals and pesticides, these words could just as easily apply to the various public health risks managed by healthcare organizations. Little is known about the cumulative risk for healthcare organizations.
Any attempt to assess and manage cumulative risk within healthcare organizations raises similar issues to those involved with managing risks individually. For example, it is not always clear what the consequences of inappropriate staff behavior or a cybersecurity breach will be in the real world given the many contingent factors—including the type and number of patients affected, the speed at which the risk is contained, and any redress made to the patients and staff members affected. These uncertainties arising from individual risks force those who need to prepare for and reduce predictable risks to make assumptions about human behavior.
However, assessing cumulative risk in healthcare organizations presents an additional layer of uncertainty. In assessing cumulative risk, we need to evaluate whether the timing of events (and the order in which they occur) matters when assessing their potential cumulative impact. Further, the response to the first incident may affect the consequences of, or response to, the second. Finally, the possibility of multiple system failures may affect both an organization’s response and the behavior of patients and staff members.
In spite of the uncertainties, this article draws on cumulative risk assessment methodology developed by the field of environmental regulation and adapts it to the healthcare context. This article first examines the increasing prominence of cumulative risk in environmental law, where the quantity and variety of chemicals and pollutants have highlighted the need to address the interaction of different environmental hazards. The article then discusses how current risk assessments by healthcare organizations are too segmented in that they view risks in isolation or evaluate multiple risks based on a simple additive principle—the harm associated with the cumulative risk is the sum of the damage of each individual risk had it occurred in isolation. Next, this article addresses the importance of cumulative risk assessments for healthcare organizations. Recent natural disasters and mass casualty events show that assessing simultaneous and interacting risks is imperative to making health organizations safer for patients and staff. Finally, this article proposes adopting the same framework used in the environmental context for evaluating cumulative risk in the healthcare context.