Eleven Risks, Eleven Owners: A Risk Register for a Hospital Cleanroom Build, From Failed Air Balancing to Fungal Spores
Student Name
American College of Education
HLTH5683: Project Management for Healthcare Administrators
Module 4 Assignment
Instructor Name
September 25, 2028
How the Risks Were Found and Scored
The composite 220-bed hospital's cleanroom project has a charter, a 45-work-package breakdown and a 45-week schedule whose critical path runs through the temporary cleanroom, construction and air balancing. Risks were identified in a two-hour workshop with the project team, the mechanical contractor, the certifier, the infection prevention director and the pharmacy's designated person for sterile compounding, working through the breakdown branch by branch and asking what could go wrong in each. The Project Management Institute (2021) treats risk as an uncertain event or condition that, if it occurs, has a positive or negative effect on project objectives, and the team wrote each risk in three parts, cause, event and effect, so that the response could target the cause.
Each risk was scored from 1 to 5 for probability and for impact on schedule, cost or safety, and the two scores were multiplied. Risks scoring 12 or more are high and are reviewed every two weeks; 6 to 11 are medium and reviewed monthly; below 6 are low and reviewed at phase gates. Every risk has exactly one owner, a person with the knowledge and authority to act on it, not a committee. A risk owned by the project team is owned by no one; a risk owned by a named person has someone who will lose sleep over it.
High Risks
R-01, score 15. Because air handling design or installation may not hold the required pressure differentials, the suite may fail initial certification, delaying opening by two to six weeks and extending the temporary cleanroom rental. Owner: Marcus Hill, mechanical engineer of record. Response: mitigate, through the certifier's early design review, a pre-certification test by the air balancer a week before the certifier arrives and door closers specified to hold pressure. Trigger: any pressure reading outside range during balancing. Contingency: four additional weeks of temporary cleanroom rental, about $60,000, held in the project contingency. R-02, score 15. Because demolition and construction generate dust, spores could reach the temporary cleanroom or the existing hazardous drug room, contaminating preparations. Owner: Angela Brooks, director of infection prevention. Response: mitigate, through the highest level of containment barriers in the infection control risk assessment, negative pressure in the work zone, sealed penetrations and daily particle counts outside the barrier.
The second risk deserves its score. Kanamori et al. (2015), reviewing four decades of fungal outbreaks during health care construction and renovation, found that outbreaks still occur, usually caused by Aspergillus, with overall mortality of about 50 percent among those infected, and they concluded that infection control risk assessments and their control measures are essential to prevention. Contaminated sterile preparations reach patients' bloodstreams directly. Trigger for R-02: any particle count above the agreed threshold outside the barrier or any environmental sample above action levels in the temporary room. Contingency: stop work in the affected zone until containment is restored and verified.
Medium Risks
R-03, score 12. Because hidden conditions may be found when two walls are opened, such as unrecorded plumbing or materials requiring abatement, construction costs and time may increase. Owner: Tom Reyes, facilities project manager. Response: mitigate through selective exploratory openings during design; accept the residual risk with contingency. R-04, score 10. Because the temporary cleanroom may fail its own certification, compounding may not be able to move out on time, delaying demolition on the critical path. Owner: Priya Shah, pharmacy designated person for sterile compounding. Response: mitigate by selecting a vendor with certified units in use at other hospitals and scheduling certification immediately on installation. R-05, score 9. Because the building department's review may exceed seven weeks, the permit may arrive after the temporary room is ready. Owner: Tom Reyes. Response: mitigate by walking the schematic drawings through with the code officials before formal submission, so that questions are answered before the review clock starts.
R-06, score 9. Because the contractor's crews may be committed to another job, walls and finishes may take longer than eight and four weeks. Owner: Kevin O'Neill, contractor's project superintendent. Response: transfer part of the risk through a contract clause with liquidated damages for delay; crashing with a second crew is the recovery option. R-07, score 8. Because staff may fail hands-on competency tests in the new suite, too few may be qualified to compound on opening day. Owner: Priya Shah. Response: mitigate through practice sessions in the temporary room and scheduling tests two weeks before opening. R-08, score 8. Because the air handling unit's lead time may slip, installation could be delayed. Owner: Tom Reyes. Response: mitigate by ordering after the design review, giving 12 weeks of float, and by weekly vendor confirmation.
Later and Lower Risks, and an Opportunity
R-09, score 8, a medium risk listed here because it can arise only after construction: because environmental monitoring in the first months may show results above action levels, the suite may need remediation before closeout. Owner: Priya Shah, with infection prevention. Response: accept, with a prepared investigation and cleaning procedure. R-10, score 6. Because the state board of pharmacy's inspection date is outside the hospital's control, opening may wait for inspection. Owner: Priya Shah. Response: mitigate by requesting a date as soon as construction is scheduled. R-11, score 6. Because the outsourcing vendor may reduce supply during the transition, knowing the hospital's orders will fall, shortages of ready-to-use syringes could occur. Owner: Linda Park, director of pharmacy, with procurement. Response: mitigate by confirming volumes in writing through the opening month.
The register also records one opportunity, since risk includes positive uncertainty. If the air handling unit arrives early, ductwork and installation could be completed ahead of the walls, allowing controls to be tested sooner. Owner: Marcus Hill. Response: exploit, by asking the vendor for the earliest possible delivery at no cost.
Keeping the Register Alive
A register is useful only if it changes as the project does. The project manager will review high risks with their owners every two weeks and medium risks monthly, updating scores, closing risks whose window has passed and adding new ones. International guidance on risk management describes it as iterative and integrated into an organization's processes rather than a one-time exercise (International Organization for Standardization, 2018). Each review will ask three questions of every open risk: has the probability or impact changed, has the trigger occurred and is the response working? R-05, the permit, will close in February; R-01, certification, will stay high until the certifier signs. The contingency budget of about $157,000 will be tracked against the risks it covers, so that the sponsor can see how much remains as the high risks pass. The best sign a risk register is working is that its highest-scoring entries at the end are different from those at the start.
Owners report on their risks in person at the review, not by email, and any owner who leaves the project hands the risk to a named successor before going. The sponsor sees the top five risks, with their owners and trends, in every monthly report.
References
International Organization for Standardization. (2018). Risk management: Guidelines (ISO Standard No. 31000:2018).
Kanamori, H., Rutala, W. A., Sickbert-Bennett, E. E., & Weber, D. J. (2015). Review of fungal outbreaks and infection prevention in healthcare settings during construction and renovation. Clinical Infectious Diseases, 61(3), 433-444. https://doi.org/10.1093/cid/civ297
Project Management Institute. (2021). A guide to the project management body of knowledge (PMBOK guide) (7th ed.). Project Management Institute.
How this HLTH 5683 Module 4 example is structured
HLTH 5683 Module 4 often builds a risk register where every entry has a named owner; your classroom's instructions decide the scoring scale and register format. This example describes how risks were identified and scored, then presents the register grouped by score, with the highest risks explained in full. Each entry names one owner by position and name, a response strategy, a trigger and a contingency. A section on review explains how the register will be updated, since a register filed at the start and never opened again protects nobody.
HLTH5683 Module 4 questions, answered
What does HLTH5683 Module 4 usually ask for?
HLTH5683 Module 4 often asks students to build a risk register for a health care project, with each risk described, scored for probability and impact, assigned an owner and given a response. Many sections expect a discussion of the highest risks. Your classroom's instructions decide the scoring scale and format.
Why should every risk have one named owner?
A single owner has clear responsibility for watching the risk, recognizing its trigger and carrying out the response. Risks assigned to a team or committee are often noticed by no one until they occur.
What are common risk response strategies?
For threats, common responses are avoid, mitigate, transfer and accept; for opportunities, exploit, enhance, share and accept. Each response should be tied to the cause of the risk and supported by a trigger and, where needed, a contingency.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official American College of Education document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.