The era of accountable care has focused more attention on doing things right. Hospitals are no longer reimbursed for what are categorized as "never events," serious adverse events that are largely preventable. While many patient safety initiatives focus on operational considerations and quality improvement, the built environment often serves as a contributing factor - a less apparent condition underlying errors in healthcare. The Center for Health Design, with support from the Facility Guidelines Institute and a grant from the Agency for Healthcare Research and Quality (AHRQ), has been working toward a consensus-based tool to proactively assess safety and risk in the built environment during the design process. New language will be incorporated into the 2014 Guidelines for the Design and Construction of Healthcare Facilities.