Construction Safety Risk Assessment for Underground Structures in Military Hospital Projects Using Activity-Based Failure Mode and Effects Analysis (FMEA) ^†

Abstract

The Indonesian government is currently focusing on infrastructure development, including military infrastructure to strengthen national defense. One of these projects is the development of the Indonesian Army Central Hospital, which is being continually expanded with facilities such as proton beam therapy. Due to its underground construction, special attention must be given to construction safety to prevent workplace accidents. This study focuses on assessing construction safety risks at the military hospital using activity-based failure modes and effects analysis (FMEA). The research methodology employed is a mixed-method approach involving 5 construction safety experts and 100 respondents directly involved in underground structure construction. Descriptive data analysis was conducted, serving as the basis for calculating risk priority numbers (RPN) using the FMEA method. Three main activities were identified with very high risks ranked from 1 to 10: lifting of contiguous pile casing, basement excavation, and installation of cast in situ bored pile gutter. These activities entail safety risks with RPN values ranging from 100 to 125, including worker’s hands being caught in tools/materials, being struck by tools/materials, falling/slipping into excavations, and being buried/struck by excavated soil. This research has positive implications as a reference for developing construction safety plans that include risk identification, risk assessment, and determination of control measures.

1. Introduction

The Indonesian government is currently placing special emphasis on the development sector, encompassing both civil infrastructure and military construction. The development of military construction projects demonstrates the Indonesian government’s commitment to strengthening national defense to face future threats [1]. One type of military construction is the military hospital. A military hospital is specifically designed to support the healthcare functions required by military institutions. These hospitals are planned, constructed, and operated by the military. The Central Army Hospital of Indonesia is one such military construction project currently under development. This development includes a proton beam therapy facility that employs an underground structure. This building is unique compared to others, with a total area of 4319 square meters, and features a basement dedicated to proton beam therapy with specially reinforced structural integrity. The construction process can be seen in Figure 1.

In addition to being unique, construction projects are inherently complicated and complex [2]. The complexity of a construction project is determined by the construction methods employed [2]. The underground structure work on this military hospital project utilizes the top-down construction method. Consequently, this project has garnered special attention [3] due to its high construction safety risks.

Furthermore, the project is large, complex, and challenging, which can contribute to numerous workplace accidents [2,4]. These accidents pose serious issues. A series of construction accidents have occurred in Indonesia over recent years due to the increasing number of infrastructure projects being undertaken. In 2020, 19% of workplace accidents in construction projects involved incidents of workers being struck by falling objects or materials [5]. Meanwhile, 16% of construction accidents, occurring in 2019, resulted in 30 fatalities and 9 severe injuries [5]. Workplace accidents can have negative impacts on project management, such as increased project costs, delays in project completion, and damage to the company’s reputation, in addition to adversely affecting workers [3,6].

Therefore, controlling construction safety risks is crucial as part of the project’s safety plan, developed based on activities [7], which is derived from the work breakdown structure (WBS) [8]. Construction work and risks are two perspectives for delineating projects and constructing work breakdown structure and risk breakdown structure (RBS) trees, building cross-matrixes between WBS and RBS [9]. WBS–RBS is used to systematically and comprehensively identify risks [9]. Construction safety risks are identified based on activities [7]. Meanwhile, activities in construction work are identified from WBS [10,11] and are at level 5 [12], because each activity poses its hazards [13] and risks [2,8,14,15]. These risks are then analyzed for their likelihood and impact levels [16].

Construction accident risks can be analyzed and assessed using the failure mode and effects analysis (FMEA) method [17]. FMEA is a technique used to systematically analyze problems within system gaps [18]. The FMEA method is highly suitable and has been successfully applied across various types of industries due to its high visibility [19]. In conducting safety analysis, the use of FMEA is highly beneficial, making it renowned for its ease of use [19]. It also serves as a tool to assist project stakeholders in identifying risks, categorizing them, and formulating appropriate management actions [20]. Risk evaluation in FMEA is conducted by constructing a risk priority number (RPN) [21]. An RPN is a common assessment performed in FMEA [22]. Mathematically, the RPN is calculated by multiplying severity (S), occurrence (O), and detection (D) values [22]. FMEA is typically used for quality risk assessment of a product and rarely for safety risk assessment in construction projects.

In previous studies, construction safety risks have been identified and assessed based on activities such as building structures, bridges, ports, airports, tunnels, dams, irrigation, and other structures. However, no assessment has been conducted on construction safety risks for military construction projects, particularly hospitals. Additionally, previous research has not employed the FMEA method for construction safety risk assessment.

Therefore, this study focuses on assessing construction safety risks in military hospital projects using activity-based FMEA. This research has positive implications for identifying construction safety risks through a different approach. The findings of this study can also serve as a basis for determining further actions in managing construction safety risks.

2. Methodology

This study employs a mixed-method research approach. This emphasizes a quantitative approach through respondent surveys. It is also supported by a qualitative approach, gathering opinions from construction safety experts in the field.

The research consists of two main stages. The first stage involves applying Project Management Institute (PMI) tools and techniques to identify risks through expert judgment [10,11]. This stage aims to obtain expert opinions on the identified risks to ensure validity. Once construction safety risks have been identified, the next stage involves risk assessment using the FMEA method.

The study involves 5 construction safety experts and 100 respondents involved in underground structure construction. The minimum educational requirement for the experts is a bachelor’s degree in engineering or equivalent, while for the respondents, the minimum requirement is a diploma in engineering. The required experience in the construction sector is twenty years for experts and five years for respondents. The minimum job level for experts is manager, and for respondents, it is engineer.

The data used in this study are primary data, collected directly from the experts and respondents. Data collection techniques include expert surveys and brief interviews with experts. In conducting the risk assessment, several parameters are evaluated, such as the level of severity, the level of occurrence, and the level of detection, through a closed questionnaire survey of the respondents.

The data analysis employed is descriptive, presenting descriptive statistical values. The collected data are then tested for validity and reliability according to statistical requirements. Once the data are deemed valid and reliable, conclusions will be drawn. The conclusions for each variable are then used as a basis for calculating the RPN using the FMEA method. Once the RPN values are obtained, the subsequent analysis involves ranking the risks based on activities according to their RPN values.

3. Result and Discussion

3.1. Risk Identification

Risk identification is an initial and crucial step [2]. After safety risks are identified, expert judgment is employed to validate these risks [10]. This study includes five expert respondents directly involved in military hospital projects, holding strategic positions in project management. The profiles of these expert respondents are presented in

Table 1. Profile of expert respondents.

Code	Project Involvement	Institution	Position	Education	Working Experience
P1	Main contractor	Civil	Project Manager	Master’s degree	25 Years
P2	Supervising consultant	Civil	Team Leader	Bachelor’s degree	46 Years
P3	Project owner	Military	Project Technical Director	Doctoral degree	33 Years
P4	Supervising consultant	Civil	Team Leader Assisstant	Bachelor’s degree	27 Years
P5	Supervising consultant	Civil	Deputy Team Leader	Bachelor’s degree	38 Years

.

The expert judgment analysis was conducted descriptively to conclude whether the experts agreed or disagreed on the identified risks associated with each activity, including their impacts, contributing factors, and the current control measures implemented.

Table 2. The results of expert judgment analysis.

No	Activities	Safety Risks	Impact	Contributing Factors	Current Control Measures	Expert Judgement
						Yes	No	Result
20	Installation of cast in situ bored pile gutter	Worker’s hand caught in a tool/material	Victim hospitalized, project halted, responsibility for accident costs	The workers did not use personal protective equipment (PPE)	Mandatory use of personal protective equipment (PPE) at the work site	80%	20%	Yes
21	Installation of cast in situ bored pile gutter	Struck by a tool/material	Victim hospitalized, project halted, responsibility for accident costs	The workers were careless and did not follow safety signs or regulations	Conducting a safety briefing before commencing work	100%	0%	Yes
22	Installation of cast in situ bored pile gutter	Struck by a tool/material	Victim hospitalized, project halted, responsibility for accident costs	The workers were careless and did not use the tools properly	Socialization and training on construction safety	100%	0%	Yes
53	Lifting of contiguous pile casing	Worker’s hand caught in a tool/material	Victim hospitalized, project halted, responsibility for accident costs	The workers were careless and did not follow safety signs or regulations	Conducting a safety briefing before commencing work	100%	0%	Yes
54	Lifting of contiguous pile casing	Worker’s hand caught in a tool/material	Victim hospitalized, project halted, responsibility for accident costs	The workers were careless and did not use the tools properly	Socialization and training on construction safety	100%	0%	Yes
55	Lifting of contiguous pile casing	Struck by a tool/material	Victim hospitalized, project halted, responsibility for accident costs	The workers were careless and did not follow safety signs or regulations	Conducting a safety briefing before commencing work	100%	0%	Yes
57	Basement excavation	Fell/slipped into the excavation	Victim hospitalized, project halted, responsibility for accident costs	The workers were careless and did not follow safety signs or regulations	Conducting a safety briefing before commencing work	100%	0%	Yes
58	Basement excavation	Fell/slipped into the excavation	Victim hospitalized, project halted, responsibility for accident costs	The workers did not use personal protective equipment (PPE)	Mandatory use of personal protective equipment (PPE) at the work site	100%	0%	Yes
59	Basement excavation	Buried/struck by excavated soil	Victim hospitalized, project halted, responsibility for accident costs	The workers were careless and did not follow safety signs or regulations	Conducting a safety briefing before commencing work	100%	0%	Yes
60	Basement excavation	Buried/struck by excavated soil	Victim hospitalized, project halted, responsibility for accident costs	The workers did not use personal protective equipment (PPE)	Mandatory use of personal protective equipment (PPE) at the work site	100%	0%	Yes

presents a partial summary of the expert judgment analysis conducted. There are 32 activities that were categorized from the foundation work package, including bored pile, contiguous pile, earth excavation, pile cap, tie beam, ground column, ground beam, bunker wall, and proton wall. Among these activities, 113 work safety risks were identified. In addition to safety risks, impacts, contributing factors, and current control measures were collectively identified to facilitate further analysis using FMEA.

3.2. Failure Mode and Effect Analysis (FMEA)

The probability impact matrix (PIM) method for assessing construction safety risks, in line with PMI standards [10], has been applied in previous studies on several projects, particularly bridge infrastructure [2,7,8,13,14,15]. PIM assesses risk based on the probability and impact values of each risk [10], which then form the basis for calculating the risk level and determining control actions accordingly [10]. However, the risk assessment approach using the PIM does not evaluate detection based on existing control actions. In contrast, the FMEA assessment method incorporates existing control actions into the risk assessment by including a detection value [20,21,22]. Therefore, the FMEA risk assessment results are considered more comprehensive, as they take into account risk severity, occurrence, and detection values of existing controls.

Risk assessment using the FMEA method involved 100 survey respondents. Each survey respondent involved in this study adheres to predefined criteria. The characteristics of the survey respondents included their positions, education, and years of work experience.

Respondent positions were categorized as 48 safety officers/site engineers, 38 assistant managers/supervisors, and 14 managers. The educational backgrounds of the survey respondents varied, with 33 respondents holding a diploma degree, 52 respondents having a bachelor’s degree, and 15 respondents having a master’s degree. Regarding work experience, 52 respondents had 5–10 years of experience, 36 respondents had 11–20 years, and 12 respondents had more than 20 years. The characteristics of the survey respondents are presented in

Table 3. Characteristics of survey respondents.

Code	Position	Samples	Education	Samples	Working Experience	Samples
1	Safety Officer/Site Engineer	48	Diploma degree	33	5–10 Years	52
2	Assistant Manager/Supervisor	38	Bachelor’s degree	52	11–20 Years	36
3	Manager	14	Master’s degree	15	>20 Years	12
Total Samples		100		100		100

.

The following activities are involved in underground structure construction with high safety risks, such as lifting of contiguous pile casing, basement excavation, and installation of cast in situ bored pile gutter, present safety risks including worker’s hands being caught in tools/materials, being struck by tools/materials, falling/slipping into excavations, and being buried/struck by excavated soil. Based on the FMEA results, these safety risks have high RPNs ranging from 100 to 125. After ranking, these safety risks are among the top 10 priorities. They should be prioritized for further management to reduce their severity, occurrence, and detection ratings, which will automatically lower their RPN values. The complete and detailed results of the FMEA based on these activities are presented in

Table 4. FMEA safety risks based on activities.

Activities	Safety Risks	Severity (S)	Occurrence (O)	Detection (D)	RPN	Risk Ranking	Conclusion
Lifting of contiguous pile casing	Worker’s hand caught in a tool/material	5	5	5	125	1	Primary priority for further ontrols
Lifting of contiguous pile casing	Struck by a tool/material	5	5	5	125	2	Primary priority for further controls
Basement excavation	Fell/slipped into the excavation	5	5	5	125	3	Primary priority for further controls
Basement excavation	Fell/slipped into the excavation	5	5	5	125	4	Primary priority for further controls
Basement excavation	Buried/struck by excavated soil	5	5	5	125	5	Primary priority for further controls
Basement excavation	Buried/struck by excavated soil	5	5	5	125	6	Primary priority for further controls
Installation of cast in situ bored pile gutter	Worker’s hand caught in a tool/material	5	4	5	100	7	Primary priority for further controls
Installation of cast in situ bored pile gutter	Struck by a tool/material	4	5	5	100	8	Primary priority for further controls
Installation of cast in situ bored pile gutter	Struck by a tool/material	4	5	5	100	9	Primary priority for further controls
Lifting of contiguous pile casing	Worker’s hand caught in a tool/material	5	5	4	100	10	Primary priority for further controls

.

4. Conclusions

Based on the analysis conducted in this study, several key findings can be summarized:

• There are three main activities with very high risks ranked from 1 to 10, namely lifting of contiguous pile casing, basement excavation, and installation of cast in situ bored pile gutter.
• These activities entail safety risks with RPN ranging from 100 to 125, including worker’s hands being caught in tools/materials, struck by tools/materials, falling/slipping into excavations, and being buried/struck by excavated soil.
• Based on the risk assessment results using the FMEA method, the recommendation is to prioritize the immediate implementation of advanced control measures. This involves developing strategic steps focused on construction activities and safety risks, which should be incorporated into a policy, planning, and actionable measures.

This research can serve as a reference for similar projects. However, the results should not be universally applied to all projects due to varying project characteristics. Therefore, reassessment and activity-based analysis are necessary to enhance validity. Future studies could expand this research by applying it to other types of buildings or infrastructure to compare results with conventional risk analysis methods.