How one hospital thought through the reporting process to make it more simple and effective for teams.
Despite an increase in safety event reports in past years, Children's National Medical Center leadership saw opportunities to increase the number of safety events staff members report, and in conjunction with the organization's board, created a three-year corporate goal to double the number of safety event reports.
At the 2018 Quality and Safety in Children's Health Conference, Rebecca Cady, Esq., B.S.N., CPHRM, DFASHRM, FACHE, vice president, chief risk officer; and Rahul Shah, M.D., MBA, vice president, chief quality and safety officer, described the organization's efforts to more than double incident reports to more than 10,000. Here's how the hospital overcame barriers to event reporting.
There are multiple barriers that can prevent staff members from reporting safety events, so it's crucial to make reporting an easy, seamless process. To help this, Children's National rolled out an iPhone app to about 6,000 staff phones. "The mobile app is a big piece of this," Cady says. "It allows for easier report submission, and provides weekly and monthly summary reports to managers."
Review the reporting systems
A safety committee mapped out barriers and motivators to reporting. Cady says these could be different for every organization, but it's important to consider:
- How does your organization's reporting system work?
- Do people have time to report?
- Are there multiple places and ways for them to report?
- Do people know how to report an incident?
Cady says to keep it simple. "Make sure there's a minimal number of mandatory fields in a form, increase the number of ways people can report, and increase people's knowledge of the system," she says. This includes conducting training sessions with new staff members to walk them through the system.
Consider staff members' perspectives
In addition to reviewing the system for reporting, Cady encourages staff members to put themselvesin their team members' shoes. One barrier is if staff members think nothing will come of their report, they won't participate. They may think, "What's the point?" but considering other perspectives can help. Cady says to consider:
- Is there a lack of follow-up information for staff members after they submit a report?
- What happens after they submit an incident report?
- Why would they be motived to submit a report?
"Harness the system you have to provide standardized follow-up to everyone who reports and use this process to encourage people not to report anonymously," Cady says.
Determine the hospital's level of commitment
Respecting the time and resources the organization has invested into the process can help increase compliance with reporting. Cady says Children's National was mindful about what they included—and didn't include—in the report. Consider:
- In terms of organizational commitment, is there transparency?
- Are you talking about how you track your progress?
- What units are good about tracking incident reports
Before taking on this project, it used to take 17 minutes for staff members at Children's National to file a report—today it takes eight minutes. "We are purposeful about what the mandatory fields in the report," Cady says. "But be careful you don't impair your ability to look at historical data. We worked with data administrators to be sure we didn't pare down too much."
Before taking on these efforts, about 30 percent of reports at Children's National were anonymous. "We realized there was fear of retribution, people didn't have time, and some people thought it was good to have anonymous reports," Shah says. "So we worked to drive that down. We wanted to decrease that number from 30 percent to 1.5 percent."
Shah and his team read every single incident report. The team uses the reporting system to close the communication loop with staff members, encourages department follow-up by managers, and holds managers accountable so staff members understand where the reports are in the review process.
"We want to fight the perception that when people submit a report, nothing happens," he says. "So, at least four sets of eyes read about 11,000 reports a year. This helps make sure we don't miss anything."
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