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Why should you keep your process simple

Abishek Goda

“Everything should be made as simple as possible, but not simpler.” – A quote often attributed to Nobel winning Physicist Albert Einstein.

Incident Management process is often quite simple. The process provides a lot of information beyond incidents themselves and are essential inputs for overall clinical risk management as well. In many cases, the knowledge that the incident management process is a first step to overall risk management is sufficient to drive us into analysis paralysis mode. Risk management is a very complex topic and has far too many factors in its implementation. We, at QUASR, have insights into clinical risk management and we will eventually integrate QUASR to provide this option for our clients. In this post, we want to address some of the common complications in implementing an incident management system and our solutions.

QUASR follows an industry-standard workflow for incident management. We implement a simple workflow and we are pretty proud of that fact. We believe we have achieved the simplest possible standard workflow that also captures the essence of incident management itself. However, during enterprise implementations, clients usually need quite a bit of convincing as to why this simple workflow is usually a good place for their needs. From our experience, this happens in two cases: when the clients have a legacy system that they have used for a while and are looking to keep the same process. Or they are looking to map their existing manual flow as-is into the new system. Both these approaches, frankly, are inefficient. Let us explain.

Legacy System Hangover

Systems that were built at least a decade back qualify as legacy systems. Any reasonably newer system might not have the issues that we are going to discuss here. For newer systems, the IT team was likely asked to implement their manual process as is! In software circles, there is an inside joke – “some unexplained bugs are actually features.”. On a more serious note, systems that were implemented a long time back don’t fully take advantage of all the technological developments of the recent times. Some of their design decisions could have been technology driven rather than user driven simply because it would be prohibitively difficult to implement differently. A newer system built on more recent technologies don’t suffer from the same limitations. And hence it is possible to achieve more elegant solutions or workflows than wasn’t possible in a legacy system. That said, if we carried forward the legacy system as is, we might not fully utilize all the enhancements that technology offers us.

Mapping Manual Process to Digital Process

Since many of our customers are implementing their first digital system for incident management, this is the typical set of issues we face while onboarding and customizations. Many things we do manually, do not scale well to digital systems as such. And we all have seen examples of this: have you ever tried to collect all people interested in paying for a gift to a colleague? We send out an excel sheet and each person returns a sheet of their own and we merge them manually? That’s exactly what we’d do before emails. We’d just go person to person, find out if they’d contribute and write it down in a piece of paper. But we all do know how inefficient that is, right? If we have to do the same thing today, we should probably setup a google form that each of the participant fills out and you get an excel sheet at the end of it. Same data is collected but far less work needs to be done by the person trying to collect it. The second option is a more digital native way of solving that problem. Incident management, incidentally, is full of such problems.

A typical example we often get as a customization request is to include additional workflow steps: include HoD as part of the workflow. Yes, we understand why you’d want to do that. But in many cases and as many of our customers agree too, this step is an FYI for the person involved. In a manual system, the HoD had no way of knowing what was happening unless you intentionally ran things by them. But digital systems aren’t really like that. Online systems even lesser so. You’d just need to notify them in these cases. In QUASR, we solve this problem by automatically having HoDs in the loop for all incidents in their department. You don’t need to do this additionally. However, we do not notify them every single time. EMail based notifications have become so common that we mindlessly mark things read or archive them even without reading them. And we do not want to add to the inbox clutter either. So the HoDs just have to login periodically and they’d be updated on all the active incidents in their department. But unless we explain this, most of the users don’t see the solution. They are wondering how to implement an additional step in the workflow because that’s what they do in the manual flow.

Another example is typically around data collection fields. Many clients request adding quite a few descriptive fields whereas these aren’t very useful for systematic analysis. Descriptive data necessitates quality managers or investigators to spend time reading and understanding much information. But there is another downside: lack of sufficient information. Some people can describe an incident in vivid details while others tend to write very little. Situations like these can be avoided by collecting quantifiable, standardized data instead. This, too, is an artifact of using paper based forms. In paper based forms, it is impractical to collect incident type specific information for every incident type we want to track. So we end up with a few generic descriptive boxes for the users to fill up. However, adopting the same to a digital system does not allow you to utilize the full power of a digitalized solution.

Adopt Digitally Native Solutions

We just saw a few reasons why users typically have difficult-to-use, complex workflows in a digital system. But its not entirely their fault. As service providers, our first mantra is “Customer is always right!”. Blindly following the mantra, however, does very little to help the customer. While the customers know what they want, it is our duty to explain and clarify how best to provide what they want. Users tend to get carried away at the flexibility and try to plan for a future well ahead. It is worth remembering that technology evolves faster than our processes. So it is not very useful to plan far ahead into the future but plan for medium to short term only.

Enhancing software solutions are often quite simple and needn’t be as expensive either. Hence it is better to implement enhancements when the need arise rather than implement them all at once. Besides, having a digital native solution allows us to adapt to a digitalized workflow better – especially moving from a legacy or a paper-based system. Once we have acclimatized to a digitalized solution, we are better suited to decide how we need to enhance our systems in the future.

How To Create-Track-Monitor Incident Report Using Excel?

Rohini K

Incident Reporting in Hospitals

In the healthcare industry, incident reporting is an important task that records all the unusual events occurring at hospitals, nursing homes, and other medical facilities. An incident report is a formal report written by practitioners, nurses, or other staff members to inform facility administrators of incidents that allow the risk management team to consider changes that might prevent similar incidents. The forms used for incident reports are either paper forms or electronic.

Despite all the advances in medical technologies, Incident management remains a paper-based manual process in many hospitals. We understand that multiple factors drive these decisions. We talk about the effects of a paper-based vs a digital system on the incident reporting process here.

The first knock of a transition from paper medical records to electronic come after the American Recovery and Reinvestment Act (ARRA) 2009. This law encouraged healthcare providers in the United States to digitize internal record systems and develop a centralized database so that doctors, physicians, and nurses can easily access health records. 

However, moving from a paper-based system to a paperless one isn’t that simple and easy. That’s why many healthcare facilities haven’t gone completely paperless even after a decade of modern record system. They might be trying to avoid a few hurdles, but in reality, they are facing multiple challenges daily with the paper-based method, such as:

  • Time-consuming
  • Ineffective Data Presentation
  • Not scalable
  • Limited security
  • Missing Audit trail and tracing
  • Prone to error
  • Difficult to analyze

Therefore, healthcare facilities required fast, secure, and quick incident reporting. In short, they need an automated incident reporting system. But, as of now, only two-thirds of hospitals have focused on automation. 

Create-Track-Monitor Incidents using Excel

We have been working with healthcare facilities for years now, so we duly understand that automation isn’t an easy task. It is an expensive and technical process that not all hospitals can adopt.

We are here to help you with an alternative, that won’t cost you a dime. A free, reliable, and effective incident management system for medical facilities— Excel reporting.

For hospitals that are not yet ready to dive into software systems for incident reporting, using Excel is an inexpensive and reliable option, as it can quickly get you off the ground. In this article, we’ll discuss how you can use Excel to maintain and track your incidents.

To manage all incidents in one place, and analyze them effectively, the quality manager needs to organize different sets of data to draw conclusive statistics. However, when incidents are recorded in papers, analyzing the data or locating patterns is a daunting task. Thus, a need for meaningful data emerges where data is easily readable and interpretable.

For Example—

In a paper-based reporting, an incident description will be recorded like this:

“A Patient A was sleeping on his bed in Ward No. 2. While turning in his sleep, he fell from the bed. The attending nurse immediately rushed to him and helped him get back onto the bed and put the bed rails up. The patient did not sustain any injuries.”

Now, if same information is captured in structured format, it will look like this:

Incident Type: Patient fall
Incident Subtype: Fell from bed
Incident Location: Ward 2
Affected People: Patient A
Injury: None

It is evident that the data recorded in the second style is easier to navigate, analyze and interpret. Therefore, the way you record data makes a huge difference in the analytical process.

If you are using paper forms for reporting and managing incidents, we have even eased your  work by creating an Incident Report Excel Template along with a process to custom create incident reports in Excel.

How to structure your data

When you want to gain insightful information from an incident report, you have to record every minute detail in it. However, the amount of report details depends upon your organization’s size, patient safety goals, claim frequency, and other relevant factors. In a hospital incident report, it is essential to add the following details:

Incident occurrence date

The well-informed incident report needs basic information such as the date and time of the incident. This is one of the most important pieces of information especially useful to calculate statistics and performance.

Location of the Incident

Specifically, mention the location of the incident along with the particular area within the hospital—for example, patient X fall in Ward no. 2 near the bed. When you use Excel, it is a good idea to make the Location field into a dropdown field. Generate a list of all possible locations, from the lift lobby to OT, and select from the values, rather than typing it as text. This helps you to convert ‘Location’ into a measurable field and you can generate statistics out of it, such as, “What is the most prone location for a fall?”.

Type of the Incident

This is the key information that will help you in analyzing and processing your data, as well as generating your statistics for the management. You can categorize the incidents as Medication Error, Patient Fall, Equipment Damage, Patient Identification, etc. When you use Excel, it is a good idea to make the Incident type field into a dropdown field. Create a list of all the incident types you want to capture and select from the values, rather than typing it as text. This helps you to convert ‘Incident Type’ into a measurable field and you can generate statistics, such as, “What is the most common incident in my hospital last year?”.

Parties Involved in the Incident

The name and contact details of all the parties involved in the incident to follow up. If there are witnesses available to the incident, it will be helpful to add their statements in your report. While writing witness statements, focus on the following attributes—specific details provided related to the incident, use quotation marks to frame their statements, note witnesses’ location at the time of the incident, and how they are related to the incident.

Detailed Incident Description

The incident description is provided by the person who reported the incident. This can be as detailed as it can get, as more the information in hand, the better it is to investigate it further.

Comments

Once you have all the information from the reporter, you can track the incident in excel by recording all the follow-up discussions, comments given by Supervisor or other managers all in one single row in excel!

Risk Assessment Score

Whether you use a 5×5 Risk matrix or a SAC scoring of 1 to 4, you can enter the severity risk score against the incident, again in the same row!

Contributing Factors

Except for minor incidents, everything else will most likely go through a root cause analysis and investigation process. It is a good practice to maintain a list of all the Contributing factors, (either London Protocol or you can follow your hospital guidelines) and select from the values, rather than typing it as text. This helps you to convert ‘Contributing factors’ into a measurable field and you can generate useful statistics, such as, “What is the top contributing factor for my incidents?”.

What is Meaningful Data?

Meaningful data is, in simple terms, usable statistics and actionable insights that can be used to evaluate the efficiency and effectiveness of your process. The meaningful data answers numerous aggregated questions, provide you useful insights without many efforts

  • How many fall incidents happened last month?
  • How many medication errors occurred last year?
  • What percentage of incidents are still open?
  • What is the most common occurrence?
  • Which location is prone to more falls?

As we have cleared in the above example that paper-based recorded data can’t help you find aggregated results without spending hours or days of effort. But, with excel, you can utilize the features such as a drop-down list and data filters to derive this meaningful information quickly.

Download our ready-to-use Excel template

If you don’t know how to turn a vanilla Excel spreadsheet into an incident report sheet, do not fret! Download our ready-to-use Incident Manager Template. The template contains all the information that you minimally need to capture and provides some incidents for reference. You can customize the template to suit your needs, especially the parent list of incident types, list of departments, and statuses. In the following sections, we also explain how you can do this.

However, if you want to build your own custom incident manager spreadsheet from scratch, read more as we walk you through the process.

Customize your Incident Manager Excel template

How to Create a Drop-down for Columns?

Drop-down is a very useful Excel feature where you can sort relevant information based on your requirements. For instance, using our template you can easily sort information based on incident type and contributing factors. However, to create a custom drop-down list, you can follow these steps:

  • Select the cells that you want to contain the lists.
  • On the ribbon, click DATA > Data Validation.
  • In the dialog, set Allow to List.
  • Click in Source, type the text or numbers (separated by commas, for a comma-delimited list) that you want in your drop-down list, and click OK.

Here is a video explaining this step by step.

How to Use Filter Function?

The filter function allows users to easily extract matching records from a larger set of data based on certain criteria. Suppose you want to know how many open incident cases were present in Ward No. 2, our incident template will immediately show you—just follow these instructions:

  • Select any cell within the range.
  • Click on Data > Filter.
  • Next, select the column header arrow.
  • Now, you can choose between Text Filters or Number Filters.

For eg. To know the number of open incidents, you should select the Status field and select ‘Open’ (unselect ‘Closed’).   To know the number of such open incidents in Ward 2, you should select the Location field and select ‘Ward 2’.  Now you have the narrowed down list of Open incidents from Ward2.

How to Create a PivotTable?

In Excel, you can use PivotTable to calculate, summarise and analyze data present in your report. Additionally, you can easily compare and find trends in your data. With our template, you can create Statistics on Incident Types or by departments or by status.

PivotTable works a little different depending on what platform you are using to run Excel, but the simple way to create PivotTable is:

  • Select a cell where you want to create PivotTable.
  • Select Insert > PivotTable.
  • Under Choose the data that you want to analyze, you can Select a table or range.
  • Verify the cell range in Table/Range.
  • Under Choose where you want the PivotTable report to be placed, you can select a new worksheet or an existing one to add PivotTable and select OK.
  • You can add fields to your PivotTable, click on the field name checkbox in the PivotTables Fields pane.

How to Refresh PivotTable?

When you add new information to our pre-made worksheet, you need to refresh the PivotTable to provide updated statistics to you. To refresh PivotTable:

  • Click anywhere on the PivotTable to appear the PivotTable Tools ribbon.
  • Select Analyze > Options.
  • Go to the Data tab, check the Refresh data when opening the file box.

How to Create Graphs?

To better analyze incident data, you can convert it into a graph and chart with our template. The graph can be created in Excel as:

  • Select a cell.
  • Choose a graph from the nine graph and chart options.
  • Highlight your data and click on ‘Insert.’
  • Adjust data’s layout and colors.
  • As per your requirements, change the size of the graph and axis labels. 

Here is a video that explains this step-by-step

Download template

Get started today by downloading this Incident Report Template we created for you to easily start managing your incidents. The template contains all the minimal information that you need to capture. You can customize this template to suit your needs, especially customizing the parent list of incident types, contributing factors, list of locations, and departments. 

QUASR Lite

QUASR Lite is the simplest online incident managing software you have been looking for. The main advantage QUASR Lite brings to you over vanilla excel sheets is that: we have built it specifically for hospital incident scenarios. We consolidated our experience working with many hospitals and created a starter tool that will grow with you as you mature into bigger and more involved processes. You’ll be able to attach evidence, share reports with selected staff or departments and notify senior management of serious incidents. Since it is digital, you can effortlessly search, sort, or churn statistics for those important management meetings.

QUASR Lite is aimed at organizations that are just getting started or wanting to digitize their incident management process. Whether you have a simple paper-form method or looking to create your own structure and process, QUASR Lite has you covered.

Check out more features of QUASR Lite. You can sign up for a 30-day free trial here.