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Participation Matters!

Abishek Goda

Active participation is an essential ingredient of all successful systems. Incident or Risk management is no exception to this. In this article, we understand why active staff participation is critical to all successful implementations. We will also explore a few ideas on how you can leverage this in your systems as well. Lastly, we add a note on how QUASR achieves this for you in the Incident Management space.

Participation-Matters

Participation

Active participation, we define, is the level of engagement users have with a system. In an incident management system, this can be the familiarity and comfort that users have to report an incident or an issue using the system. In common parlance, there are metrics like daily active users (DAU) or monthly active users (MAU) used to define how successful a software system is. However, in Incident or Risk management systems, these metrics are not very useful indicators. We measure participation as the willingness to interact with the application for these cases.


Interestingly, the only way to unlock the full potential of an incident or risk management system is by optimizing for high DAU. We need all the staff to play their role in ensuring incidents are handled with sufficient detail to ensure they don’t occur again. Except, this is not something that the software provider can manage. The organization needs to facilitate and encourage this as part of its culture.

Factors Affecting Participation

A common problem with most enterprise systems is the user attitude to the system. Multiple factors influence the user perception of the system: organizational stand on the system; hierarchy and their position within that; whether the system feels intimidating; and how welcome they feel when they do participate in the process. For an incident management system, however, a lack of active participation results in poor outcomes. If the system does not capture as many incidents as possible, the organization cannot improve its safety process. Or if the incidents reported are not analyzed, investigated, and brought to a closure in a timely fashion – again, the organization cannot improve its safety process. In both these cases, the problem might be that users are not playing the role required to ensure the overall success of the process.

Secondly, incidents are not the domain of any particular staff of a hospital. For instance, caregiving is exclusive to doctors or nursing staff, just as dispensing is exclusive to pharmacy staff. But when an incident occurs, everyone from the nursing staff, pharmacy staff to janitorial staff, and service providers that are peripheral to the organization have an essential role to play — report the incident and help in whatever way they can to ensure a smooth closure and learning from the incident. 

Investigation of an incident or its root cause analysis is a group activity. In many cases, each hospital has its designated and identified experts at running this activity. Despite their expertise, the investigation staff cannot conduct a productive root cause analysis if the staff who understand the incident or the process do not come forward with their viewpoints and suggestions. Often, though, staff might quickly feel intimidated to participate amidst experts and refrain from voicing their opinions. Users on the ground may have a slightly different perspective of the issue and have important insights. Their lack of participation denies the organization a chance at improving the process!

Similarly, staff should not feel like they are “on the hook” for their participation. The environment to encourage participation is very forgiving and open in nature. The management usually needs to step up, ensure a safe space for all their staff, and encourage them to do the right thing. From the perspective of patient and worker safety, the only way forward is inclusive of all stakeholders.

Lastly, an overlooked reason for the lack of participation is that the user interface is very complicated and intimidating to use. When the quality or risk management teams implement a digital solution to their process, they are often focused on the process and forget the importance of keeping things simple. As the understanding goes, it is pretty complicated to design a simple system and is quite simple to design a complicated one. When designing a system, we often optimize for the results and impacts but fail to account for ease of use; users need to participate actively to achieve the results.

How Does QUASR Achieve This For You?

A core tenet in the design of QUASR is user participation. QUASR builds on the best practices commonly used elsewhere in the software industry. Our user interface and usability are very similar to hugely popular apps like Facebook or Gmail. Similarity with other popular applications helps us leverage the familiarity that the users already have. 

Secondly,  QUASR brings multiple simple but niche features like save draft, multi-stage forms, flags, and widgets to simplify how a user sets to achieve their tasks in the incident. Further, we have features like pseudo-anonymity to encourage participation without fear of repercussions. The list is exhaustive, and covering them all would become a blog post on its own. Feel free to talk to us to understand how you can benefit from using QUASR in your organization.

QUASR Feature: Pseudo-Anonymous Reporting

Abishek Goda

QUASR results from a decade-long experience working in the incident and risk management space across industries. Through that experience, we saw the specific difficulties that the healthcare industry suffered from using generic products altered to suit their needs. We didn’t want to be presumptuous either. So we spoke to many industry leaders across the region, of hospitals of different sizes, and across roles and functions. One common feedback we received early on was the need for “anonymous reporting”.

anonymous-reporting

Anonymous Reporting

As the name suggests, anonymous reporting is when an incident report is not attached to any particular user/staff in the system. Many hospitals felt the need for such a system to ensure more participation from all staff. While every hospital works very hard to provide a safe space for all its staff, fear is irrational. While the purpose of incident reporting and management is to improve organizational quality and safety, it isn’t easy to convince their staff that reporting an incident will not lead to repercussions.

Generally, anonymous reporting is employed only for whistle-blowing. And whistle-blowing is typically associated with grave issues in the organization. Incidents, on the other hand, whether grave or silly, are valuable sources of lessons and improvements for the organization. Secondly, coming from a computing background, we understand that genuinely anonymous is somewhat difficult to guarantee. It is usually possible to narrow it down to a small list of people! But not everyone realizes this. So we did not want to design a solution that would potentially blindside a staff. After all, the only guaranteed way to drive away any fear of repercussions is to build trust.

The other problem with anonymous reporting is: we cannot enable many user-friendly and time-saver features like multi-stage captures, draft retrievals, and the like. We are forcing the user to fill in a, typically, long incident form in a single sitting. Hospital staff are usually amongst the most time-crunched workers ever. Expecting them to block off time to report incidents will deter them from actually reporting any minor or near-miss incidents at all. For the organization, though, the near-miss or minor incidents are where the wealth of inputs are lost. Additionally, the quality managers and investigation teams do not have any starting point for conducting further assessments on the incidents — assuming they do not know who reported the incident.

Pseudo-Anonymous Reporting

At QUASR, we aren’t thrilled with anonymous reporting. We strongly feel that making incident reporting anonymous does not enable our customers with the right tools to improve their overall culture. After many discussions internally and externally, we arrived at what we call the “pseudo-anonymous” reporting or the “Protect” feature. This feature is available as standard and out of the box for all our enterprise customers. Lite does not support this feature. For Basic, we will wait to hear from you before enabling support for this feature.

To report an incident in the pseudo-anonymous mode, the staff user must first log in to the system. The reported incident is internally attached to the user. However, QUASR will hide this information from most stakeholders of the incident. QUASR will show the reported user as “PROTECTED” instead of their actual name. This way, the user’s identity is protected from the rest of the system. We believe this enables them to report without any fear of repercussions.

Like we mentioned, this mode is not an anonymous reporting mode. Typically, only Quality Managers will have access to the reporting person’s identity. Accessing the identity ensures that the quality teams can proceed to facilitate further investigations without much difficulty. Additionally, in places where a user trusts their supervisor, they can allow access to their supervisors. In most installations, only quality managers and optionally supervisors have access to the identity for protected incidents.

When users choose to report an incident with “protection” enabled, they have to read and understand their choice. There is an inline explanation of the behavior of the “protect” mode and allows the user to make a conscious choice. This additional step acts as a deterrent to using this mode unless necessary. We do not want the staff to abuse this option — even though it is not entirely anonymous, it does complicate the investigation process. It limits the options available to the quality management teams.

Advantages of Pseudo-Anonymous Reporting

The main advantages of pseudo-anonymous reporting or protected mode are as follows:

1. It allows users to report an incident without being anonymous and still protecting their identity from the larger group.

2. It enables quality management and investigation teams to perform meaningful analysis of the incident without revealing the reporting person’s identity. For anonymously reported incidents, it isn’t straightforward to get a significant investigation done from the report. Quality teams are left to make reasonable assumptions and proceed, which doesn’t lead to preferred outcomes.

3. It enables the organizations to set the right precedent in terms of their follow up actions to assure the staff that incident reporting does not lead to punitive measures.

Disadvantages of Pseudo-Anonymous Reporting

There are no silver bullets. And our solution is not without its limits. The main disadvantages of our approach are:

1. The staff must trust their quality managers to do the right thing. As we noted, this is not an easy task for the hospitals or the quality departments to achieve amongst all their staff.

2. Our solution targets Clinical incidents. However, many of our customers choose to track other incident categories as well. For a selection of HR-related issues, the pseudo-anonymous mode is not a good solution. It might worsen the situation for the staff.

3. Some incidents need to be whistle-blown for real change to occur. These are usually severe issues within the organization that pervade the entire structure. Pseudo-anonymous mode is not an answer to these types of problems.

We worry that enabling users with this mode gives them a false sense of security in the wrong situations! One of the purposes of this blog post is to educate our users on using this mode responsibly.

QUASR Feature: Sensitive Incidents

Abishek Goda
QUASR-Feature-SensitiveIncidents-Header

One of the core tenets of QUASR is transparency and knowledge sharing. In some sense, these two go hand in hand in most cases. Knowledge sharing happens when there is transparency within the community or organization. Incident Management is an essential first step to many organizational improvements. Pro-active Risk Management uses Incident Management as one of its drivers, for instance. Awareness of the incidents that occur in the hospital helps the management plan their mitigation and ensure they do not affect their facility’s overall quality and safety. Similarly, tracking and investigating incidents usually gives valuable inputs to quality and safety policy that every institution’s staff is aware of intimately.

Incidents, sometimes, have information that cannot be widely disseminated or discussed across all staff. We can identify many reasons why this is the case: maybe the people involved are highly placed individuals in the society; perhaps the event has a far-reaching impact if mishandled, or maybe there are legal reasons to restrict the audience. General dissemination of such information can lead to gossip or widespread speculation. In the era of viral social media, the organization may be dealing with a PR nightmare while managing the actual issue or incident. Besides, such speculation can also cause unintentional and unfounded concerns to staff or patients.


It is, then, only natural that Senior management and Quality Managers will want to restrict the audience of specific incidents to a select staff only.  

Sensitive Incidents are the digital equivalent of a “Private & Confidential” document of the paper-office era.

Sensitive Incidents in QUASR

We, at QUASR, recognize this problem very well. While we want to build a transparent, knowledge-sharing platform, we also want to enable our customers to restrict information to a restricted group of staff as the need arises. This feature is a standard feature built into QUASR and is available for all BASIC and Enterprise plan customers.

The LITE plan does not include this feature since the plan only targets a closed group of users within the larger institution. If enough customers feel LITE should have this feature, we will enable it for that plan.

Sensitive Incidents in BASIC

In BASIC, any user with sufficient privileges can mark an incident as Sensitive. Sensitive incidents in the BASIC plan have a fixed behaviour for all our customers. Only users with the privilege to view such incidents are allowed to view all parts of the incident. Other users can only access the basic incident information and supervisor review information. Similarly, access to widgets is also limited to users with access to sensitive incidents. Only users with sensitive incident access can attach files, invite other participants, and add new notes to such incidents.

Sensitive Incidents in Premium

The premium plan has two significant differences from the BASIC plan. In the premium plan, the sensitive feature is in quality manager access. By default, the quality manager is the only role that can mark an incident as sensitive. The Quality Manager role is the primary stakeholder in the premium plan for incident management, hence this decision. However, it is possible to configure and extend this to other roles at the time of implementation.

Secondly, we implement the sensitive feature as a “flag” in the system. Doing so allows us to extend all the additional benefits of the flag to the sensitive flag. Flagging an incident adds a visual cue to the incident view to indicate the flag. It also notifies a predefined set of stakeholders about the occurrence of a sensitive incident. Additionally, these predefined stakeholders automatically gain access to the incident — even if they are not initially involved in the incident. We will dedicate another post in the future to discuss the flag system in QUASR.

Premium and BASIC versions treat the access to the incident information similarly. Whereas the role and its permissions determine the behavior in BASIC, Premium restricts access to Quality Managers, Administrators, and Management roles. Again, in Premium, it is possible to configure this behavior to the organization’s specific needs

Striking A Balance

In QUASR, by implementing this feature, we forgo transparency and open communication. However, we believe we have struck a middle ground between restricting access and openness. The primary incident information remains accessible to all staff at all times. Only the more advanced information like Quality Review or Investigation and RCA details are unavailable to all users. We believe this still allows all stakeholders to stay updated on all their concerning incidents in the organization.

How does your organization handle sensitive incidents? Whether you use a manual or a paper-based system or a digital system to manage your incidents, please let us know your thoughts and suggestions on this feature.

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What can Healthcare Sector learn from Aviation Industry?

Abishek Goda

Ever since we spoke to Dr. Rosas, we have been wondering how healthcare safety can learn from the aviation industry – which, despite being nascent compared to healthcare, is reputed for its safety standards. We did much studying, and this article is a distillation of our thoughts. We have included all our references at the end of this article – as it turns out, we weren’t the first to ask this question!


Two seemingly different industries: What do they have in common, and where do the differences begin?


If one looks at it objectively, the conclusion one can draw is that although they are vastly different, they have many mutual lessons that can benefit each other. Over the last century, the aviation industry has seen massive growth, be it air traffic or the expansion of travel to different parts of the world. The sector has also secured a name for itself in terms of passenger comfort, safety, and, in most cases, timeliness. On the other hand, the healthcare industry has existed for more than a century and has seen many changes in treatment methods, care for patients’ wellbeing, and newer scientific discoveries for better health.


So, the question arises then: What can a sector created for transporting people and cargo by air have in common with the healthcare sector that deals with patients and treatment?


To give a fair picture, let us see some areas where we can compare the two, and the healthcare division can imbibe some lessons.

Safety

By and large, the aviation industry had the privilege of understanding what safety is regarding passenger and crew management. Use of Incident Reporting is one of the successful ways this is implemented. IR is a term familiar to many sectors and plays an essential role in preventing safety hazards or repeating errors. The aviation industry follows a standardized protocol for IR, which focuses on the larger picture and does not place all the accountability on the pilot alone.

Both pilots and doctors are professionals that hold the responsibility of safeguarding lives. Often errors have significant, irreversible consequences in either field. Yet, despite the high risks, the aviation industry leads IR with a blame-free atmosphere. A culture that is “open” and focused on learning allows the concerned parties to report incidents without the fear of adverse consequences. In the health industry, the report is often downplayed, leading to the repetition of an error. Healthcare requires an openness to modify policies without shifting the blame onto the staff or the members concerned.

One of the most successful ways the Aviation industry has ensured the safety protocols of its consumers is by adopting worldwide standards of secure transport. Many of us are familiar with the NTSB (National Transportation Safety Board). The NTSB takes on much responsibility when there is an accident. The incident is treated with grave seriousness, immediately catapulting a series of investigative reports regarding manufacturing, operation, and administration. This process guarantees that a quick decision is made and thus, lessens future debacles. When an incident occurs, the NTSB, given its integral influence on Aviation, is eligible to conduct a parallel investigation with the concerned Aviation system. The overall process has been largely effective in reducing fatality rates.

While the NTSB is a U.S-based organization, its standardization works across various countries. This two-layered work on incident reporting, where Aviation Boards work in solidarity with a larger system, has considerably played a critical role in increasing aviation safety.

Communication

In many sectors, employees downplay incidents for various reasons – one of the crucial reasons is the fear of losing employment. When an IR is created in the aviation industry, meetings discuss the incident, and there is no question of terminating employment. This openness to discussion discusses what had taken place and goes a step further in filling up gaps in communication. Aviation has a “Crew Resource Management” system, a system specifically designed for training on the job and facilitating professional communication. This system is where the airline crew, including the pilots and the flight attendants, and the ground crew and anyone involved with the airline communicates, and their cooperation dramatically reduces the risk of imminent danger.

Journaling is another vital aspect of airline staff that has helped the sector blossom. Pilots often write about their experiences of navigating a flight after landing. These journals are first-person accounts, maintained with details that may be both positive and negative, discussing the troubles faced during the flight and the overall journey. The crew are not penalized for sharing the mistakes in the journal. Every meeting is a step to betterment. Sharing the journal with the larger group of employees helps maintain transparency and leads to prevention. 

Understanding that passenger safety is of paramount importance and conceding that risk affects both the passengers and the crew, the open and learning culture of the aviation industry has come a long way in terms of care

Standardization

Indeed, the industries are different in terms of their period of existence, aim, and intricacies of customized caregiving. However, one significant learning that the aviation sector can provide is in terms of standardization. 

For airlines, the procedures are standard. From equipment, training, the language used to the IRS; the essentials are all well-structured and easy to follow for those involved. Most procedures in the aviation industry do not need second-guessing since all the information is readily available, including external factors such as imminent weather conditions, thereby reducing the risk of an unexpected catastrophe.

However, despite the differences that the healthcare sector faces from patient to patient, implementing standardized procedures for IRS or training the staff would greatly add value and be a step towards betterment

Responsibility

The final section is an overview of the workforce involved in either industry. When issues occur, an investigation is often conducted nationwide or even internationally for the aviation sector. However, many of the incidents in hospitals are only locally addressed and do not receive widespread attention unless for exceptional reasons. Doctors and staff are often at the receiving end of criticism, and the effects are long-lasting. Even minor incidents in aviation garner media attention. This attention contributes to an efficient working atmosphere in the aviation sector. Governing bodies created to address issues and almost infallible checklists to verify the smooth functioning of an airline, both on the ground and in the air, has primarily created a positive customer experience.

Aviation ensures an atmosphere of zero anxiety both for the staff and the passenger while placing enormous importance on comfort and safety. While healthcare organizations and national health governance bodies carry out significant reforms frequently, the lack of a centralized body responsible for investigation and policy formation leaves the individual organizations on their own regarding patient safety

To Conclude

There are many reasons why we cannot compare the healthcare industry to the aviation sector. The above are some aspects the two industries are similar. Over the years, the healthcare sector has seen much positive change, and these suggestions can only steadily contribute to a healthier future, mindful of safety and transparency.

References

Beentjes, Bianca (August 20, 2020). “What can the aviation sector teach the healthcare sector about safety?” Accessible here.

 

Dhand, Suneel (April 7, 2016). “Here’s Why You Can’t Compare Healthcare to the Airline Industry.” Accessible here.

 

Hunter, Greg. (September 27, 2017). “Healthcare Can Learn From the Aviation Industry About Safety” Accessible here.

 

Kapur, N., Parand, A., Soukup, T., Reader, T., & Sevdalis, N. (2015). Aviation and healthcare: a comparative review with implications for patient safety. JRSM Open, 7(1), 2054270415616548. Accessible here.

 

Meiners, John (June 13, 2019). “What can healthcare learn from the airline industry?” Accessible here.

 

Parmar, Hemraj (September 19, 2014). “Lessons for the Healthcare Industry from the Aviation Sector.” Accessible here.

 

Rice, Stephen ( February 7, 2020). “What Can Healthcare Learn From Aviation Safety?” Accessible here.

 

Swartz, Martha K. Swartz (2015). “What Health Care is Learning From the Aviation Industry”. Journal of Paediatric Health Care, Vol 29 Number 1. Accessible here.

 

Incident Reporting in Healthcare: A Complete Guide (2021)

Abishek Goda

Hypothetically, if you ask someone where you are likely to meet with an accident — in a hospital or while driving a car — most people will say hospitals are the most unlikely place to get injured.
  

Unfortunately, the actual medical situation is a bit different compared to a hypothetical situation. According to a 2015 study by the UK National Health Services (NHS), it is believed that 10% of critical accidents occur in all hospitals. 


Even the World Health Organization (WHO) has estimated that 20-40% of global healthcare spending goes waste due to poor quality of care. This poor healthcare quality leads to the death of more than
138 million patients every year.

Patient safety in hospitals is in danger due to human errors and unsafe procedures. Everyone makes mistakes, even good doctors and nurses. However, by recording those errors, analyzing and following up, we can avoid the future occurrence of errors/accidents.


To err is human, they say. The best thing we can do as humans is to learn from these mistakes and avoid repeating them in the future. When we adopt this feedback approach in hospitals and other healthcare spaces, we can improve patient safety in healthcare.


Knowing why, when, and how to report an incident can help improve patients, hospital staff, and organizations’ safety. This guide will walk you through all the different aspects of incident reporting in healthcare. It will show how to file an accurate incident report to establish high healthcare standards worldwide.

What Does Incident Reporting in the Healthcare System Means?

To err is human, to cover up is unforgivable, and to fail to learn is inexcusable."

Prof Liam Donaldson (WHO Envoy for Patient Safety)

An incident is an unexpected event that affects patient or staff safety. The typical healthcare incidents are related to physical injuries, medical errors, equipment failure, administration, patient care, or others. In short, anything that endangers a patient’s or staff’s safety is called an incident in the medical system.

The process of collecting incident data and presenting it properly to action is known as ‘Incident Reporting in Healthcare.’ With incident reporting, an emerging problem is highlighted in a non-blaming way to root out the cause of the error or the contributing factors.

Designated staff with authority to file a report, or staff who has witnessed an incident firsthand, usually file the incident report. Usually, nurses or other hospital staff file the report within 24 to 48 hours after the incident occurred. The outcomes improve by recording incidents while the memories of the event are still fresh.

When To Write Incident Reports in Hospitals?

When an event results in an injury to a person or damage to property, incident reporting becomes a must. Unfortunately, for every medical error, almost 100 errors remain unreported. There are many reasons for unreported medical incidents, but not knowing when to report is one of the most common ones. 


Unfortunately, many patients and hospital employees do not have a clear idea about which incidents to report. Knowing when to report in hospitals can boost safety standards to a great extent.

Let’s consider these situations:

✅ A nurse is helping a patient walk from his bed to the bathroom. However, he stubs the big toe on his left foot on the IV pole that he is dragging.

✅While injected the accident patient’s IV with pain medication, the nurse misread the label and administered a heavy dosage than prescribed, which increased the patient’s blood pressure level. 


In these situations, it is necessary to fill in the incident reports. Simply because an unexpected event occurred and lead to harm, it doesn’t matter how severe or minor the incident is. It is essential to report all incidents.

 

Purpose of Incident Reports

Incident reports provide valuable information to hospital administration facilities. They capture data required to highlight necessary measures to improve the overall safety and quality of the hospital. An accurate incident report serves multiple purposes.

1. Root Cause Identification

All incidents have a cause. Mishaps are pretty uncommon in hospital settings, and most incidents can be root caused by a potential reason. Correcting the root causes can easily avoid future incidents of that type. In this sense, root cause analysis of an incident is an essential investigation step for all hospitals to ensure their staff and patients are safe under most conditions.

2. Policy and Process Improvements

 

Some incidents are part of a larger pattern that can only be identified by looking at them together – let’s say, for example, through a Swiss cheese analysis model. Such assessments usually identify more significant issues that aren’t immediately apparent from individual incident reports or investigations. These assessments feed into clinical risk management as well as help guide the hospital administrators to tweak their policy or process guidelines to help staff adhere to a safer care routine. 

 

For example, let’s take a pattern of incidents. Each has a root cause individually to what looks like a handover issue – but at different stages or different type of facilities. It would be possible to tweak each of these handover processes individually to fix that specific issue. However, it may be more productive to improve the overall handover process by taking all the incidents as a whole and tweak to address them together.

3. Clinical Risk Management

 

All hospitals have and use their enterprise risk management processes. Clinical risk management, a subset of healthcare risk management, uses incident reports as essential data points. Risk management aims to ensure the hospital administrators know their institution’s performance and identify addressable issues that increase their exposure. And the ability to assess clinical risks ensures the hospitals can stay ahead in their business and provide high-quality care and a safe workplace for all staff.

 

4. Continuous Quality Improvement (CQI)

 

All hospitals have continuous improvement plans that help them stay updated with all the latest developments in patient safety and quality by assessing, evaluating, and improving their processes and methods over time. Having incident reports duly filled and followed up to closure helps the CQI process to identify potential areas of improvement and help the organization achieve a more successful CQI cycle that takes them forward.

 

5. Better Training and Continuous Learning

 

Incident data are essential sources of knowledge and on-the-job training material. Incident investigation is a rich source of information that will help new staff understand why the hospital has a specific process that may differ from their previous workplaces. Similarly, having a robust incident management system helps implement a good continuous learning program for the staff that helps them learn the most important details they need to be efficient in their day-to-day work.

 

Different Types of Incident Reporting in Healthcare

An incident is an unfavorable event in health organizations. But, the nature of the incident can vary based on numerous circumstantial factors. Broadly, there are three types of incident reports:

1. Clinical Incidents

A clinical incident is an unpleasant and unplanned event that causes or can cause physical harm to a patient. These incidents are harmful in nature; they can severely harm a person or damage the property.

For example—

● Nurse administered the wrong medication to the patient. 

● Unintended retention of a foreign object in a patient after a surgery. 
● Blood transfusion reaction.

2. Near Miss Incidents

Sometimes an error/unsafe condition is caught before it reaches the patient. Such incidents are called “near-miss” incidents. However, the problem might have diffused before the severe harm, but it is still essential to report near-miss incidents. Nearly 50 near-miss incidents occur for each injury reported.

 

For example—

● A nurse notices the bedrail is not up when the patient is asleep and fixes it. 

● A checklist call caught an incorrect medicine dispensation before administration. 
● A patient attempts to leave the facility before discharge, but the security guard stopped him and brought him back to the ward.

 

3. Non Clinical Incidents

Non-clinical incidents include events, incidents, and near-misses related to a failure or breach of EH&S, regardless of who is injured or involved.

For example—

● Misplaced documentation or documents were interchanged between patient files. 

● A security mishap at a facility.

4. Workplace Incidents

A work accident, occupational incident, or accident at work is a discrete occurrence that can lead to physical or mental occupational injury. The workplace incidents are related to mental as well as physical hurts. According to the BLS’s Workplace Injuries and Illness News, nursing assistant jobs have the highest incidence rates.

 

For example—

● Patient or next-of-kin abuses a care provider – verbally or physically – leading to unsafe work conditions. 

● A healthcare provider suffered a needle prick while disposing of a used needle.

 

Who Prepares Incident Reports in Healthcare Facilities?

At QUASR, we believe all staff (and patients, too) should be able to report incidents or potential incidents they have witnessed. But in practice, it is a bit different. Some hospitals have designated persons who are authorized to file the reports. In some other hospitals, the staff usually updates their supervisor about an incident, then can file the report. 

QUASR clients, usually, have configured to give access to all their staff so that they can initiate an incident report enabling them to stay aware of all the issues that occur – however minor or inappropriate it may be. Allowing all staff to report requires a training effort from the quality and safety teams to ensure all the employees understand what and when to file an incident report

incident-reporting

Critical Components of Incident Report

One comprehensive incident report should answer all the basic questions — who, what, where, when, and how. Most hospitals follow a preset reporting format based on their organizational needs. However, an incident report must cover the following aspects:

1. General Information

The well-informed incident report needs basic information such as the date and time of the incident. Additionally, for future analysis, your report must include general information.

2. Location of the Incident

Specifically, mention the location of the incident and the particular area within the property—for example, patient X fell in Ward no. 2 near the washroom. With the location specifications, administration staff can better investigate the reason behind the incident and fix it.

3. Concise yet Detailed Incident Description

The incident description needs to be clear and meaningful — don’t use vague language, never add baseless information, and keep personal biases out. Whenever you have to add your opinion to the report, mark it as an assumption or subjective opinion.

4. Type of the Incident

You should define the nature of the incident while reporting to get a clear view. We can categorize the hospital incidents into different sections such as Medication Error, Patient Fall, Equipment Damage, Abuse, Pressure Ulcer, Radiation, Surgery/Anesthesia, Laboratory related, Security, Harassment, Loss or damage to property, Patient Identification, among others. QUASR offers 25 such incident types built-in by default.

5. Information of all Parties Involved in the Incident

The administration needs the name and contact details of all the parties involved in the incident. The report should capture all the relevant information required to follow up with the involved parties.

6. Witness Testimonies

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 accounts, note witnesses’ location at the time of the incident, and how they are related to the incident.

7. Level of Injury

In case of injury, the reporting staff must record the injury level and cause in the report. If the incident involves an in-patient at the hospital, their medical records will reflect the treatment and diagnosis of the injury. However, for others, it might be required to follow up and record their injury diagnoses.

8. Follow Up

The incident report is incomplete without the follow-up action details. Each report should include remarks stating what preventive measurements and tactics you have opted to avoid such incidents in the future.

9. Reviews

Once a final follow-up on the incident report is made, the next phase is reviewing. In this step, the supervisor or manager ensures the implementation of corrective actions against the report. The goal of the review is to prevent the recurrence of the incident and create immediate action plans. While reviewing incident reports, a reviewer should consider the following things:

10. SBAR

SBAR abbreviates Situation, Background, Assessment, and Recommendations. The reporting person’s supervisor at the time of the incident typically performs SBAR. SBAR attempts to capture more structured information about the incident, what happened, pre-conditions leading to the incident, information about the patient or staff, if involved, a first assessment of what caused the incident, and recommendations for follow-up or corrective actions.

11. Risk Scoring

A risk score is a calculated number that reflects the severity of risk due to some factors. We compute risk scores as a factor of probability and impact. It is common in the industry to use a 5×5 risk scoring matrix. But there are other methods too, and sometimes the scoring changes based on the type and nature of the incident.

12. Investigation Information

An investigator or an investigation team needs to go through all the supporting evidence to analyze the incident. The incident supporting comes in different forms, such as photos, CCTV footage, and witness statements. It is essential to verify the supporting evidence during an investigation. Information investigation often leads to:

13. Root Cause Analysis

Root cause analysis is a problem-solving method used to identify the root cause of the problem. The typical output of the RCA step is a set of contributing factors that then indicate systemic issues that may be addressed together by policy or process changes.

Standard RCA tools used in the industry include the Five Why method, Ishikawa, or the Fishbone Analysis. Some cases use more advanced techniques like the Swiss cheese model or PRISMA.

14. Contributing Factors

Contributing factors are those factors that influenced a single event or multiple events to cause an incident. If contributing factors are accelerated, it will affect the severity of the consequences. Therefore, with the knowledge of contributing factors, management can eliminate them to prevent similar incidents from occurring in the future.


QUASR implements a form of the
London Protocol for capturing these factors.

15. Executive Summary

The compelling executive summary is the final step in reporting incidents. It is a short document produced for management purposes. It summarizes a more extended report so that readers can quickly become acquainted with the material. Management can get a crisp reading of the incident from the executive summaries without reading the entire report.

Benefits of Hospital Incident Reporting

Through healthcare data analysis, setting the correct key performance indicators in your organization becomes simpler. Here are some vital benefits that you can gain from reporting.

1. Preventive Measures

 

One of the most powerful elements of an incident report is streamlining historical and current data to spot potential incidents in advance. Using predictive analysis, healthcare facilities can improve the quality of patient care and reduce workplace mishaps. Around 60% of healthcare leaders have confirmed that adopting predictive analytics has improved their efficiency considerably.

 

2. Disease Monitoring

 

Disease monitoring is one aspect of the first predictive analytics. With the incident reports, healthcare organizations can monitor potential disease outbreaks by using past and present metrics. 

 

During COVID-19, many hospitals have struggled to prevent disease outbreaks on their premises. But, the organizations that have insightful data with them may have managed the pandemic outbreak a lot easier.

3. Cost Reduction

 

Reporting can also make healthcare operations more economically effective. By gathering and analyzing incident data daily, hospitals’ can keep themselves out of legal troubles. A comprehensive medical error study compared 17 Southeastern Asian countries’ medical and examined how poor reporting increases the financial burden on healthcare facilities.

 

4. Enhanced Patient Safety

 

Improving patient safety is the ultimate goal of incident reporting. From enhancing safety standards to reducing medical errors, incident reporting helps create a sustainable environment for your patients. Eventually, when your hospital offers high-quality patient care, it will build a brand of goodwill.

Healthcare Incident Reporting Challenges

Healthcare incident reporting has various managerial and safety-related benefits. To create a result-driven incident report, you have to cross the next hurdles also:

1. Paper-based Reporting

 

In this technology era, many healthcare organizations still rely upon traditional paper-based reporting. Paper-based reporting is a manual approach where the incident details are recorded and managed using paper and often hand-written reports.

 

Paper-based reporting has numerous disadvantages, including low-quality data, limited flexibility, costly process, error-prone, time-consuming, and more. Get started digitizing your incident data by downloading our Excel-based Incident Reporting Template and quickly replace paper-based reporting. We even have a post explaining the template and how you can benefit from it.

2. Underreporting

The problem of underreporting is widespread in the healthcare industry. Common causes of underreporting include:

1) Lack of awareness about when and what to report.

2) Fear of repercussions from colleagues or seniors.

The reason behind underreporting might vary, but no one can deny that it is the biggest reporting challenge. We had written a detailed article on our assessment of under-reporting in our blog.

According to the
Agency for Healthcare Research and Quality, all healthcare facilities should offer a simple and anonymous reporting way to their staff. QUASR has built-in features to encourage reporting in a pseudo-anonymous manner encouraging staff to file a report without fear.

3. Busy Schedule

 

The busiest hospital personnel, nurses, and doctors are mainly responsible for filing incident reports. Due to their busy and often overworked schedule, they sometimes fail to report incidents. A solution must factor in this constraint at the time of design and implementation to ensure all incidents are recorded in a timely fashion without over-burdening the staff.

Conclusion

After understanding the purpose, benefits, and challenges of incident reporting in healthcare, it is clear that reporting is essential for medical facilities. Whether you wish to improve patient safety or reduce workplace mishaps, incident reporting can serve multiple purposes. But, compiling, reviewing, and investigating incidents in a timely and unbiased fashion isn’t a simple task. 

 

You require an automatic incident reporting system to manage hundreds of incidents at any given time. We can say that QUASR has practical tools to help you create track-analyze incident reports. QUASR is easy to use and access, which allows fast and accurate incident reporting. 


We have various elements in our software for resilient healthcare incident reporting ensuring all the best practices. To better understand what QUASR can do for you,
book a free demo today

 

Also, please stay connected with us as we will be covering more topics related to digitalized incident reporting.


Meanwhile, feel free to
contact us for further information!

An Introduction to QUASR Basic

Abishek Goda
Basic-Features-Banner

When we brainstormed the QUASR Lite design, we had a list of features for another version that’s slightly more advanced than Lite but not as involved as the Premium version. Even amidst our customers and prospects, we understand Lite is a little too simple for their process because they have had a computerized system in place for a while and are familiar with the advantages of having one. They need to upgrade but are not ready to set aside budgets or time for enterprise implementation.

So we built QUASR Basic to give you a flavor for what the enterprise system can do for you without having to go through full implementation. There are limitations, of course. In this post, allow us to introduce QUASR Basic to you.

QUASR Basic is Lite with an automated workflow

QUASR Basic is Lite with a workflow. It does not have all Premium version features and will probably remain that way for more time. BASIC and Premium target different types of organizations.

BASIC targets single/independent hospitals, which are:

 

1) accustomed to having a system in place.

2) using Lite for a while and want to graduate their process.

3) Enterprise-ready users who wish to try QUASR before taking on an enterprise implementation.

 

I hope we convinced you to read on, as this might be just what you need at your org right now.

 

What do we mean by a workflow anyway?

In Lite, when you report an incident, the system doesn’t do much apart from saving it to a database and ensuring the data’s integrity. In BASIC, however, a few things happen: the system triggers an email to a pre-designated group of Quality Managers as soon as you report an incident.


The incident details collected also contain additional information such as the Supervisor for the incident, a team of investigators, a group of people to sign off on the incident etc. Each of these is a stage in the incident lifecycle. The Supervisor assigned is then required to perform the review and fill in the SBAR. Similarly, upon quality review completion, the investigation report can be updated and so on. This linearizing sequence of events in the incident lifecycle is what we call the “workflow”.

There’s more to QUASR Basic compared to QUASR Lite

But that’s not all of it either. There are more things under the hood in BASIC as compared to Lite. Flags assigned to incidents in Lite are merely indicators. They help you identify or classify incidents at a glance. However, in BASIC, you can use Flags to include pre-designated people in the incident loop. They’d automatically get notifications and access to the incident details.

Similarly, you can add other users to the incident and notify them of the occurrence – voluntarily. These might be other department heads or an HR supervisor or a Line supervisor instead of the department supervisor. These users would otherwise not have access to the incident or its details.

 

One last thing to highlight about Basic would be the “Sensitive Incidents” feature. We will write a detailed note on sensitive incidents in another post in the future. But for now, sensitive incidents are a type of flag that limits the access to the incidents to a predetermined group of users – Quality Managers, investigators and other management level users. QUASR does not have an opinion on how or when to use this flag. We leave it to our customers to use it as they see fit in their organization.

QUASR Basic vs QUASR Premium

Lastly, as I mentioned, BASIC is Lite with automated workflow.

 

But how does Basic compare to Premium?


Premium
targets a group of institutions as opposed to independent hospitals or providers. A group has other requirements in terms of uniformity of process across their participant hospitals. They tend to prefer a single cluster implementation where the group management can get their dashboard with the essential information they need about the overall incident performance.


BASIC, on the other hand, does not support a cluster implementation. There are other differences in terms of support access, implementation, customization provisions in Premium that aren’t available in Basic.

For more information, check our pricing page, and it’d be able to give you even more clarity on both these versions and options.

Why should you keep your process simple

Abishek Goda
simple incident process

“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 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 doesn’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 set up 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 are 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 to 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 detail 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 it’s 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 arises 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.

A brief introduction to QUASR Lite

Abishek Goda
quasr-lite

When we launched QUASR a couple of years back, our motivation was to create an enterprise incident management software specifically for healthcare organizations in this region (South-East Asia). Having over a decade of experience working with the big guys in this region, we have an excellent understanding of what the big solutions did to service the big guys as well. In some sense, we were uniquely positioned to generate value. But we also figured that the big organizations are well serviced and tended to have very complex requirements on their tools. So our entire vision was to bridge the gap for medium-sized hospitals. To date, all our customers say they are pleased about their implementation of QUASR, which is unique to their organization and processes.

In early 2020, the pandemic hit. The pandemic meant a lot of the healthcare organizations had to start working remotely too. Much non-frontline work had to go remote in an environment that is traditionally not trained to work remote. While our solution is perfect for organizations to take their quality process online and remote, our solution wasn’t armed to help the smaller or niche, healthcare providers. Some of these providers have not evolved to have their quality processes, have a paper-form based flow but do not have volumes to warranty a separate software or are very early to benefit from even a mid-sized solution like QUASR. The features in QUASR, though, strategic and straightforward, is sometimes far more involved and complex for an organization that is just getting started on this path.

That’s the genesis story for QUASR Lite. QUASR Lite is aimed at organizations that are just getting started on an incident management process. Whether you have a simple paper-form method or looking to create your own structure and process, Lite has you covered. QUASR Lite is unopinionated in that it does not enforce a workflow.

What is QUASR Lite?

QUASR Lite is an online incident repository. It is a simple data capture tool and allows you to capture the incident data in a structured format. It makes your life easy to gather incident statistics and generate reports.

Want to know how it works? QUASR Features 


You could very well do the same with an excel sheet. And we would have to agree. But the main advantage Lite brings to you over vanilla excel sheets is that: we have thought this one out for you. 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 to bigger and more involved processes.

Who is QUASR Lite for?

Lite perfectly suits small hospitals, clinics, speciality hospitals, nursing homes and care centers and individual hospitals, that are either:

  • ✅New to incident management 
  • ✅Looking forward to digitalizing their incident data; 
  • ✅Looking to get started with a starter tool and graduate to more complex tools along the way.

Lite takes all these scenarios into account. There are some opinionated decisions we have made in Lite, though. Lite is primarily meant as a tool for the Quality Management team. So we limited the number of user licenses to 5 per account. Ideally, 5 seats are plenty enough to have quality managers and even senior management from your hospital.

Also, since Lite is for a closed team of Quality Managers, we don’t have email notifications baked in. We believe that if it is your primary tool for work, you might not want to be notified of every small action. However, this might change in the future. There are other uniquely designed features that we’ll go over in individual posts over the next couple of weeks.

Join the community

Lite is an evolving product. The first version which is taking trial requests now is the first feature-complete version. We will be adding an overall roadmap of features to Lite over the next several quarters. But more importantly, we believe that its users will drive the roadmap for Lite.

We built the enterprise version of QUASR, ‘QUASR Premium’ the same way – based on customers’ direct feedback, their specific needs and requests. So we don’t see why Lite is any different. So if you want a product that suits your process, get on the train right now and help build the product you need.

Check out more features of QUASR Lite.

You can sign up for a
14-day free trial here

World Patient Safety Day 2020

Abishek Goda
World Patient Safety Day

WHO designated 17 September to be celebrated as World Patient Safety Day (WPSD) in 2019.

The theme for this year’s WPSD is “Health Worker Safety: A Priority for Patient Safety”. As we all agree, there couldn’t be a better time to discuss this topic when health workers, globally, brave the pandemic facing distressing safety risks.

We, at QUASR, spent quite a while brainstorming how we should celebrate this event. After much discussion, we decided the right thing to do would be to gather valuable learnings from leaders in the industry and share them with the community at large. As an advocate of patient safety, we feel this is a way we can do our bit to share actionable insights from across the region so everyone can adopt or tune their processes.

We kickstarted our WPSD 2020 celebrations with a thought-provoking chat with Dr. Juan Lucas Rosas of the FV Hospital, Vietnam. We spoke to leaders in Malaysia, Indonesia, the Philippines, and more. While we are working to bring all this content to you, we invite you to share your thoughts, suggestions, feedback, or frankly, corrections.


Stay tuned to read them all. Or see them all, yes! we do have exclusive videos too.