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Under-reporting Patient Safety Incidents: A Real Problem

Rohini K

Amy had been a staff nurse in the same hospital for 30 years. Her shift starts with making rounds in different 15 wards and ensuring they follow all the patient safety protocols.

One day she found water on the Ward No. 3 floor due to the cleaning staff’s negligence. Despite noticing this issue, she keeps on moving with her job. Her reasons to not report the problem were:

  • – Reporting meant lots of paperwork
  • – Reporting could put her hours behind schedule
  • – She had to waste time on hearing back from the admin department
  • – Importantly, she doesn’t want to cause any trouble to the poor cleaning staff

So, she didn’t report at that time, and the issue remained unresolved. After a few days, some patients fall from the wet floor in the ward. Now patient falls are serious. And it doesn’t look good if the investigation reveals negligence. So, they go unreported as well!

The result? The hospital continues to score poor safety results. The reason for not reporting could be credible or just laziness. Under-reporting doesn’t help the organization meet its safety goals. The story above is not an isolated story of anyone hospital or nurse. Statistics tell us that this seems to be the norm:

  • – Almost 25% of incidents go unreported. (Source: Sentis)
  • – Around 100 errors go unreported while recording. (Source: Pharmacy Times)
  • – Every year about 7,150 deaths occurred due to not reporting incidents in hospitals. (Source: Yale News)
  • – The Journal of Patient Safety]] suggested in 2013 that 440,000 people per year die from preventable medical errors. (Source: Medscape)

Even though we have data indicating under-reporting in hospitals, not many practitioners follow the proper reporting process. QUASR tries to address this issue with simple tools that seek to address common reasons for under-reporting. Let us first understand Under-reporting and its Reasons.

What is Under-reporting?

Under-reporting means an issue, incident, or the fact that an individual or organization has not reported. Under-reporting is a failure in data gathering.

In hospitals, sometimes individual staff hide or don’t report some incidents. However, unfortunately, it is not possible to know ahead of time how these under-reported incidents affect long-term patient safety.

Recently a study published in the Stanford Business on how hospitals acquired infections is reported in Medicare claims. Researchers found that hospitals with lighter reporting requirements were more miscoded by examining hundreds of Medicare patients, as hospital-acquired infections(HAIs) were presented on admission (POAs). 18.5% of infections said to present upon admission were acquired in the hospital.

Overall, under-reporting is a critical issue that should be analyzed and treated by the hospitals on priority.

4 Reasons Behind Under-reporting in Hospitals

There are plenty of different reasons that generate under-reporting problems in hospitals worldwide. Some of the common underreporting causes in hospitals are:

Fear of Repercussion

One of the most common reasons why an incident goes unreported is a fear of repercussion. We don’t think there are any organisations in today’s day and age where an employee is penalised for taking the initiative.

Still, many staff that we have met on and off have mentioned that they are afraid it will reflect poorly on them if they reported an issue. Organisations may have to do more to ensure that an incident is not a reflection of the staff. From our discussions with our clients, this is often amongst the top few reasons why incidents go unreported.

No Time To Report

Staff on the floor are amongst the busiest people we meet on a given day. Incident reporting in such a dynamic is quite tricky. Most incident forms are lengthy and require the staff to write up in sufficient detail, then participate in multiple investigation sessions to complete the incident report.

Often incident reports have to be filed within a predetermined number of hours since the incident occurred. If they cannot do this, they usually forget and don’t get around to filing the same. It is especially true for incidents that don’t cause any harm to the patients as such since everyone’s priority is patient safety and care.

Hospital staff often do not have time, and hence they may tend to ignore incidents that they believe are not serious enough. Lack of time is also one of the top reasons why under-reporting occurs, based on our discussions with our clients.

Lack of Transparency

Often the reporting person is wholly left out of the incident processing loop. Many organisations have a perfect reason to do this for some types of incidents too. But some processes are not designed to be transparent at all. The process leaves many people out, and they don’t understand how their reporting an incident helped the organisation or patient benefit. This can also lead the staff to believe that their incident report went into some “filing black hole”, and no one even had a chance to process their report.

It is possible to revise the incident process to be more transparent when it is digitalised. A digital system allows for frequent and early feedback to all the stakeholders. By being transparent, the system becomes more inclusive of all staff and helps them realise the value of their contribution.

Insufficient Training or Knowledge

Many healthcare institutions are unaware of the fact that their incident reporting system isn’t transparent. Not many hospital staff members know when, how and whom to report. The lack of reporting knowledge occurs due to poor communication.

Most hospitals would share this information with their new workers during the orientation and training process. But learning occurs differently to different people. Often, a single knowledge sharing session is insufficient to orient all the users in the processes.

Additionally, organisations share critical information via email. Frontline workers like nurses or ward attendants don’t have regular access to a computer to receive information on time.

The only way to address this is continuous training or frequent sessions to help the staff get oriented to new systems better. The other often ignored method is to build intuitive systems.

How does QUASR help you address under-reporting?

QUASR has a suite of nifty tools integrated into the system to help address under-reporting. For instance, to specifically address the fear of repercussions, QUASR uses a novel pseudo-anonymous reporting that allows users to hide their identity at the time of reporting. We do this so that the users will feel safe reporting, but at the same time, the Quality Managers don’t have to deal with insufficient data for investigation later on. Similarly, we use a multi-stage questionnaire for collecting the details with the ability to resume your data at any step. This allows staff to fill in the incident report over multiple breaks without blocking off a significant portion of their time to do this.

QUASR, at its core, believes that an incident management system is an essential knowledge repository for the healthcare organisation to learn from and disseminate information over. So transparency is one of the critical considerations of the design with suitable mechanisms to protect sensitive data when the need arises.

Finally, QUASR aims to keep the application simple in appearance and manner. The bottom line consideration for every element added into QUASR is the amount of training each user would need to use that element effectively. We have designed the UI in line with some of the social applications familiar to us. This allows us, the users, to quickly adopt and start using QUASR with minimal training efforts.

We will be covering some of these features like pseudo-anonymity or sensitive incidents in individual blog posts in the future. So do watch this blog for more information. Meanwhile, feel free to contact us or drop us a note if you need further information on any of these topics in particular or QUASR in general!

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.

Digitization – A Pathway Towards Digital Transformation

Rohini K

If we look back two and half decades, businesses have to provide input to their computing devices to convert data into a digital format.

Leaping of few years, businesses gain capabilities to process data over digital technologies instead of the manual or offline system.

This digital evolution is called digitization to digitalization!

Confused?

Like their spellings—digitization and digitalization are insanely interlocked together that anyone can get confused between both terminologies. However, if we try to explain in one line—‘digitization is information’ and ‘digitalization is a process.’

We know it still doesn’t give away why digitization and digitalization are different when they both deal with processing and interpreting information? So, let’s dig deeper and understand what lies in the roots of digitization and digitalization.

What is Digitization?

According to Oxford’s Dictionary — “Digitization is the process of changing data into a digital form that can be easily read and processed by a computer.”

In layman’s terminology, digitization is a method to turn information into binary digits (1’s and 0’s) so that computers can easily understand and process it.

In this process, the user takes analog information such as photographs, soundtracks, or documents and converts them into a digital form that can be stored and accessed by digital devices.

For example, a hospital converting patients’ paper records into Excel sheets for better preservation and access. Additional examples—scanning old documents to PDFs, transforming printed reports to meaningful data, turning a vinyl record into an MP3 file, and so on.

Whether you wish to preserve old information or capture new information for later use, the information dealing process will be called digitization.

Why is Digitization Important for your Business?

According to a McKinsey report, the pharmaceutical and medical industry shows the least amount of digital frontier gap for 13.4% and travel sector maximum for 51%. In this, if you are still wondering why to take a step towards digitization, reasons are:

Market Trends: It doesn’t matter which industry you are part of—the digital wave is everywhere. Thanks to cheap internet services and smart gadgets, today, digital technologies are in everyone’s hands. From booking a cab to consulting a doctor, everything is digital—now, it’s up to you whether you want to part of the trend or not?

Improve Efficiency: Your paperback business documents are prone to theft, loss, wear and tear—with no way to replace them. Therefore, if you don’t want to reduce your business efficiency due to inefficient information, safely store your data in a digital format.

Better User Experience: Presently, a fast and smooth user experience is an imperative way to grow your business, which you can’t achieve via manual services. The progressive businesses have completely understood this phenomenon, such as Pizza Hut started taking their customers’ orders through the interactive touch screen in their restaurants.

Limited Growth: If you haven’t digitized your data yet, you cannot take leverage from the new growth and marketing metrics such as social media.

What is Digitalization?

If you search for digitalization definition on Oxford’s dictionary, you will receive the same definition as digitization.

Wait, what?

Then, how come both terms are different?

Well, they are different—trust us, just let us break the concept for better understanding. Earlier, we mentioned that when a hospital converts patients’ records into Excel sheets, it’s digitization—but, when a hospital receives patients’ records in email and adds them into Excel sheets, records are already digitized; thus, this concept will be called digitalization.

So, digitalization is a process of converting information into different digital equivalents. For instance, recording patient’s data using a digital registration method is digitalization, but scanning printed records into digital form is digitization.

Digitalization is an ongoing process as new technologies are emerging and expanding the further scope of digital development. Therefore, twenty-first-century businesses can’t avoid digitalization!

Why Is Digitalization Important for your Business?

Roughly 4.66 billion people around the globe are using the internet at the beginning of 2021—that means 60% of the world’s population has embraced digitalization. However, if you haven’t digitalized your business yet, you should because:

Collaborated Team: When marketing and technical teams collaborate together, they can better understand customers’ needs and find better solutions to satisfy them. Using the analytical tool, the marketing team can effectively analyze market trends and provide correct data to the sales team to quickly convert potential leads into customers.

Improved Data Collection: Nowadays, businesses are busy collecting mountains of data related to their customers, but the real benefit is optimizing collected data for analysis. With digitalization, a system can gather the right data and intelligently analyze it.

Resource Allocation: Digitalisation can consolidate business resources into a centralized software for easy access. In 2020, businesses used an average of 900+ applications to run their operations, which makes it very hard to derive information from the various portal. Digitalization can help in streamlining different data silos to provide efficiency across units.

Elevated Profits: Digitization pushes businesses towards better efficiency and profitability. According to the SAP Center for Business Insights and Oxford Economics report, —80% of fully digitalized companies have recorded upward growth in their profits. Now, this fact is sufficient to know to prove how digitalization can improve business profits.

Key Differences Between Digitization and Digitalisation

For better clarification on the notion—‘digitization is information’ and ‘digitalization is process’—let’s understand what primarily set both terms apart:

Information Conversion

In both terms, information is converted from one form to another. Where digitization is converting analog information into a digital form, on the contrary, digitalization transfers information to equivalent digital devices. The information might be a common factor here, but the way to deal with it completely different.

Basic Purpose

Digitization is performed to make information highly accessible to a company. Imagine, when a hospital wants to retrieve the gynecologist department’s records for 2012, the manual search might take lots of time—even if all the documents are chronologically arranged. On the other hand, digitize records can be retrieved with one click, which makes it easy to access information.

The purpose of digitalization is beyond accessing information; it is a process of analyzing and interpreting information to improve productivity and efficiency. Such as, once the hospital has received information, they can analyze the gynecologist department’s data and interpret comparisons between 2012 and 2021 performance rates.

Functionality

Both terms are polar apart on the functionality grounds—digitization operates to store information permanently, and digitalization focuses on improving data accuracy.

For instance, a healthcare clinic can create permanent data backup digitally so that natural calamities, theft, or other incidents won’t damage their vital information. Next, they can form a correlation between information and arrange systematically to provide solutions. In a way, digitization stores information, and digitalization process that information.

Nature of Data

Historical data is converted into a digital format under digitization, like a media institution converting their old paper-based accounting files into ERP software. So, digitization deals with old information and gives it a new digital look.

However, digitalization revolves around both old and new information, such as a medical institution can record their old financial reports into the latest accounting software along with new year financial information.

Tools

Digitization and digitalization aren’t possible without adequate tools. For digitization, input tools are mainly used like Scanner, Digital Camera, Storage & Retrieval Systems, OCR Software, and others.

Multiple software solutions are used to accomplish the digitalization process, such as ERP Software, Messaging & Conferencing Software, Predictive Maintenance Systems, Robotics & Controller Systems,, and more.

Example

Suppose a doctor is conducting a study on traditional chronic diseases. For research purposes, he collected multiple handwritten paper manuscripts of his old patients and converted them into a checklist app to easily access the relevant information for his research.

Next, he used digital technologies to process and analyze data in real-time and draw insightful conclusions to include in his study.

Future of Digitization & Digitalisation — Digital Transformation

Digitization was started around 25 years back when computer systems become part of mainstream activities—so we can say that it’s now completed.

After digitization, the digitalization process began and continued to evolve with the introduction of new technologies. Slowly, digitalization is moving towards the digital formation—the future.

Digital transformation is a high-level digital business perspective where strategic decisions are made to take leverage from all digital technologies and change the overall approach of the business to create a resilient environment.

It is a broad framework, which is still evolving with the help of new technologies. It is projected that the global digital transformation market size to expand at a CAGR of 22.5% between 2020 to 2027.

Wrap Up

On parting thoughts, digitization deals with information, digitalization manages processes, and digital transformation happens to be a reformation. If we say digitization was the past and digitalization is the present, digital transformation is definitely the future.

So, it is step after step, which businesses should embrace to stay ahead of the competition and prepare themselves for the future.

Moving from a paper-based system to a digital system

Rohini K

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. There is no single reason why any hospital continues on a manual process. 

Let us briefly describe the incident reporting process in a hospital. A reporter/witness has to fill in a paper form with as many details as possible. The quality team then reviews the report and collects other witness accounts and additional supporting information from the supervisor(s). Based on the data collected, the quality team performs risk assessment. At this stage, the quality team also decides whether the incident requires a more detailed, structured investigation. In cases where an investigation is not needed, the record is closed and filed for archival. But when an investigation is required, the quality team identifies a team of investigators: a group consisting of just the quality team or a team of individuals from across functions. This is the standard process followed in most hospitals, with some having variations to cater to their operations. This process can be followed either manually, which we call a paper-based system, or digitally, with the help of a software.

This article expounds on the effects of a paper-based vs a digital system on the incident reporting process and the various aspects to consider when moving from a paper-based system to a digital system.

Paper-based system

In simple terms, a paper-based system is one where information is kept on paper, rather than on a computer. 

Let us take the example of a hospital that uses a paper-based system for incident reporting. As you can see above, in every stage of an incident, the incident form (paper) is passed around to various stakeholders. Each stakeholder gets a copy of the incident form based on which they create their reports. The quality team collects all these individual reports and then files them together as part of the incident report. Each step involves moving paper, tracking them carefully across many staff. The process usually takes a few weeks until closure. 

With paper forms stored in files and folders, there is no simple way to locate a specific report involving a particular patient or generate statistics or identify any patterns. As a quality manager, suppose you want to analyze incidents from the past year and develop a set of guidelines or device process improvements so that some incidents do not happen in the future. There is no easy way to do this when you deal with paper forms. By practice, the quality team identifies common incidents and recommendations for preventing those. But to effect the changes, the quality manager has to collect conclusive evidence and statistics to highlight the pattern. With paper-based incident reports, this is a few weeks of effort to collect the required data and present it to the management.  

Keeping track of paper documents is not only a hassle but a waste of time and resources. Additionally, the data collected is relatively low quality in nature due to legibility issues. Safe storage from various hazards, securing from unauthorized staff only increases the complexity.

Digital system

In simple terms, a digital system is a system that stores the data in a searchable format on computerized storage. This storage could be on a local computer, on a server or the cloud. A Searchable format can be anything ranging from a simple Word document or an Excel sheet, a text document, or an elaborate record-keeping system on the cloud.

The same incident process: collaborating with multiple stakeholders, investigation reports, gathering statistics and identifying patterns become far more straightforward with a digital system. It is also simple to collect and manage all types of incidents – major or minor – leading to identify issues that otherwise go unreported. 

The quality of the data collected is better, and it is effortless to avoid duplication. The data may be accessed from anywhere while enforcing sufficient levels of security and authorization. It is also possible to restrict access to specific data and get visibility to all the modifications made. Moving to a digital system saves time, effort, resources and enables collaboration. It also helps improve communication and brings in better accountability. 

How to choose a digital system?

At this point, the motivations to going digital are quite apparent. The critical question, then, is – how does one choose the right digital system? Our answer is: start small. The transformation process is quite involved and can be daunting if we accounted for all the factors in the first attempt. There are also factors about data storage location and format to use. Our recommendation is to start with the most comfortable and familiar format: Excel Sheets. Manage the sheets on the local laptop/desktop or a network shared folder. Just doing this is already a successful first step to the transition to a digital system.

It is essential to build a habit of collecting the required data digitally using the newly devised system. It is easier to improve the system and the process to collect all the right data with regular use. Having the right data is the first step to identifying the system that suits the process in place. While digital data storage comes with many benefits, there are downsides based on the actual system in place. 

To understand this better, let us take a case where we use Excel sheets for managing incidents. For all the benefits that Excel offers, it is quite challenging to “organize” data effectively. Often it is possible to end up with multiple versions of a file shared over emails leading to merging efforts. Further, charting or pivoting the data requires significant knowledge and skill with Excel itself. Do watch this blog for an article on managing incident data effectively using Excel sheets.

We can address some of these complexities by using other tools like Google Forms or repurposing project management apps to manage incidents. For the technically savvy, bug tracking systems commonly used in software development companies are also a good starting point for incident management systems.

To conclude, the benefits of a digital system far outweigh the perceived convenience of a paper-based system in almost all aspects. However, transitioning to a digital system need not be a daunting task if it is taken one step at a time. Picking the right tools to aid in the transition by leveraging familiarity is an excellent way to get started quickly.

Digitize vs Digitalize

Rohini K

Yes, you read that right. There is a small but appreciable difference between them. We’ll try to articulate this as we go.

What is Digitization?

A vast majority of small to medium healthcare providers in the region track their safety and quality metrics manually. ‘Manually’ is sometimes as basic as a paper record, sometimes is an excel sheet and some other times its a Google form. We categorize all of these as manual. The effort required by a single person to track and maintain this data is significant. Moving from paper record to a digital record is simply digitization. That is, you made the record accessible as data. But digitization, by itself, doesn’t solve the problem of manual effort involved. It still is an excellent first step to take.

What is Digitalization?

On the other hand, digitalization is to enables an organizational process on top of digitized data. It involves a slight rethinking of how to transform the process to suit an online world. Digitalization is the use of digital technologies to change a business model and provide new revenue and value-producing opportunities,” according to Gartner’s glossary. Digitalization will be a crucial tool in enabling better decision-making and better improvement programs across the organization. This usually federates the data collection across stakeholders with each performing their portion of the workflow. Alongside collecting valuable and insightful data, digitalization can reduce a lot of time for anyone involved in the quality and safety workflow.

What is Digital Transformation?

Digital transformation is beyond Digitalization. Digital transformation is not entirely only technology. Although IT will play an important role in driving digital transformation strategy, the work of implementing and adapting to the massive changes that go along with digital transformation falls to everyone.  Digital transformation is essentially about the customer and how you fundamentally change your way of operations and deliver value to customers.  It is a cultural change that requires organizations to continually challenge the status quo.

There is no magic formula for the digital transformation project to be successful, as all digitalization projects need to be customized to your specific situation.

World Patient Safety Day 2020 – A video collage

Rohini K

We kickstarted our World Patient Safety Day 2020 celebrations in September 2020. One of our campaigns was called “Conversations with”, which is a series of interviews and discussions with healthcare leaders across the region, as a collaboration to promote awareness on staff safety and a joint call for action to prioritize health worker safety.

Watch a video collage of excerpts from our chats here:

Our first conversation was an insightful chat with Dr. Juan Lucas Rosas, Quality Management Director, FV Hospital in Ho Chi Minh City, Vietnam. Dr. Rosas urged the need to empower staff and engage them in patient safety and staff safety initiatives and the importance of work-life balance. Dr. Rosas rightly highlighted how there is no international healthcare safety board and the need to establish one. He urged all healthcare organizations to focus on their foremost responsibility and accountability – to make it safe. Read the article about the full interview here.  

We hosted Dr Ana Maria Jimenez and Dr Roger Macusi from the Phillipines. 

Dr Ana Maria Jimenez is the Director of Quality Management at Asian Hospital and Medical Center (AHMC), Philippines. Dr. Jimenez spoke compassionately on the importance of having health worker safety an integral part of patient safety culture, paying tributes to pandemic heroes and safety champs, and having emergency management plans and dashboards that enable AHMC to respond quickly to the crisis and make informed decisions. You can read the full interview here.  

Dr. Roger Macusi is a member of the Board of Trustees of the Philippine Society for Quality in Healthcare (PSQua) and the Chairman of its Publications and Public Relations Committee. Dr. Macusi spoke about PSQua’s roles in patient safety, the impact of the Covid-19 pandemic on the healthcare industry, why education is the key in raising awareness on health worker safety. He also proposed that our Society looks into tapping the educational institutions to teach that health worker safety is important and linked to patient safety. You can read the full article here.  

From Indonesia, we hosted Dini Handayani from Medistra hospital. Dini Handayani is the CEO of Medistra Hospital, Jakarta, Indonesia. Dr. Dini spoke to us with a wealth of knowledge on safety culture, managing safety risks, and crisis management. At the national level, Dr. Dini relates the nationwide health worker safety campaign organized by MOH Indonesia and WHO South-east Asia Regional Office; and the role of accreditation agency in developing infection prevention and control training programs. You can read the full article here.  

In Malaysia, we hosted a variety of healthcare leaders and professionals from various hospitals and specialties – Dr. Hasri Samion and Dr. Farina Mohd Salleh from National Heart Institute of Malaysia (IJN), Dato’ Dr. Mohamed Ibrahim from Beacon Hospital, and Ms. Phang Moon Leng from Oriental Melaka Straits Medical Centre (Oriental). 

Dr Hasri Samion, is the Chief Clinical Officer & Senior Consultant Paediatric Cardiologist and Dr Farina Mohd Salleh is the Director of Quality and Emergency Physician & Manager, Observation & Emergency Department, National Heart Institute of Malaysia (IJN). Dr Farina and Dr Hasri shared with us their safety culture and their roles and experience in managing patient and staff safety during this pandemic as a tertiary referral heart centre. You can read the full article here.  

Dato Dr Ibrahim spoke about health workers’ protection and safety as the utmost priority, investing in cutting-edge technology while making pricing affordable and how digital innovation is impacting healthcare. You can read the full article here.  

Ms Phang spoke about their commitment to health worker safety, their experience in crisis management and the importance of emergency preparedness, not just for any pandemic but also in dealing with natural disasters. You can read the full article here.  

All in all, we are more than happy to have celebrated World Patient Safety Day 2020 in the perfect way we could think of. Gathering valuable learnings from leaders in the industry and sharing them with the community at large. Plus, there couldn’t have been a better time to discuss this topic than in 2020.

Conversations with Dr Hasri Samion and Dr Farina Mohd Salleh

Rohini K

In conjunction with World Patient Safety Day (WPSD) 2020, QUASR is organizing a series of interviews with healthcare leaders to share their thoughts and to join the call for action to protect and support health workers. Our final interview in the series is with Dr. Hasri Samion and Dr. Farina Mohd Salleh from the National Heart Institute of Malaysia (IJN).

Dr Hasri Samion, MD, M.Med, FNHAM, FAsCC  is the Chief Clinical Officer & Senior Consultant Paediatric Cardiologist, IJN. Dr Hasri’s specialities are Paediatric Cardiology, Interventional paediatric cardiology and Paediatric electrophysiology and pacing.

Dr Farina Mohd Salleh, M, M.Med is the Director of Quality and Emergency Physician & Manager, Observation & Emergency Department, IJN. Dr Farina is the Chair of Quality & Patient Safety Committee and Chair of Medication Safety Group in IJN. Prior to joining IJN in 2015, Dr Farina was an Emergency Physician at the Emergency & Trauma Department, Sungai Buloh Hospital. She is a recipient of Excellent Service Award from Ministry of Health Malaysia.

In this interview, Dr. Hasri and Dr. Farina share with us IJN’s safety culture and its roles and experience in managing patient and staff safety during this pandemic as a tertiary referral heart center. While it is important to be prepared for a crisis, being able to adapt quickly to new diseases and changing environment is just as crucial. Last but not the least, a valuable lesson learned is taking the opportunity during the lockdown period when the patient load was low to improve and redesign processes. This is an approach another hospital can emulate.

We take this opportunity to thank Dr Hasri and Dr Farina for their generous sharing.

Here is a video excerpt from the interview with Dr. Hasri and Dr. Farina

On health worker safety

Dr Hasri believes that staff safety should be within the patient safety framework and patient safety initiatives. Without healthy staff, patient safety initiatives could not be successfully implemented. Achieving health work safety is also a shared responsibility of all health workers, while management should give full support to provide a safe working environment throughout the organisation.

“Staff safety should be within the patient safety framework”

On protecting staff from safety risks, Dr Hasri’s view is that all healthcare organisations should set up an occupational safety & health (OSH) unit to look after staff safety and wellbeing. At the same time, staff at all levels of care need to be aware of the risk of infections. There are several ways to ensure staff safety during a pandemic, such as through education and training, proper and adequate PPE, screening and testing, staff engagement, effective communication and continuous support from the leadership team.

IJN’s safety culture

Safety culture is not something that can happen overnight, said Dr Farina. It is cultivated over many years, not only to reach a certain level of safety culture, but also to nurture new staff into the organisation’s culture. It is a continuous process. For IJN, the basic quality and safety structure should include local and international accreditations. That is the baseline or reference point for IJN in terms of how safety is practiced all over the world. We want to standardise safety processes and adopt best practices in IJN, said Dr Farina.

“Knowing your weaknesses, addressing them, working together on process improvement, analysing data and continuously improving. That is the safety culture in IJN”

According to Dr Farina, it is very important to have a single culture of safety – something simple and everyone understands the principles. A safety culture should trickle down from the top, with support from the management team down to every staff, whether they are clinical or non-clinical. IJN has specific goals for patient safety that include elements of staff safety as well. 

Having a healthy environment, adequate and skilled manpower, clear responsibility for care givers and effective communication, as well as creating the concept of shared patients, are essential to delivering safe and good quality care, added Dr Hasri.

Initial response to Covid-19, reopening and new norm

IJN has an infection control committee (ICC) that conducts regular surveillance of any acquired infections in the hospital. When Covid-19 cases first surfaced in Malaysia, IJN set up a task force to focus on containment and early detection processes, as well as setting up screening and testing facilities for patients. The next step was educating staff on appropriate PPE, planning for manpower needs, expanding the ICC team and ensuring new operating procedures are in place.

When IJN realised there was community spread and some patients and staff were infected and others were exposed to Covid-19, management raised the level of alert, tightened safety control, adjusted work schedules and deferred elective procedures. The volume of clinical services and patient load went down significantly during the Movement Restriction Order (MCO) period. During this lockdown period, processes were improved and adjusted to the new norm, which put IJN in good stead for the reopening as movement restrictions were gradually lifted. As the country is facing the third wave, IJN is now working on the next level of preparation to mitigate the risk of virus infection in the hospital. Dr Hasri said that as 70% Covid-19 cases are asymptomatic, staying vigilant, compliance to safety procedures and keeping good habits are the responsibility of everyone.  “We conduct regular observations and audits, share findings with the respective wards and departments so that people are aware of the issues and risks”. IJN’s current staff compliance rate is around 80% and the adherence rate is getting better.

A Covid-19 designated hospital for patients with heart conditions

In Malaysia, all Covid-19 cases are treated in designated Ministry of Health (MOH) hospitals. IJN is an exception. As the tertiary referral heart centre, IJN was asked by the ministry to be part of the Covid-19 team, as there are patients with heart conditions and are suspected of being infected by Covid-19. Symptoms such as chest pains are similar to Covid-19 symptoms. In-house Covid-19 detection PCR and Rapid Kit) are available to triage patients. “The need for treating patients with heart conditions is greater and more urgent than the risk of Covid-19 infection”, said Dr Hasri. Once the heart conditions have stabilised, the patients will be transferred to the nearby Hospital Kuala Lumpur. If the initial admission is suspected to be heart conditions, but later diagnosed to be otherwise, the patient will be transferred to a designated MOH hospital.

“The need for treating patients with heart conditions is greater and more urgent than the risk of Covid-19 infection”

Paying tributes to front liners

The Covid-19 pandemic has exposed health workers to increased workplace safety risks, including mental health and well-being. In this aspect, IJN management has been proactive in providing emotional support to staff, particularly those who respond poorly to stress and need more support. “What our management did was immediately form support groups and pre-emptively go to areas where people are at higher risk of getting infected”. The support groups, which includes senior staff members, provide counselling and address individuals with poor coping mechanism and high stress levels, Dr Farina said.

In conjunction with WPSD, IJN organised various online activities, including online games with prizes, to celebrate WPSD and pay tribute to staff and frontline workers. The first ever Patient Safety Awards were given to staff who contributed the most to patient safety. IJN management also sent out emails with pictures and messages to the swab teams, infection control, patient support, nursing and some other new teams created to manage Covid-19. Positive messages from IJN management is a way of paying tributes and showing appreciation to staff and front liners, as well as to boost staff morale.

JCI and MSQH accreditations

IJN is a JCI and Malaysian Society for Quality in Healthcare (MSQH) accredited hospital. Both accreditations are useful for safe and efficient operation of hospital, said Dr Farina. In particular, there is a chapter on global communicable diseases added into JCI’s latest edition last year. “It was as though they predicted something like this would happen. I’m quite amazed it came at a timely manner”. We had plans and drills but did not expect the pandemic to be at this magnitude, said Dr Farina.

Apart from having policies and SOP in place, Dr Farina thinks that an organisation’s ability to adapt quickly to new diseases and crisis, and to find new ways of handling the situation, is equally important. What IJN did this time was to review existing policies and develop multiple new workflows to for various scenarios. This expanded manual is useful for future references, Dr Farina said.

“Apart from policies, the adaptability of the organisation to new diseases, new requirements and new ways of handling them is just as crucial”

Lessons learned

The pandemic has highlighted the importance of being prepared for crisis, working as a team and looking out for any potential risk in healthcare. We need to continuously communicate and engage with staff and patients to understand their needs and be ready to offer options when crisis happens. That is the main takeaway for Dr Hasri.

“IJN had taken the initiatives to improve workflow and processes on patient journey during the initial strict lockdown period when patient load was low”

New process improvements were implemented during the initial lockdown and improvised quickly for both Covid and non-Covid related processes. “I think this is a good lesson learned and a good tactic. Some hospitals might have felt the shock and when hospitals reopened found themselves unprepared. We took the opportunity and made ourselves well-prepared when MCO was lifted”, said Dr Farina with a sense of pride. What motivates her team? “Patients need us. Heart diseases don’t go away because of Covid-19. IJN is the tertiary referral heart centre and patients don’t have anywhere else to go. We need safe processes in place and be ready to receive patients”, is her earnest response.

Conversations with Dato’ Dr. Mohamed Ibrahim

Rohini K

In conjunction with World Patient Safety Day (WPSD) 2020, QUASR is organising a series of interviews with healthcare leaders to share their thoughts and to join the call for action to protect and support health workers.

Dato’ Dr Mohamed Ibrahim A. Wahid is the Medical Director and a Consultant Clinical Oncologist at Beacon Hospital, Petaling Jaya, Malaysia.

Dr Mohamed Ibrahim received his Bachelor of Medicine, Bachelor of Surgery (MBBCh) degree from the University of Wales, College of Medicine and his postgraduate specialist degree from the Royal College of Radiologists in London, United Kingdom (UK). After being trained in the UK, he returned to Malaysia and set up the Cancer Unit at the University of Malaya Medical Centre (UMMC) where he was appointed as the Head of Clinical Oncology before joining Beacon Hospital.

His fields of interest include lung, breast, head and neck, urological and gastrointestinal tumour. Apart from his role as a stereotactic radiotherapy & SBRT specialist, Dr Mohamed Ibrahim pioneered the development of high technology radiotherapy treatment in Malaysia.

Dr Mohamed Ibrahim has contributed to over 50 journals and publications and is a speaker at local and international oncology conferences, public and media forums as well as health program in Malaysia and SEA.

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In this interview, Dato Dr. Ibrahim speaks about the protection and safety of health workers as the utmost priority, investing in cutting-edge technology while making pricing affordable and how digital innovation is impacting healthcare. He also describes with pride that Beacon Hospital CSR programs are helping hundreds of underprivileged patients avail of quality cancer treatments.

We take this opportunity to thank Dato Dr Ibrahim for sharing his views and opinions with us.

Here is an excerpt from the video interview with Dato Dr Mohamed Ibrahim
On World Patient Safety Day theme “Health worker safety is a priority”

Dato Dr Ibrahim strongly agrees that the World Patient Safety Day (WPSD) theme on health worker safety is a timely message, as we are now facing a world health crisis. “We need to adequately protect our health workers because if we do so, we are not only protecting ourselves but also our patients. If health workers are not protected, patients will also be at risk. Protection and safety should be the utmost priority”.

Beacon Hospital celebrated WPSD by creating greater awareness on health worker safety and protection, and tightening safety measures. Building a safety culture is an on-going process in Beacon. This crisis has made us more vigilant on personal hygiene and taking safety precautions, said Dato Dr Ibrahim.

“This pandemic has not only heightened awareness on staff safety but has also reinforced good habits we always take for granted. We hope this can continue beyond Covid-19 as our new culture”

The hospital sets up ventilated tents as screening areas for staff, patients and visitors at the parking area outside the hospital building. All patients undergoing any forms of procedures are required to take Covid-19 test. “Safety is not compromised, we check everybody”.

On private hospitals’ roles in Malaysia

In Malaysia, all Covid-19 cases are referred to government hospitals. Some private hospitals are asked to standby their ICUs and ventilators, and to support government facilities when they are overwhelmed. Fortunately, Ministry of Health (MOH) Malaysia has the situation under control so far and private hospitals have not been called upon to provide ICUs and ventilators.  Malaysia did very well in containing the virus. There was an initial panic that Malaysia might run out of ventilators. In the end there was no shortage. The role of private hospitals is mainly to provide Covid-19 screening and refer any positive cases to MOH.

“I must congratulate MOH, they are so efficient. I think they are more efficient than many western countries. That’s why our Director General Tan Sri Dr Noor Hisham is well respected”

On how Covid-19 impacts cancer patients

Before this pandemic, there was MERS, SARS and other infections, but it never came to the point where we had to be locked down. “We have to admit a lot of us in Malaysia were unprepared that Covid-19 could hit us so hard”, said Dato Dr Ibrahim. “Fortunately, many hospitals acted swiftly and were able to manage the situation. I’m glad to say that we did quite well”. A lot of credits go to MOH.

One of the key challenges Beacon Hospital faced was the Movement Control Order (MCO) which made it difficult for some cancer patients to visit the hospital for treatment. “Our patients’ concerns are not so much the fear of contracting Covid-19, but more on how to get to the hospital for treatment with so many roadblocks”.  They also don’t want the hassles of being stopped and questioned by police. “I had a lot of patients who needed hospitalisation and chemo treatment but were turned back”, said Dato Dr Ibrahim. The challenge is to find a balance between patient’s healthcare needs and restricting the public’s movement to contain the virus. The situation has improved since then.

Investing in cutting-edge technology and equipment

As a leading specialist cancer hospital in Malaysia, Beacon Hospital has always invested in cutting-edge technology on cancer treatment.  Last year, Beacon invested in Halcyon, the state-of-the-art intelligent radiotherapy machine and became the first in Southeast Asia to introduce Varian Halcyon 2.0 machine to its cancer patients.

Beacon Hospital also installed the TrueBeam radiotherapy system last year, a new generation of a linear accelerator that can deliver much faster and accurate radiation dose compared to conventional radiotherapy system. “But we are also very sensitive towards pricing”, added Dato Dr Ibrahim. Beacon Hospital wants to provide affordable healthcare, particularly on cancer treatment.

“Beacon Hospital has always invested in cutting-edge technology but also making treatments affordable”.

Digitisation and IT innovation

Beacon Hospital has also been investing in digital innovation for better outcomes, patient safety and operational efficiency.  For instance, the hospital has incorporated IT solutions into treatment machines. Patients can verify their identify before the start of a treatment to reduce errors. Doctors can monitor remotely treatment in progress to ensure that it is being given properly.

Dato Dr Ibrahim highlighted two areas where digital technology has impacted healthcare sector. The first is care delivery via telehealth. While he sees the opportunities for growth in telehealth, particularly for follow up visit and general visit, he believes that virtual consultation has its limitations. A leading oncologist in Malaysia, Dato Dr Ibrahim is of the opinion that patient-doctor contact or in-person touch will be more effective for certain types of consultations.

The second area where digital innovation is impacting healthcare is in continuing medical education (CME) through medical events and conferences.

“Virtual medical conferences and continuing education may become a new norm”

Due to the pandemic, medical meetings, events and exhibitions are going virtual. Dato Dr Ibrahim said he attends 3-4 major international conferences a year. One of them is ESMO Congress in Europe (ESMO is the society of reference for oncology education and information). Like many other events, ESMO Congress too has gone virtual this year.

Beacon’s CSR Programmes

According to Dato Dr Ibrahim, Beacon Hospital is the first and only hospital in Malaysia offering Corporate Social Responsibility (CSR) programmes that provide financial assistance to patients who cannot afford cancer treatments. The hospital sets aside certain budget for the CSR fund. The fund aims to help underprivileged patients to receive cancer treatment.

“Over the last 5-7 years, we have spent around RM30m, benefitting hundreds of patients under our CSR programmes”

There are two types of treatment schemes – radiotherapy and chemotherapy. Patients who apply will be assessed for affordability and insurance coverage, and in some cases the treatment is fully funded by the CSR Fund. It is in essence charity work with a big heart.

Conversations with Ms. Phang Moon Leng

Rohini K

In conjunction with World Patient Safety Day (WPSD) 2020, QUASR is organising a series of interviews with healthcare leaders to share their thoughts and to join the call for action to protect and support health workers.

Ms. Phang Moon Leng is the Chief Clinical Officer of Oriental Melaka Straits Medical Centre (Oriental). Ms Phang began her career in the healthcare industry since 1991. Her wide-ranging experiences includes the administration of both medical and non-medical divisions. Academically, Ms. Phang holds a Master’s Degree in Business Administration and is a certified nursing graduatant. Moreover, she is also a seasoned expatriate, serving faithfully as healthcare administrator in various locations for many years. Upon her return to Malaysia, she joined Gleneagles Medini, Johor as the Senior Operations Manager, overseeing the licensing, commission, and operations of the hospital. Subsequently, she then moved to Parkway Pantai Holdings to serve as the Senior Nursing Quality Improvement Manager.

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In this interview, Ms. Phang speaks about Oriental’s commitment to health worker safety, a new initiative to promote a Just Culture and the need to have occupational safety and health (OSH) officers working hand in hand with infection control to ensure a safe workplace. She also shares Oriental’s experience in crisis management and the importance of emergency preparedness, not just for any pandemic but also in dealing with natural disasters.

We take this opportunity to thank Ms Phang for graciously accepting our interview request and sharing her thoughts.

Here is an excerpt from the video interview with Ms Phang

On World Patient Safety Day 2020 theme

Health worker safety is a priority for patient safety. “The theme for this year resonates with me very strongly during these tiring times as we are faced with Covid-19”, said Ms Phang. Our hospital is endeavouring to keep all our health workers safe in order for us to provide a safe environment for our patients and their families and visitors, as well as our internal clients. Given the recent uptrend in Covid-19 cases, as Malaysia sees the third wave, Oriental is giving more emphasis on ensuring health worker safety through the strict practice of safety protocols for all staff.

On patient safety, Oriental has always been focusing on the six international patient safety goals (IPSGs). However, due to the pandemic, the focus this year is mainly on infection control practices. Ms Phang shared that they recently celebrated World Patient Safety Day. Her nursing team put up a special video on IPSGs and some great posters on speaking up for safer care. The event involved clinicians, health workers, patients and their relatives and visitors. For this patient safety event, we also created our own Oriental “Safety Pledge”, said Ms Phang.

Oriental Medical’s ‘just’ culture

Oriental has started a safety culture project aimed at optimising behaviours and safety practices that will result in an improved safety culture and reinforce and support the prevention of patient harm. It is called Just Culture. “In a just culture, we encourage open reporting and participation in prevention and improvement when incidents occur”, Ms Phang explained. Her team is running a series of safety culture in services to make people aware of the importance of speaking up on safety. For instance, if staff feel that they are not being adequately provided with PPEs, they need to speak up. Human errors do occur. We should not hide errors and should be brave enough to report and address them to see how we can use errors as a way for improvement.

“Just culture also means to encourage and give recognition for speaking up, not to penalise. It is not just us leaders who should play a role; everybody should be involved”.

Setting up OSH committee to ensure a safe workplace

Having a safe workplace environment is a pre-requisite for ensuring patient and staff safety. On this, Ms Phang emphasises the need for hospitals to have OSH policies and safety officers. It is important for hospitals to set up an OSH committee to deal with safety hazards in the workplace such as chemicals, radiation and construction and renovation works on hospital facilities. Infection control looks at how to prevent the spread of infectious diseases, while a safety officer looks at the safety of the entire workplace. Both need to work hand-in-hand to create a safe working environment. Ms Phang highlights, “As leaders, we have to continuously strive to improve these two aspects of safety”.

Head-start on pandemic preparation

Due to an influenza outbreak in November and December 2019, Oriental started preparing for sufficient PPEs and closing some entry/exit doors to manage human traffic flow. When Covid-19 pandemic started in February, Oriental further enhanced the traffic flow, screening method and triaging patients, including compulsory screening of patients for OT and hospital admission. “We are also the first hospital registered and licensed to conduct screening and PCR testing”, says Ms Phang. Oriental is now a Covid-19 testing centre in Malacca, running two both PCR and antigen rapid test kits (RTK) testing. “MOH commented that we are the only private hospital to have the flow done correctly at that time”, she says.

Oriental’s experience in crisis management

Oriental is a Malaysian Society for Quality in Healthcare (MSQH) accredited hospital. Ms Phang thinks preparing for emergency and pandemic is a critical part of hospital management. “Part of the MSQH Standard – Prevention and Control of Infection Chapter – talks about pandemic preparedness as well as a disaster manual”. For Oriental, their CEO, Medical Director and safety officers were all involved in the preparation of a pandemic policy – a general policy for any type of communicable disease outbreak. “You don’t just deal with a pandemic as such, but also deal with natural disasters”. Oriental is located next to the Malacca Strait.  “This is where risk management comes in. We are located near the sea. If a tsunami or typhoon hits and causes flooding, this is what we will need to do”, said Ms Phang, referring to a crisis manual.

There was an episode of food poisoning at Oriental where several of their nursing college students were affected. With the crisis manual and risk policy, the hospital was able to quickly perform a service recovery and address the issue before public health officers arrived. The latter commented that Oriental took the right steps.

“I’m glad to say we now have a crisis manual, risk manual, pandemic policies, infection control policies and safety policies in place”

On managing health worker safety and wellbeing

In the beginning, the main challenge was to ensure there were adequate PPEs for our staff. There was a fear of our staff getting infected. It was about giving assurance to the staff, particularly the front liners, on their safety. “But after a while, we realised that mental health of our workers is another important aspect (of staff wellbeing)”, said Ms Phang.

“We are still encountering the problem of the public not understanding the importance of complying with safety guidelines while they are in the hospital”. Front liners are getting occasional verbal abuses and outbursts from patients and their relatives. This is one other source of stress, according to Ms Phang.

Front liner workers in a full set of PPE to triage patients can get very tiring and stressful. Staff who are exposed to Covid-19 patients have to undergo a 14-days quarantine and put in isolation, which is a stressful experience. To address staff health and mental wellbeing, Oriental provides food vouchers, rotates the teams, conducts debriefing sessions to hear the concerns of the front liners. “We also have a clinical phycologist onboard to give sessions on how to cope with stress”.

Digital transformation in healthcare

The pandemic has opened our minds on how to reach out and provide care to patients. Many hospitals are trying to go digitally savvy and adapt to the new norm, said Ms Phang. “I think telehealth is one of the new service delivery models many hospitals are exploring, and it is the way forward”.

However, she also cautioned that challenges remain, not only in terms of cost of investment but also the readiness of network infrastructure and internet connectivity in certain areas. Relevant policies and criteria should also be established for wider adoption, while concerns on data security need to be addressed to assure the public. At a recent digital health summit on accelerating digital transformation in healthcare, Ms Phang noted Dr Fazilah, the Senior Deputy Director of the Planning Division from MOH, spoke about revitalising the Malaysian economy, which has been badly impacted by Covid-19, by enhancing our digital technology and innovation. She is looking forward to some help from the government to support telehealth industry.

Reasons for optimism

“We have seen the creativity of our team with regards to innovation, the ability to move forward quickly with a purpose when faced with a situation such as this”.

The pandemic threatens our lives and causes anxieties. The paradox of it is that it has made us healthier and stronger in many ways. It has also helped to accelerate the changes in our behaviour as well as our healthcare delivery that hopefully will be a long-lasting journey, said Ms Phang with a sense of optimism.

Conversations with Dr Dini Handayani

Rohini K

In conjunction with World Patient Safety Day (WPSD) 2020, QUASR is organising a series of interviews with healthcare leaders to share their thoughts and to join the call for action to protect and support health workers.

Dini Handayani, MD, MARS, FISQua is the CEO of Medistra Hospital, Jakarta, Indonesia. She is a member of National Patient Safetey Committee of Indonesia Ministry of Health, International Surveyor for JCI (Joint Commission International), a member and fellow of International Society for Quality and Healthcare (ISQua), and a member of ACHE (American College of Healthcare Executive). Dr Dini is also the Ambassador of Habitat for Humanity Indonesia.

In this interview, Dr Dini speaks with a wealth of knowledge on safety culture, managing safety risks and crisis management. She also shares Medistra Hospital’s support for health worker safety and wellbeing, digital initiatives and new service offerings. At the national level, Dr Dini relates the nationwide health worker safety campaign organised by MOH Indonesia and WHO South-east Asia Regional Office; and the role of accreditation agency in developing infection prevention and control training programmes.

We take this opportunity to thank Dr Dini for accepting our invitation and sharing her thoughts and the experience of Medistra Hospital.

Here is an excerpt from the video interview with Dr Dini

What follows is an edited transcript of the virtual interview between Dr Dini and Hak Yek Tan, Founder & CEO of QUASR.


Hak: What are your thoughts on WPSD theme “Health Worker Safety: A Priority to Patient Safety”

Dr Dini: This year’s WPSD theme is a tribute to health workers around the world for their commitment in the fight against Covid-19. Many health workers especially the frontline workers, have lost their lives. We knew very little about the virus at the beginning and it was a struggle and learning process for all countries, not only in Asia but also in Europe and the US. The theme on health worker safety is very important in promoting awareness on health worker safety globally, especially during this pandemic.


Hak: How did Medistra Hospital celebrate WPSD and support health worker safety and wellbeing?

Dr Dini: We celebrated WPSD this year by acknowledging our low infection rate on Covid-19 among our staff. From February to end-October, our staff infection was below 5%. It has been a lot of hard work to maintain our safety behaviour during this time and we are very proud to achieve that. We pay tribute to our staff by giving assurance on safety and security that they will receive the safest practice in delivering services.

We give our staff the appropriate PPEs, avoid long hour shifts by adding more staff to cover for each shift especially in the Covid-19 isolation area, give vitamins and supplements to boost immunity and provide a new open-air dining room. A zoning area to treat Covid and non-Covid patients is designed to ensure a good flow of infectious and non-infectious patients. We also develop a convenient and proper staff screening flow to check their health status upon treating or exposure to Covid-19 patients. We give security and emotional support by having regular meetings with each unit to know how we could support them better.

“Health workers are our frontline assets. They need to be safe and secure first before delivering any services. Keeping them safe and secure is definitely a requirement for me”

For me and our senior management, we are being present at all times. We did not work from home during the pandemic so that our staff know we are going through this together. I think this provides a good emotional support for our staff. I’m also sending them thank you cards for always be there for us and to stay safe and health. For this WPDS, we provided treats – a pizza day – for everyone. This is one of the things we can do to try to keep up a good spirit.


Hak: What is your overall view on safety culture in the healthcare industry?

Dr Dini: I think hospitals in many countries are still struggling with safety culture. This is because a culture of safety is the core value and behaviour that come about when there is a collective and continuous improvement and commitment by the organisational leadership, managers and all health workers to emphasise on safety, among many competing roles and objectives.

Safety culture is a very big concept with numerous activities. To successfully implement this concept requires a huge driven power, starting from the Board to the CEO, senior management team, the physicians down to all the staff. Getting everyone onboard is definitely a continuous journey which usually takes a while for the organisation to change it culture.

“The first thing we need to build a safety culture is the awareness that it involves everyone in the organisation”


Hak: You are a member of the National Patient Safety Committee. Was there any national campaign on health worker safety?

Dr Dini: We had a very good campaign for health worker safety nationwide together with the Ministry of Health (MOH) Indonesia and WHO South-east Asia Regional Office.  Our campaign asks health workers nationwide to speak up and raise the issue to hospital management upon any conditions that may cause harm to hospital staff. It was a big event with numerous nationwide media coverage. We are very happy with the campaign and believe that it has created awareness for everyone, especially among health workers in Indonesia.

“With increasing number of Covid-19 cases and mortality among health workers, this is a priority for MOH and for Indonesia to wake up and speak up for health worker safety”


Hak: As an international surveyor yourself, what do you think are the roles accreditation agency can play?

Dr Dini: I think this pandemic is a good moment for us to learn new things. Accreditation agency, hospital management and healthcare professionals should work hand in hand to create impactful training programmes together. Once the awareness is already there, the accreditation agency can offer consecutive training programmes and give hospitals updated resources on infection prevention and control. This will ensure that we can learn from these good programmes on how to protect ourselves. I believe some of these have already been done nationwide by the accreditation agency.

“The need to create awareness on health worker safety starts with individuals to speak up under any circumstances of harm…this is the key to engage management to pay attention to the situation and improve”


Hak: How does Medistra Hospital manage safety risks?

Dr Dini: We manage safety risks of this pandemic from the clinical aspect and facility aspect. From the clinical aspect, we make sure that patients are given the best treatment possible to prevent mortality and complications from comorbid factors such as diabetes, obesities, heavy-smoking patients and others. Our Covid-19 management team is part of the nationwide Covid-19 management team under MOH, comprising of the most resourceful professors and senior doctors in Indonesia. Medistra is one of the private hospitals with the lowest Covid-19 mortality rate in Indonesia.

For facility risks, we add specific zoning for Covid-19 and non Covid-19 patients throughout the hospital. We have drafting facilities, hyper-filtering systems, additional areas for gowning and drafting, conduct regular high-level disinfection for all surface areas, fogging system, temperature screening camera, touchless button for lifts, ensuring the profiling and availability of PPF or all staff.


Hak: Is Medistra Hospital offering any new services?

Dr Dini: We have added new services like telemedicine, Covid-screening programme, isolation centres at nearby hotels (“fun-solation”) where customers can have other activities like fun games, sunbathing, ping-pong, billiards and watching movies. Medistra Hospitals is also the appointed Polymerase Chain Reaction (PCR) laboratory for the Presidential Office, embassies, MNCs and several prominent international airlines. There are many referral hospitals for Covid-19, most of them are government hospitals. Over time, Medistra has become the leading hospital for PCR testing in Jakarta and Indonesia. We have 6 to 8 types of PCR equipment with different levels of virus detection capabilities. Medistra is now the leading private hospital for PCR testing in Jakarta and Indonesia”


Hak: Could you briefly take us through how you responded to Covid-19 pandemic?

Dr Dini: I joined Medistra in January 2020. When the pandemic hit, the first thing I did was to set up a single communication line. Establishing a clear line of communication and solid command centre from the leadership is the key in crisis management to ensure everyone receives the same information. Following that we set up zoning areas and many other facilities were set up overnight. Overall we had a smooth and effective communication across all aspect of the hospital operation.

“A clear communication line and solid command centre is the key in crisis management”

In JCI standard, there is a chapter on Prevention and Control of Infections. There is also a specific provision on disaster preparedness where hospitals are required to develop, implement and test their emergency preparedness programmes as a response to global communicable diseases. This pandemic is a very good test for all of us on emergency preparedness. It is a learning process. In the meantime, there will be more issues and additional resources and trainings that will be required.

“This pandemic is a lesson learned for everyone and prepares us on how we should be providing healthcare services in the future”


Hak: How do you see the pandemic accelerating IT adoption and digital transformation in healthcare?

Dr Dini: Digitalisation is the game-changer as well as the opportunity for healthcare providers to gain advantage over competition. The pandemic provides the opportunity for digital transformation more than we can image. It pushes us over the boundaries of care delivery both onsite and online. Hospitals need to create an online service delivery platform to be competitive in future.

Medistra Hospital has implemented several new digital initiatives during Covid-19. We added a web-based app for Covid-19 patient monitoring connecting to our existing EMR system. Starting with screening questionnaires, to the overall monitoring of Covid-19 patient conditions online and creating dashboards for each patient.  “Medistra Hospital has implemented three digital initiatives. Namely a web-based app for Covid-19 patient monitoring, telemedicine and a breath screening app for our staff.”

The second initiative is telemedicine. In Medistra, our cases are mostly complex and chronic patients. Therefore we design our service lines to be very specific around patient needs and age sensitive-based. Our patients are mostly above 40, very loyal and choose quality over price. Patients above 60 are the most conservative to telemedicine as we know. So we offer our telemedicine services differently to be closest to the real patient feel and to provide a good customer experience.  We develop a special portable telemedicine suite-case containing digital stethoscope, portable ECGs, digital thermometer, digital blood pressure monitor, HD camera video call equipment. The suite-case is connected to our web-based data storage and EMR. All the patient information from the bar-code registration and the examination results will be automatically sent to the doctors prior to the video consultation. We deploy this portable suite case to patient’s house accompanied by our nurses. The patients will have their consultation based on real-time data just exactly as they did prior to the pandemic.

The third initiative is the implementation of breath screening application for our staff. This is in addition to the different PCR testing methods currently available.

“One of the legacies of Covid-19 is the major transformation on digitalisation in healthcare. It will outlive the pandemic. There is a lifestyle change…so I think the demand is there and people are enjoying the new normal”

On the management side, integrated telehealth comes with the capabilities of patient data gathering, AI, reporting on clinical care and enhancing workflow management. Telehealth will be a source of patient referrals in the future and offers new possibilities in care delivery.


Hak: What are the key lessons learned?

Dr Dini: We have learned from the pandemic that hospitals need to embark on their own digitalisation plans and develop online platforms to supplement their onsite services. This is the future and there is no other options. The second lesson is that we need to make behaviour choices – wearing masks, social distancing and washing hands regularly – notwithstanding “the Covid-19 fatigue”. The third lesson is strong leadership is needed to successful manage and safely navigate a pandemic such as this.