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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.

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.

 

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.

7 Essential Patient Safety Tools

Hak Yek Tan

Going Back to Basics

Simple and easy to use tools can bring surprising insights and amazing results. Most healthcare professionals especially safety and quality officers are familiar with and use them during their day-to-day work. Yes, we are talking about essential patient safety tools and techniques that ensure the delivery of safe and reliable care. These tools are the foundation of your hospital’s patient safety practices.

This article looks at 7 essential patient safety tools that are commonly used by hospitals and other healthcare settings. Most of the tools are simple and easy to use practical hands-on techniques. These essential tools are effective and provide a structured and systematic approach to improving patient safety. From fostering a culture of safety and teamwork, understanding the problems and bottlenecks, identifying root causes and areas for improvement, to proactively predicting and preventing failures, the toolkit can bring about sustained improvements. It is your companion in patient safety.

Listed below are 7 essential patient safety tools for your toolbox. You will find a short description for each of the tools, when to use them, how they work and in what way they help to improve patient safety. A general guide on tool selection for specific scenarios is provided for quick reference.

 

7 Essential Patient Safety Tools and Techniques

1. Safety Huddles

A short meeting involving multidisciplinary care team members at the start of a workday or shift to focus on care coordination identify safety issues and flag concerns. It is an effective and efficient way for healthcare teams to review performance, share information and enhance team communication. In the process, it helps to build a culture of safety and teamwork.

2. SBAR (Situation-Background-Assessment-Recommendation)

This is an easy-to-use, structured form of communication that enables information to be transferred accurately between individuals. It helps you to formulate your thinking and convey information clearly and by doing so prevent miscommunication. SBAR is particularly effective in communication across different disciplines and between different levels of staff.

 

3. 5 Whys

This is a simple yet effective tool used to identify the root cause of a problem by repeatedly asking the question “why” 5 times. It helps us to truly understand a problem and get to the root cause. No statistical data required. This tool allows you to focus your resources on the right area, solve the true cause of a problem, and not just its symptoms.

4. Action Hierarchy

Action Hierarchy tools help to determine the strengths of the action by levels or categories. The outcome of an investigation and root cause analysis is often a set of recommended actions (hence RCA2).  This tool will assist the team to identify corrective/preventive actions that will give the biggest impact and greatest results.

5. Cause and Effect Diagram

Also known as Ishikawa Diagram or Fishbone Diagram, this tool helps your team to explore the many causes contributing to a certain effect and graphically displays the relationship of the causes to the effect or outcome. It is a commonly used tool to help identify areas for improvement. Causes are typically grouped under 5 categories, namely People, Methods, Materials, Equipment, and Environment.

6. Process map

A process map or flowchart is a graphical representation of the sequence of steps and how things get done in a process. It helps your team to visualize and have a clear understanding of current processes – an important first step to help identify problems, inefficiencies, and areas for improvement. Common symbols are used so that the flowchart is easily understood by everyone.

7. FMEA

FMEA is a tool for conducting a systematic analysis of a process or product to identify and prevent the problems before they occur. It prompts your team to proactively review and evaluate what could go wrong (failure mode), why failures happen (failure causes), and the consequence of failure (failure effect).  Improvement plans can then be carried out to prevent those failures. The focus of FMEA is to proactively identify potential risks and their impact, prevent failures and make the system more resilient.

General Guide on Tool Selection

Look for opportunities for safety improvement or launch new safety improvement programs in your hospital. Set your patient safety goals and objectives. Use the following as a general guide to select the appropriate tools.

Source: Developing a safety culture, building teamwork and enhancing communication – Safety Huddles, SBAR