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Tag: incident reporting

Strategies For Promoting Medication Safety in Transitions of Care

Celina B

In our previous blog, we discussed how polypharmacy significantly increases medication safety risk, especially in older people living with chronic diseases. In this blog, we will discuss how patient safety is compromised in transitions of care and what strategies must be adopted to overcome it.

Transitions of care is the patient’s movement from one healthcare setting to another or home. When patients receive care at various healthcare facilities, there is a greater chance of medication discrepancies, errors, and adverse drug reactions.

At each point in transitions of care, the medication a patient was taking prior to the transition needs to be identified by medication reconciliation. Medication reviews are vital at each transition to avoid or reduce medication discrepancies.

Medication Safety during transitions of-care

Image source: Medication Safety in Transition of Care by WHO

Medication Harm Due to Discrepancies

Discrepancies or errors that are not identified and resolved may place the patient at risk of medication-related harm. For instance, adverse drug reactions often go unidentified or undiagnosed during routine clinical screening and treatment, which puts the patient at greater risk of further harm. 

 

In addition, polypharmacy, high-risk medications, or the presence of morbidity increases the risk of a patient experiencing medication-related harm at any point during transitions of care settings. 

 

Early confirmation of medication intake and timely diagnosis and management of medication-related harm is necessary to minimize patient harm. Reporting adverse drug reaction events to the patient safety incident reporting or pharmacovigilance systems is necessary to facilitate learning at organizational, national, and international levels. 

Risks Associated with Insufficient Medication Safety

Medication-related harm affects almost every patient in the transition of care. The following are the risks associated with insufficient medication safety during transitions: 

1. Medication errors

The risk of medication errors is potentially high during transitions of care. Such errors occur when a patient has been prescribed the wrong medication with the wrong dosage at the wrong time. 

2. Medication duplication

Lack of communication between healthcare providers often causes medication duplication during transitions of care. When the patient is prescribed the same medication by multiple healthcare providers, it can lead to overdose or other adverse events. 

3. Medication discrepancy

When patients are transferred from one healthcare setting to another, there is a high risk of medication discrepancy. The difference in medication regimen in new settings arises from poor communication, manual processes, patient forgetfulness, and time constraints. Medication discrepancies cause delays in treatment and increase potential harm to the patient. 

Possible Barriers to Medication Safety

Challenges to medication safety in transitions of care are divided into three categories: 

1. Patient level barriers

1.1 Competency

Competency refers to the patient’s understanding of the use of medications. Most patients don’t have enough knowledge on how to manage medications successfully. 

 

Limited health literacy compromises the ability of patients to provide accurate medication histories at the time of hospital admission. Such inaccurate medication history leads to medication discrepancies. 

 

Moreover, patients and family members also find it hard to understand the discharge instructions. It is because of their educational level, or they may be too reluctant to ask questions. 

1.2 Insufficient engagement between patients, caregivers, and physicians

Lack of involvement of patients and caregivers with physicians during transitions compromises the quality of care. For instance, the patients and caregivers may not provide a comprehensive patient history to the physicians, which is necessary for making the right diagnosis. Additionally, they may not ask appropriate questions from healthcare practitioners regarding patient conditions. 

 

Similarly, physicians may forget to provide adequate information on the patient’s condition and care, which leads to confusion and medication errors that put the patient at risk. 

2. Health system-level barriers

2.1 Lengthy and confusing discharge paperwork

The lengthy discharge forms of hospitals complicate communication, decrease treatment compliance, increase the risk of discrepancies, and compromise patient safety. It is because written discharge instructions are long and hard for the patient and family to understand. Patients who don’t understand their medical discharge instructions will not stay compliant, which can lead to unfavorable outcomes.

2.2 Inadequate time to give health education

Limited time is another important system-level barrier. Generally, hospital staff doesn’t have sufficient time to thoroughly discuss discharge instructions with patients. When the staff cannot educate the patients, it causes confusion and compromises the quality of care.      

2.3 Poor coordination between transitions

Poor communication and coordination between transitions of care negatively impact patient safety. It occurs when different practitioners and healthcare settings are not communicating or coordinating effectively to ensure continuity of care. This can result in medication errors, unnecessary treatments, adverse medication reactions, and other serious complications.

2.4 Inadequate Workforce

Lack of workforce in healthcare settings is another cause of compromised care during transitions. When healthcare providers are overloaded, they are not able to provide necessary care coordination and follow-up services for successful transitions of care. Moreover, chances for errors to occur are high, which can cause delays in diagnosis and treatment.

3. Practitioner level barrier

3.1 Lack of communication between physicians

Poor coordination and communication among healthcare providers are commonly seen in hospital setups. It is because different physicians visit at different times and add discharge orders without even interacting with each other. This inadequate transfer of information in transitions of care puts the patient’s safety at risk and compromises care.

3.2 Poor medication reconciliation

Poor medication reconciliation during transitions of care increases the risk of medication errors, medication duplication, delays in treatment, and increased healthcare costs. It usually occurs when healthcare providers are not aware of the complete and accurate medical regimen of the patient. And they end up prescribing medication that can lead to complications and hospital readmissions. 

Potential Solutions for Ensuring Patient Safety in Transitions of Care

Optimizing patient safety as they navigate various healthcare settings is crucial. 

The following strategies should be considered to optimize medication safety at transitions:

1. Improving information management

Effective information exchange is vital for patient safety. Healthcare facilities should improve the information management process by simplifying discharge forms and introducing e-script. For instance, the discharge forms should be very simple, written in lay terminology, and organized with separate categories so the patients can easily read and understand the information. Similarly, the use of e-scripts should be established to overcome meditation discrepancies. When electronic prescriptions are sent to pharmacies, it will reduce the risk of medication harm. 

 

Health systems should switch to centralized electronic health records (EHRs) for a long-term change. It keeps the physicians connected, allows seamless transfer of information, and minimizes the risk of errors at transitions of caregivers.

2. Medication reconciliation

Healthcare professionals should be trained for proper medical reconciliation. In this process, healthcare professionals work closely with patients and their family members to ensure that complete and accurate information is transferred consistently across care transitions. 

 

Effective medication reconciliation allows caregivers to avoid hazardous drug combinations, dose changes, duplications, and adverse events. It also reduces its reliance on patients’ recall abilities and allows easy analysis of medication information for better management decisions.

3. Increase engagement between patients, caregivers, and physicians

Improved communication between patients, caregivers, and physicians is critical for reducing the risk of adverse events. 

 

Healthcare professionals should fully inform the patients and caregivers about the patient’s condition, treatment options, and expected outcomes. When the healthcare team involves patients and caregivers in the treatment process, it develops trust and makes it easier for them to communicate. As a result, they are more likely to follow the treatment plan as prescribed.  

4. Incorporating an incident reporting system

Healthcare facilities should set up an incident reporting system to ensure patient safety during transitions of care. It is designed to strengthen existing organizational processes by automating incident management workflow, performing risk assessment, providing real-time analytics and insights, and resolving incidents related to patient care.

The incident reporting system allows healthcare providers and organizations to track and report incidents related to patient care during transitions and enables them to take proactive steps to address the issue before it results in adverse events. It also helps identify areas that require improvement to ensure better patient outcomes and increased efficiency in transitions of care. 

By incorporating an incident reporting system, providers can provide valuable information that can be used to identify patterns or common causes of medication errors. 

It also allows for: 

    • ● Early identification of potential safety issues: Through a reporting system, healthcare professionals can identify the possible issue and risk factors leading to medication errors. It enables them to take quick actions to avoid future errors and ensure patient safety.  

    • ● Root cause analysis: Incident reporting systems work efficiently for conducting root analysis of the underlying cause of medication-related errors. This information helps in making targeted interventions to prevent future events which put the patient at risk. 

    • ● Quality improvement: With incident reporting systems, healthcare providers can get instant reports on their performance aimed at improving medication safety. It allows them to track their interventions’ effectiveness, evaluate their efforts’ impact, and make adjustments as needed.

    • ● Compliance: Incident reporting systems can be used to demonstrate compliance with regulatory requirements related to medication safety, such as The Joint Commission’s National Patient Safety Goals.

5. Improve coordination between different transitions of care

Coordination between transitions of care is essential for positive health outcomes of patients. It eliminates the risk of medication errors, discrepancies, and adverse events. When patients receive consistent and appropriate care throughout different stages of healthcare, it can prevent hospital readmissions and unnecessary treatments. So, physicians, specialists, nurses, and other healthcare professionals should work together to provide comprehensive and coordinated care to patients. 

6. Workforce planning

Effective workforce planning is critical for the quality of care of patients. When there is adequate staff during different stages of the healthcare journey, the patients will receive appropriate and consistent care. This results in better treatment and reduced medical costs. So, healthcare settings must identify the number of healthcare staff required to meet the demands of patients.

Conclusion

Patient safety during transitions of care is a critical concern for the healthcare industry. To overcome this challenge, a multi-faceted approach is required where organizations, practitioners, and patients must work together to ensure smooth transitions. Healthcare organizations should optimize and establish clear protocols for medication management to avoid medication-related harm. An electronic system must be incorporated to improve communication among patients and care providers. 

 

Additionally, patients should be educated about their rights and responsibilities toward their medications. All these approaches will help to reduce the risk of medication errors and improve patient outcomes. 

 

Are you planning to incorporate an online incident reporting system to improve patient care? QUASR is a robust incident reporting system, which makes it easier for healthcare settings to identify, investigate, and manage risks by implementing corrective actions.

 

Book a demo to learn more about medication reporting in QUASR.

Request Demo of QUASR

Incident Reporting in Healthcare: A Complete Guide (2021)

Abishek Goda

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

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


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

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


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


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

What Does Incident Reporting in the Healthcare System Means?

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

Prof Liam Donaldson (WHO Envoy for Patient Safety)

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

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

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

When To Write Incident Reports in Hospitals?

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


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

Let’s consider these situations:

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

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


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

 

Purpose of Incident Reports

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

1. Root Cause Identification

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

2. Policy and Process Improvements

 

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

 

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

3. Clinical Risk Management

 

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

 

4. Continuous Quality Improvement (CQI)

 

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

 

5. Better Training and Continuous Learning

 

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

 

Different Types of Incident Reporting in Healthcare

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

1. Clinical Incidents

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

For example—

● Nurse administered the wrong medication to the patient. 

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

2. Near Miss Incidents

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

 

For example—

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

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

 

3. Non Clinical Incidents

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

For example—

● Misplaced documentation or documents were interchanged between patient files. 

● A security mishap at a facility.

4. Workplace Incidents

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

 

For example—

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

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

 

Who Prepares Incident Reports in Healthcare Facilities?

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

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

incident-reporting

Critical Components of Incident Report

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

1. General Information

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

2. Location of the Incident

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

3. Concise yet Detailed Incident Description

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

4. Type of the Incident

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

5. Information of all Parties Involved in the Incident

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

6. Witness Testimonies

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

7. Level of Injury

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

8. Follow Up

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

9. Reviews

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

10. SBAR

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

11. Risk Scoring

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

12. Investigation Information

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

13. Root Cause Analysis

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

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

14. Contributing Factors

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


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

15. Executive Summary

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

Benefits of Hospital Incident Reporting

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

1. Preventive Measures

 

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

 

2. Disease Monitoring

 

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

 

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

3. Cost Reduction

 

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

 

4. Enhanced Patient Safety

 

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

Healthcare Incident Reporting Challenges

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

1. Paper-based Reporting

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

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

2. Underreporting

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

 

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

2) Fear of repercussions from colleagues or seniors.

 

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

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

3. Busy Schedule

 

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

Conclusion

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

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


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

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


Meanwhile, feel free to contact us for further information!

Under-reporting Patient Safety Incidents: A Real Problem

Hak Yek Tan

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 organizations in today’s day and age where an employee is penalized 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. Organizations 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 organizations 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 organization 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 digitalized. 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 realize the value of their contribution.

Insufficient Trainin 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, organizations 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 organization 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 user interface 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!

An Introduction to QUASR Basic

Abishek Goda
Basic-Features-Banner

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

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

QUASR Basic is Lite with an automated workflow

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

BASIC targets single/independent hospitals, which are:

 

1) accustomed to having a system in place.

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

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

 

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

 

What do we mean by a workflow anyway?

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


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

There’s more to QUASR Basic compared to QUASR Lite

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

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

 

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

QUASR Basic vs QUASR Premium

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

 

But how does Basic compare to Premium?


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


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

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

Why should you keep your process simple

Abishek Goda
simple incident process

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

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

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

Legacy System Hangover

Systems that were built at least a decade back qualify as legacy systems. Any reasonably newer system might not have the issues that we are going to discuss here. For newer systems, the IT team was likely asked to implement their manual process as is! In software circles, there is an inside joke – “some unexplained bugs are actually features.”.

On a more serious note, systems that were implemented a long time back don’t fully take advantage of all the technological developments of recent times. Some of their design decisions could have been technology driven rather than user driven simply because it would be prohibitively difficult to implement differently.

A newer system built on more recent technologies doesn’t suffer from the same limitations. And hence it is possible to achieve more elegant solutions or workflows than wasn’t possible in a legacy system. That said, if we carried forward the legacy system as is, we might not fully utilize all the enhancements that technology offers us.

Mapping Manual Process to Digital Process

Since many of our customers are implementing their first digital system for incident management, this is the typical set of issues we face while onboarding and customizations. Many things we do manually, do not scale well to digital systems as such. And we all have seen examples of this: have you ever tried to collect all people interested in paying for a gift to a colleague? We send out an excel sheet and each person returns a sheet of their own and we merge them manually?

That’s exactly what we’d do before emails. We’d just go person to person, find out if they’d contribute and write it down in a piece of paper. But we all do know how inefficient that is, right? If we have to do the same thing today, we should probably set up a google form that each of the participant fills out and you get an excel sheet at the end of it. Same data is collected but far less work needs to be done by the person trying to collect it. The second option is a more digital native way of solving that problem. Incident management, incidentally, is full of such problems.

A typical example we often get as a customization request is to include additional workflow steps: include HoD as part of the workflow. Yes, we understand why you’d want to do that. But in many cases and as many of our customers agree too, this step is an FYI for the person involved. In a manual system, the HoD had no way of knowing what was happening unless you intentionally ran things by them. But digital systems aren’t really like that. Online systems are even lesser so. You’d just need to notify them in these cases.

In QUASR, we solve this problem by automatically having HoDs in the loop for all incidents in their department. You don’t need to do this additionally. However, we do not notify them every single time. EMail based notifications have become so common that we mindlessly mark things to read or archive them even without reading them. And we do not want to add to the inbox clutter either. So the HoDs just have to login periodically and they’d be updated on all the active incidents in their department. But unless we explain this, most of the users don’t see the solution. They are wondering how to implement an additional step in the workflow because that’s what they do in the manual flow.

Another example is typically around data collection fields. Many clients request adding quite a few descriptive fields whereas these aren’t very useful for systematic analysis. Descriptive data necessitates quality managers or investigators to spend time reading and understanding much information. But there is another downside: lack of sufficient information. Some people can describe an incident in vivid detail while others tend to write very little. Situations like these can be avoided by collecting quantifiable, standardized data instead. This, too, is an artifact of using paper based forms.

In paper based forms, it is impractical to collect incident type specific information for every incident type we want to track. So we end up with a few generic descriptive boxes for the users to fill up. However, adopting the same to a digital system does not allow you to utilize the full power of a digitalized solution.

Adopt Digitally Native Solutions

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

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

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

Hak Yek Tan

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 14-day free trial here.

Digitization – A Pathway Towards Digital Transformation

Hak Yek Tan
Digitization-vs.-Digitalization-Banner

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 for a 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 be 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 a 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: Digitalization 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 Digitalization

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 is 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, digitized 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

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, digitized 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.

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 & Digitalization — Digital Transformation

Digitization was started around 25 years back when computer systems became 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 will 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

Hak Yek Tan
paper digital system

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

 

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.

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 identifying 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 go 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.

A brief introduction to QUASR Lite

Abishek Goda
quasr-lite

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

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

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

What is QUASR Lite?

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

Want to know how it works? QUASR Features 

You could very well do the same with an excel sheet. And we would have to agree. But the main advantage Lite brings to you over vanilla excel sheets is that: we have thought this one out for you. We have built it specifically for hospital incident scenarios. We consolidated our experience working with many hospitals and created a starter tool that will grow with you as you mature to bigger and more involved processes.

Who is QUASR Lite for?

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

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

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

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

Join the community

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

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

Check out more features of QUASR Lite.

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

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