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      DHL PARTNERS WITH ORIGAMI RISK FOR AN AWARD WINNING IMPLEMENTATION THAT
      DRAMATICALLY IMPROVED CASUALTY AND CARGO CLAIMS OPERATIONS AND PROMOTED A
      CULTURE OF SAFETY
      
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Blog Post


HOW HOSPITALS CAN INCREASE PATIENT SAFETY EVENT REPORTING

Suites:
Healthcare
Industry:
Healthcare
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Adverse safety events—some that lead to serious harm—occur every day, affecting
people across entire health systems. With a full schedule of patients and
life-or-death situations a part of daily life in hospitals, reporting efforts,
not surprisingly, may end up taking a back seat. The ability to collect and
analyze this data is crucial for preventing future incidents and improving
patient safety.

Yet, according to a 2008 study, “only 13% [of U.S. hospitals] have broad staff
involvement in reporting adverse events.” Sometimes, however, the issues that
impact reporting run deeper. Hospital staff may fear repercussions from
reporting safety events. In other instances, the reporting process may be so
convoluted and time consuming that, despite good intentions, staff is
discouraged from doing so. Or maybe, the biggest issue comes after reporting,
with hospitals failing to share or apply healthcare analytics in a way that
positively impacts the quality of care provided and makes staff feel a part of
something bigger.

No matter the reason, any issue that negatively impacts patient safety event
reporting has consequences for every person associated with a hospital or health
system—especially the patients. In fact, the ECRI Institute listed
“standardizing safety efforts across large health systems” as one of the top 10
patient safety concerns for 2019. Even events that seem minor have the potential
to result in grave harm. The Joint Commission reported medication error and
product and device events in the list of top 10 most frequently reported
sentinel events in hospitals in 2018.

To address this issue, the Patient Safety Network’s Patient Safety Primer says
every reporting process should have the following attributes:

 * Institutions must have a supportive environment for event reporting that
   protects the privacy of staff who report occurrences.
 * Reports should be received from a broad range of personnel.
 * Summaries of reported events must be disseminated in a timely fashion.
 * A structured mechanism must be in place for reviewing reports and developing
   action plans.

By instituting a cultural shift and implementing an easy-to-use healthcare risk
management system with reporting, automation, and healthcare analytics
functionality, hospitals can boost staff reporting and see life-changing results
for their patients.


CREATE A POSITIVE SAFETY CULTURE

The process of patient safety event reporting often carries a negative
connotation. As former British Health Secretary Jeremy Hunt said at the 2018
World Patient Safety Summit in London, “People are terrified that if they're
open about what happens, they...might get fired by their hospital, and it'll be
bad for the reputation of their unit and their trust.”

Switching from a negative reporting culture to a positive one is essential. This
means, Hunt says, “moving from a blame culture to a learning culture so doctors
and nurses are supported to be open about mistakes rather than cover them up for
fear of losing their job.” Here are a few steps hospitals can take to enact this
cultural shift:


INVOLVE EXECUTIVE LEADERSHIP

A cultural shift must start at the top. The EHS Today article The Risks of Using
Injury and Illness Reporting as Measurements of Success says hospital leadership
should reexamine their existing patient safety programs to make sure they’re not
incentivizing non-reporting, prohibit retaliatory actions against staff who
report incidents, and provide training to workplace leaders to communicate these
compliance measures.

Then they must show—not just say—that they’re fully invested in the incident
reporting process. Rahul Shah, MD, vice president, chief quality and safety
officer at Children’s National Health System in Washington, D.C., provides a
good example. “Staff members also know their incident reports are being reviewed
at a senior executive level,” he told Health Leaders Media. “I read every
incident report in the organization. I made that pledge about three-and-a-half
years ago, when we had 4,000 incident reports. I still stand by that pledge when
we have 11,000 incident reports.”

Senior leadership can also demonstrate their involvement through executive walk
rounds (EWR). These weekly visits to different teams throughout the hospital
allow them to ask staff about patient safety events, near misses, and any
factors that may have led to adverse events. OSF St. Joseph Medical Center in
Bloomington, Illinois, uses the WalkRounds™ concept, sending on-the-ground
information directly to the highest levels of leadership for increased awareness
and strategic planning.


PRIORITIZE TEAMWORK TRAINING

Hospital staff who know how to work well together and communicate effectively—in
both routine and challenging situations—are more likely to raise concerns and
report incidents. As the Patient Safety Network states, such training “focuses
on developing effective communication skills and a more cohesive environment
among team members, and on creating an atmosphere in which all personnel feel
comfortable speaking up when they suspect a problem.” The Veterans
Administration implemented a teamwork training program called Medical Team
Training in 43 of its hospitals. A follow-up study showed a dramatic reduction
in mortality within surgical units that had undergone the training compared to
those that hadn’t. The VA found that the team-focused culture brought about by
the training was essential to improving safety.


SHIFT TO A NEAR MISS FOCUS

An important component of making the mental shift from negative to positive is
viewing patient safety reporting not as tracking errors, but as collecting data
to inform measures of improvement. Known as leading indicators, these pieces of
data are necessary for informing change and preventing future incidents.

In a hospital setting, near miss reports make exceptional leading indicators.
However, a 2017 study in the International Journal for Quality in Health Care
about attitudes toward incident reporting states that hospital staff are more
likely to report severe events than near misses, at an odds ratio of 1.78.
Hospitals must encourage near miss reporting by stressing how capturing this
healthcare data is essential for harm prevention and meaningful change. As
discussed in How to avoid the new OSHA culture penalty:

“If near miss reports help identify preventable future incidents, then those
reports have a beneficial value (instead of a punitive one). This incentivizes
more reporting, since additional data points (near miss incidents) increase the
potential of finding new root causes.” Without leading indicators, without near
miss data, growth culture is impossible. Former health secretary Hunt puts it
this way: “A thousand worries prevent the one thing that really should be
happening, which is proper learning from that mistake and a proper attempt to
make sure it can never be repeated.”


ESTABLISH TANGIBLE BENCHMARKS AND REWARDS

The article 10 steps for improving your hospital’s safety culture points to
staff recognition as a key way to establish a positive safety culture. The
article suggests that leadership “[r]egularly acknowledge those who identify
unsafe conditions or make excellent suggestions to improve care processes, and
share this information widely.”

To put this type of approach in place, Children’s National Health System in D.C.
developed its own comprehensive program of positive reinforcement, called 10,000
Good Catches. As noted in Overcome 3 Challenges In Hospital Incident Reporting,
hospital leadership celebrated staff for reporting incidents and near misses
through “one-on-one outreach, naming a monthly Reducing Harm Hero, and the
awarding of ‘Zero in on Zero Harm’ pins.”


SIMPLIFY THE INCIDENT REPORTING PROCESS

A major part of increasing patient safety event reporting comes down to
simplifying the reporting process itself. The urgent nature of doctors’ and
nurses’ jobs means stepping away isn’t always an option, leading them to
overlook reporting. An overly complicated, time-consuming, and restricted
incident reporting process further decreases the likelihood of reporting. So
although having a healthcare risk management system at all is a great first
step, hospitals will see a real boost in reporting by going a step further and
implementing one that streamlines and simplifies the process.

The right healthcare risk management software should allow for:

Increased efficiency

Many hospital incident reporting processes involve far too much manual data
entry—and too much muddling through long forms that contain questions not
applicable to a staff member’s specific unit or department. This takes up time
and leads to distracted, rushed, and inaccurate reporting. A healthcare risk
management system with configurable incident reporting forms that include
elements such contingent questions, drop-down lists for code selection, and
dynamic field population can reduce data entry errors and cut down on the amount
of time staff is away from patients and other urgent matters.

Options for submitting reports

Anonymous reporting offers both benefits and challenges. Making an incident
report anonymously can remove some fear of blame, which can lead to more
healthcare data and more honest healthcare data. But given the personal nature
of the staff-patient relationship in hospitals, employees may, conversely,
prefer direct involvement in the progress of an incident they have reported.
Staff at the U.S. Department of Veterans Affairs, for example, “are asked to
report safety events to their facility's patient safety manager. The employee
who makes these internal reports remains ‘identified’ until the root cause
analysis is completed so that the employee can be notified of and comment on the
findings.”

The Federal Aviation Administration has a reporting system that asks employees
to identify themselves upon submitting an incident so they can be contacted in
the event that more information is needed. But “the reports are subsequently
‘de-identified,’” protecting employees’ anonymity until that time. Origami
Risk’s incident reporting functionality has the option for making a report known
or anonymous, giving hospital staff options based on their personal preference.

Accessible reporting

To increase reporting, hospitals can benefit from a healthcare risk management
system with broad accessibility. Origami Risk’s healthcare risk management
software allows for reporting via an intranet portal on desktop or via mobile
device. This allows staff to capture healthcare data when and where a patient
safety event occurs, adding convenience and increasing accuracy. Furthermore, as
stated in How to create a successful and sustainable near-miss culture, “The
ability to input incident and near miss data while in the field can be a
critical part of the process...Mobile reporting reduces lag time and helps
investigations begin faster.” The sooner an incident gets reported, the sooner
that data can lead to patient aid and organizational change.


IMPROVE HEALTHCARE ANALYTICS AND COMMUNICATION OF INCIDENTS

To increase patient safety event reporting, hospitals must be equally proactive
after incidents are reported. This means alerting the necessary parties,
strategically analyzing aggregated healthcare data and, finally, sharing the end
results with staff. According to The Patient Safety Primer, however, many
hospitals do none of the above. The error management study referenced above
notes that “most hospitals surveyed did not have robust processes for analyzing
and acting upon aggregated event reports” and only “20–21% [of hospitals] fully
distribute and consider summary reports on identified events.”

This discourages employees from reporting in the future, as they see no evidence
that doing so makes a difference.

Hospitals can make following up on reports a priority by:

Setting up automated alerts/messages

The first step in developing real change comes by alerting key parties after a
patient safety incident has been reported. The article How to create a
successful and sustainable near miss culture states, “The worst-case scenario is
near miss reports that appear to go into the organizational black hole, never to
be seen or heard about again.” With a healthcare risk management platform like
Origami Risk, hospitals can set up rules-based automation that fires off alerts
and messages to the appropriate people for swift action and increased
accountability.

As an incident report progresses, the employee who reported the event in the
first place can receive automated updates. After the data undergoes healthcare
analytics (see below), the same employee can see how exactly his or her incident
report helped move the needle. As the Patient Safety Primer says: “Failure to
receive feedback after reporting an event is a commonly cited barrier to event
reporting by both physicians and allied health professionals.”

Using healthcare analytics

With automation—and automated communication—in place, hospitals can set their
sights on the bigger picture. They can effectively turn data into insight,
analyzing the incidents in order to see trends and spot outliers. Origami Risk
uses several root-cause methodologies—including fishbone, RCA2, and the 5
whys—to help make better strategic decisions and enhance program quality.

Sentara Norfolk General Hospital in Virginia recognized the importance of
healthcare analytics in creating organization-wide change. One of the four
strategies it has adopted to improve patient safety is:

“Improve the staff's ability to conduct timely and rigorous ‘root cause
analysis’...of major safety events, such as by identifying the common
contributing causes of a series of events, so that these analyses identify
long-lasting, systems-oriented change.” When hospitals are able to dive deeper
into data and implement corrective actions that bring about noticeable
change/improvement, staff see the full impact of their reporting activity. As a
result, they are encouraged to continue contributing to a patient safety and
learning culture.


ORIGAMI RISK’S HEALTHCARE RISK MANAGEMENT SOFTWARE HELPS ENCOURAGE PATIENT
SAFETY EVENT REPORTING

Increasing incident reporting is no small feat. The key lies in a cultural shift
that starts at the top and makes its way through the entire organization. This
can be paired with healthcare risk management technology that’s capable of
streamlining the incident reporting process, communicating report details to the
appropriate people, and using healthcare analytics in a way that leads to
noteworthy change. Origami Risk’s flexible, simplified healthcare risk
management software delivers the best-practice tools you need to see an increase
in reporting and an improvement in patient safety.

Find out how Origami Risk’s healthcare risk management software can help your
organization increase its patient safety event reporting.


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