A children's hospital has more than doubled its number of submitted incident reports, overcoming challenges such as employees' fear of retaliation for reporting.
Over a three-year period, Children's National Health System in Washington, D.C., more than doubled the number of incident reports filed by employees, creating opportunities to improve quality and safety for patients.
"If we don't know what's going on in our organization, we can't improve," says Rahul Shah, MD, MBA, vice president, chief quality and safety officer. "Any organization that fears increased reporting is missing the boat."
A research study about the incident report initiative was recently published in Pediatric Quality & Safety. Data in the study quantify the achievement at Children's National as follows:
- 2014 safety event reports totaled 4,668
- 2017 safety event reports totaled 10,971
- Report submission time was decreased by nearly 30%
- Number of submitting departments increased by 94%
- Anonymous reporting decreased 69%
Overcoming 3 Challenges
Before Children's National, which features the Sheikh Zayed Campus for Advanced Children's Medicine with 316 inpatient beds, doubled their incident report numbers, they identified three incident report challenges that it needed to work through to achieve the goal of improving quality and safety for its patients.
"What we realized is we had to improve technology, we had to change the culture so it was safe to report, and we had to show reporting made a difference," Shah says.
- Improve technology
To ease reporting through improved technology, Children's National rolled out mobile reporting with an app-based platform and optimized the platform with specific reporting categories such as falls and compliance. In another effort to save time, the number of mandatory fields in the reporting templates was reduced.
The technology upgrades have made it easier to submit incident reports, helping to cut submission time from 12 minutes to 7 minutes, Shah says. "That's a big 5-minute time saving for a clinical nurse or respiratory therapist who is busy."
- Change organizational culture
Creating a culture where employees feel safe to submit incident reports is a significant challenge, Shah says.
The decrease in anonymous reporting reflects well on efforts to assuage fear of making a report, he says.
"People will say they are making an anonymous report out of fear and to avoid retaliation. We worked on that aspect of our culture. We believe the decrease in anonymous reporting is a surrogate for our culture improving," he says.
Shah continues, "We adopted the concept of a just culture, where everyone in the organization gets treated in the same way. We partnered with human resources to ensure that we embodied, espoused, and showed employees that we had a just culture."
Children's National also adopted a positive philosophy for incident reports, he says.
"Many organizations call these documents incident reports. We call them safety reports, which takes away a pejorative and negative connotation. The whole initiative was called 10,000 Good Catches and when people make good catches, we celebrate them," Shah says.
Other efforts to gain trust and reporting participation from Children's National staff have included one-on-one outreach, naming a monthly Reducing Harm Hero, and the awarding of "Zero in on Zero Harm" pins.
Staff members also know their incident reports are being reviewed at a senior executive level, Shah says. "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."
One of Shah's subordinates also reads all incident reports, as does the chief risk officer and a deputy. "Everyone in the organization knows that when they file an incident report, at least four leaders will look at it," he says.
- Show reporting makes a difference
Showing employees that their incident reports make a difference also can be challenging. But Shah cites two examples of incident reports that led to significant quality or safety improvements.
Example 1: Code Simulation Program
In one instance, a patient required resuscitation at a Children's National satellite clinic. "That is pretty much all the incident report said," Shah says.
Based mainly on the incident report, Children's National decided to spread its emergency code simulation program from the main hospital to the satellite clinics. The simulation program focuses on cardiac arrest and other resuscitation emergencies. Children's National subject-matter experts developed the program, which is also staffed internally.
Shah believes the new code training has saved at least one life.
"Six months later, a child was having a seizure in one of our satellite clinics, turned blue, and needed resuscitation. It took EMS about 10 minutes to get to the clinic. By the time EMS arrived, the child was intubated, stabilized, and properly coded."
Example 2: Safe Restraint Techniques
Another example of incident report impact involves behavioral health patients.
"One area that hospitals all over the country struggle with is behavioral health and violence in those patients. We had a safety event report regarding violence toward staff from behavioral health patients," Shah says.
Several safety changes were adopted, he says. "From that safety event report, we asked, 'How can we keep our staff safe?' Now, we have training. We have Kevlar sleeves for our employees to use. We have different techniques for restraining patients."
National Children's incident report initiative has far exceeded Shah's expectations.
"To see those 11,000 reports come in, they are almost changing in front of my eyes. I'm seeing them getting rich with information and opportunities for improvement. People are trusting me and the organization, and they know we have their back," Shah says.
Christopher Cheney is the CMO editor at HealthLeaders.