Maximize Incident Management Participation: Train for Success
Who’s accountable for capitalizing on quality improvement and patient safety opportunities in your healthcare organization?
- The Quality Improvement Director
- The Chief Nursing Officer
- All of the above
- None of the above
Modern methods of shared accountability for healthcare quality improvement carve out a role for everyone in effecting positive change, making 5 the correct choice. Like the “see something, say something” campaign that Homeland Security uses to build awareness and to educate the public about the importance of reporting safety issues, in healthcare clinicians, staff members, and even patients and visitors participate.
Often a part of a Just Culture program, incident management is one such method of shared accountability. It’s defined as a process to collect data on incidents and near misses, analyze and report on the information, and learn from the events toward the goals of greater patient safety and quality. Incident management in action might mean tracking a reported patient complaint through analysis to outcome. Alternatively, it can be used to identify when equipment, processes, or policies fail/are not adhered to and may require revision. All could or should be able to be reported anonymously.
Incident management is a potentially powerful improvement tool, but it can’t succeed without participation at all levels. To make it successful, train all parties—administration/management, clinicians, staff, and patients—on how it works. The goal is to develop a robust program that encourages everyone to report incidents, near-misses, and errors in a blame-free environment.
Cultivate trust with participants
Even if incident reporting and management is a regulatory requirement and a factor in satisfaction scores that affect reimbursement, how your organization does it is a cultural choice. Creation of a learning organization where staff feel safe to speak up requires transparency, trust, and follow-through. Likewise, reflection of your hospital or health system as one that patients can count on for safety and quality requires confidence built upon trust—and you must earn it every day.
Historically, healthcare organizations held individuals accountable for mistakes, often in a punitive environment. Outmoded patient safety models assume that an organization’s policies and procedures are properly constructed, understood by all, and that incidents occur where and when systems fail or people break from policy. They gathered patient input, but not proactively or in meaningful ways weighted equally with feedback from inside the organization.
Today, we understand the value in models of shared accountability and realize that multiple system factors cause incidents or errors. In other words, organizations are responsible for the systems they design and for their responses to the actions of clinicians, staff, and patients. Meanwhile, individuals are accountable for the choices they make, including reporting (near) incidents, as well as speaking up about larger systemic problems or failures they see. Patient safety initiatives like Safety-II recognize that issues often overlooked in the design of the organization's policies and procedures cause most preventable incidents.
Use role-based training
A structured approach to incident management that includes ongoing training is a good start. But consider taking it a step further with role-based training. Keep participants informed and focused on taking the steps pertinent to their role in the incident management program. Organizations such as the Agency for Healthcare Research and Quality (AHRQ) provide “train the trainer” toolkits to create or supplement your organization's program.
Tier 1 trainees
While everyone participates in incident management, it’s an approach uniquely designed to aid the front-line quality and nursing leaders ultimately responsible for capturing incidents and near incidents as they occur. The individuals in this group maintain oversight of incident reporting, management, analysis, and improvements. They’ll lead organization-wide training by department or other means, electronically (e.g., self-driven online training) or in-person. Their role should be extensive and include:
- Regular policy and procedure maintenance. Policies should define what’s reportable and identify who should initiate incident reports. They should describe how and when to report potential claims to facility administrators and the insurance company, especially when claims require investigation. In addition, policies should contain a timeline for reporting and follow-up with all parties involved.
- Compliance and legal guidance for others. Train tier 1 staff on precautions such as maintaining only one copy of each report (preferably electronic), and avoiding tying an incident report to a medical record. Educate about the importance of incorporating patient and/or witness accounts as appropriate and the need for honesty and objectivity in reporting the facts.
- Software training as super users of a digital incident reporting system. Train this group extensively on the use of the entire incident software system. It’s likely that tier 1 will work with your software provider to construct the forms and questions used for incident reporting organization-wide. That may include customizing reporting functions for specific data sets that will be provided regularly to administration and the insurance company. Tier 1 staff in turn should be capable of training others in using online forms accessible by mobile phone, tablet, or computer to report any (near) incident, avoiding lags in time and loss of critical details.
- Guidance and communication beyond reporting. Tier 1 staff should be trained on their responsibilities to attend to areas particularly vulnerable/at risk for (near) incidents (e.g., complaints, quality of care issues, scopes of practice, medication and lab errors, infection control, fraud, policy/procedure violations, HIPAA, physical safety, etc.). They should drive organization-wide communication efforts about what is done with reported incident data and how it will directly influence things like ongoing orientation and training, staffing ratios, and other patient safety issues. Strive to have this group consistently demonstrate to others that all reporting is accomplished in a blame-free and transparent environment.
- Soliciting positive feedback. A well-designed incident management program recognizes individuals’ positive contributions to safety by acknowledging the actions. Ensure that tier 1 staff are equipped to train others on the message that improving our healthcare system also requires recognition of what we’re doing right, not just identifying the failures or near misses.
Tier 2 trainees
Physicians, advanced practice professionals and other clinicians working at the point of patient care are obvious catalysts for improvement, especially when they participate in or see a (near) incident occur. In addition, any non-clinician employee or staff member would fall into this tier. Their training should focus on the following:
- Adherence to policies and procedures. While tier 2 staff don’t typically set or maintain the incident management policies, they must be familiar with them and receive ongoing training to foster participation and compliance.
- Understanding of how to access and complete incident reports. Provide this group with instruction on the methods available to them for reporting, preferably using an online form as part of a digital solution (i.e., mobile phone, tablet, or computer). Beyond simple instruction for filling out forms, offer tips for report completion, such as:
- Be objective
- Include patient/witness accounts
- Act quickly
- Avoid using second-hand information
- Avoid assigning blame when naming individuals involved
- Guidance and communication beyond reporting. Communicate to tier 2 clinicians and staff the importance of their role in promoting quality and safety. Provide assurances that reports are intended to bring errors and areas of improvement to light, not to punish individuals for errors. Inform them about the entire process, focusing on what the organization does with incident data and how it will affect compliance, reimbursement, hospital grades, and patient safety scores. Finally, encourage individuals in tier 2 to recognize positive contributions to safety.
Tier 3 trainees
Patients, visitors, vendors, and other non-staff don’t require training on incident reporting, but they must be informed of their right to communicate any incidents they witness or are involved in. Alternatively, instruct them on how to provide positive feedback based on exemplary interactions or services received or suggestions for improvement.
Communicate through email, as well as hardcopy posters, forms, or flyers in the patient areas. Provide contact numbers of patient safety advocates, quality and performance improvement officers, ombudsmen, or any other party that should receive patient or visitor feedback. Provide the web links for them to directly access reporting methods available to them (i.e., if using an online form accessible by smartphone, tablet, or computer). Alternatively, make paper forms accessible, with clear instructions for completion and submission.
Combine training for clinicians
Clinicians’ and healthcare staff’s time is in short supply, and they’re asked to follow an ever-growing number of policies and regulations. Use development and training methods that achieve multiple goals whenever possible to honor their time and to avoid adding burdensome extra steps. Created for clinicians by clinicians, the AHRQ provides one such program that addresses safety issues by combining clinical best practices, safety science, and attention to safety culture. The Comprehensive Unit-Based Safety Program (CUSP) toolkit contains modules that aid in assembling safety teams, engaging leadership, spreading safety culture, and communicating with patients, among others.
Likewise, the Institute for Healthcare Improvement offers resources for training, including its Patient Safety Essentials and Quality Improvement Essentials Toolkits, containing documents on improving teamwork and communication, tools to help better understand the underlying issues that cause errors, and guidance about how to create and maintain reliable systems.
Are quality and safety part of your team’s daily work within the organization? symplr Patient Safety’s solutions and experts have been helping organizations worldwide to improve their safety and quality for over 15 years.