Provisional Topic Title: The impact of implementing electronic incident reporting system on the pattern of reporting in hospital.
Proposal structurally approved by the workshop tutor: Yes/No
1. Aims/objectives/Research Questions:
The importance of incident reporting in healthcare cannot be underscored. Ideally, this new technological approach is vital in ensuring that safety of the patients is guaranteed beyond any reasonable doubt. Functionally, the incident reporting system thrives in the analysis of past incidents as well as the efficiency of the remedial measures deployed. In this case, effective recommendations can be put in place in line with the comparative evaluation of the past instances. This way, any potential errors will be internalized to achieve a perfect operational efficiency in the healthcare industry.
Following the importance of the incident-reporting framework, it is vital that virtually all healthcare facilities embrace the approach. For the framework to be effective, comparative analysis of the past situations should be pegged on the proper comprehension of the frequency of the incidences, the intensity of the problems, and the causal agents of the medical errors (Reznek & Barton, 2014). This can be achieved through the conduction of an intensive research aimed at shedding light on the matter.
The system in place at the current moment thrives on the use of paper-based reporting system. In as much as the system has been in place over the past years, it is worth noting that modern technology has posed a great threat to the efficiency of the method. Typically handled by the managers and the hospital supervisors, the system has been subject to human errors such as poor categorization of the errors. It is for this reason that the need for electronic systems has been catalysed significantly. While the installation of the technology systems might seem to be expensive, the results are price worthy.
As a matter of policy, this paper is focused on analysing the effectiveness of implementing an electronic incident reporting system in a given hospital facility located in UAE. By March end, the system will be implemented across the hospital. Ideally, this system will be introduced through a comprehensive platform that will highlight the implementation process, the policies, and operational guidelines as well as the standards of the framework. As the aim is to facilitate and reduce the barriers of the reporting process, after the evaluation, a report will be presented in line with the core objectives of the proposal.
This paper is aimed at achieving the following set of objectives:
- To understand the challenges facing the incident reporting system
- To highlight the recommendations of the new technology of the incident reporting system
- To highlight the operational standards and guidelines in the incident reporting system.
The research questions will be as follow:
- Is the current IR system efficient?
- What is the attitude of the multidisciplinary toward reporting?
- What are the challenges facing the current IR system?
- Will the new electronic IR system affect positively on quality and rate of reporting?
- Will the new system reduce the barriers of reporting?
The raw data gathered for the reasons of examination can be either quantitative or qualitative in nature. The quantitative exploration gives careful consideration to the scientific readiness of the information to deal with the arrangement of different analytical issues. Through the quantitative methodology, the investigation of the raw data will take a target point of view in the improvement of different deductions and contentions in agreement with the core aims of the study (Davis & LaCour, 2014). Quantitative information is gathered and subjected to an investigation concerning an assortment of factual methods and recipes.
In this study, a survey will be conducted through e-mail questionnaire method, as it is efficient way in quickly gathering information, convenient for the respondents as they can respond in their free time, the bias will be reduced and it will be answered honestly, since the manager of the survey will be detached. The latent way of the information accumulation approach guarantees that the respondents answer the inquiries genuinely without any form of exploitation (Committee on Quality of Health Care in America, Institute of Medicine, 2001).The questionnaire will be answered by 50 employees from different departments include doctors, nurses, pharmacists and other healthcare assistants, then structured interview will be done for 10 staff to understand their feeling and thought about IR system. The questions will include the barriers of reporting using paper based IR system, their attitude toward errors reporting, their perception toward implementing the new electronic system, and how will it contribute to facilitate the reporting process. Then after 4 months of implementing the electronic IR system, another survey and interview will be conducted to re-evaluate the effectiveness of the new system and getting the feedback to facilitate continuous improvement.
It is of great importance that the methodology presents a clear guideline on the evaluation of the impacts of implementing electronic incident reporting system. To achieve this, the research paper will collect electronic data in specific healthcare facilities across a period of 4 months in a bid to develop a substansive argument. Structurally, the data collection and analysis of this situation will be conducted before and after the implementation of the electronic systems. This way, there will be a greater comparative base for more statistically accurate references. Critically, this approach will present extensive data that will analyse the overall reporting rate, the categories of the report, as well as the departmental participation.
The collected data will be used in analysing and evaluating the current IR procedure, to determine deficiencies and identify improvement area. Thus reviewing of related literatures is important to identify the best practice, policies and guidelines that needed to be followed.
For the reasons of assorted qualities as well as enhanced proficiency levels, this paper will embrace the utilization of both the qualitative and the quantitative ways to deal with information accumulation. The utilization of both the qualitative and the quantitative methodology of data collection and examination gives the analyst a more comprehensive extent of correlation. In this line of thought, the analyst can think about the aftereffects of both avenues and create considerable conclusions on nature and effectiveness of the electronic incident reporting system.
Qualitative data analysis will provide the administration and quality department with useful information on system weaknesses, and help them to work on standardization and strengthen the system, in order to develop appropriate action plans to reduce level of patients harm and minimize the errors, thereby improve patients safety.
- Brief Literature Review:
Incident Reporting System (IRS) will keep on being an essential impact on enhancing persistent wellbeing in the healthcare industry. It gives important experiences into how and why patients can be hurt. However, it is not the panacea that several people trust it to be, it has a few confinements that ought to be considered.
Patient safety is becoming a central concern and a policy priority for healthcare organizations. Understanding the seriousness, frequency and causes of medical errors and analysing the collected data through an incident management system will lead to quality improvements while caring for patients (Kaldijian et al, 2008).
Improving incident reporting system intend to improve patients safety, as errors detection is fundamental to errors prevention (Reznek & Barton, 2014). Best practices in healthcare suggest that there should be an incident management system in place for healthcare organizations and incident management system is a standard that most accreditation bodies will audit against and is part of patient safety standards. Providing healthcare providers with reports of adverse effects will lead to systematic improvements in healthcare quality (Throckmorton & Etchegaray, 2007).
In most healthcare organizations in the Middle east and in other parts of the world, there is an incident management system and is maintained by quality department which investigate and analyze data for quality improvements and patient safety purposes. There should be important measures and systems in place where errors are reported in a healthy manner to promote quality improvements, as the good quality lead to save money by doing the right thing at the right time (Walsh & Antony, 2007). In light of those views, it was highly appropriate to move to electronic IRS to increase the efficiency of the reporting system in the hospital.
The Department of health and human service USA has published report in January 2012, after inspecting 189 hospitals, that the administrations heavily rely on IR to improve patients safety practice. However the IR does not provide complete information of the events, and they do miss 86% of the events because of unclear reporting requirements by the staff. However, since the hospitals rely on IR to investigate, track and analyse the errors, it is recommended to improve the usefulness of the IRS in order to trend and analyse data to improve patients safety (Roehr, 2012).
The institute of medicine encourages the healthcare organization to focus on errors reporting and care quality improvement, as it announced in 1999 that up 98000 patients die in USA annually from medical errors. However, the best way to increase errors reporting is still unclear with limited studies. Hence, the writer in this research will study the effect of implementing electronic incident reporting on reporting rate.
World Health Organization in 2008 has addressed the guidelines and the importance of errors reporting in healthcare organization, as it is the most valuable way to reduce patients harm during care and treatment by detecting patients safety related issues through investigating and analysing the data results, and help the healthcare worker to implement safer work. However, it cannot give full picture of patient risk and harm source, so other sources of risk and safety information should be used along with errors reporting system (National Agency for Patients Rights and Complaints, 2014)
Some studies have addressed the barriers that inhibit the employees from reporting errors, such as time consuming, negative attitude toward reporting and usefulness of it, lack of feedback and complicated reporting process (Martowirono et al., 2010). Another article result three major barriers to reporting as the employees believe of no benefits of reporting near misses, fear of disciplinary action, and lack of feedback, in addition to that the study shows that nurses are more aware of IRS than doctors, doctors report 50% of occasions only(AbuAlRub et al., 2015).
Another study mentioned some reasons preventing healthcare worker from reporting the errors like time consuming to complete forms, lack of feedback and the fear of disciplinary action (Westbrook et al., 2015). Hence, the writer will evaluate and analyse the survey data that will be done to understand the employees concerns and the barriers of reporting in the current system, then try to facilitate the reporting process through implementing simple and accessible electronic reporting system for all participant from different departments.
There are limited studies related to electronic IR , but several studies have shown measurable benefits from adopting information technology in healthcare industry , such as minimizing medication errors, among 154 studies 62% results were positive which mean the IT in healthcare contribute in improving some aspect of patients care (Buntin et al., 2011). Most healthcare data storage and analysis moved to digitation to support healthcare functions and clinical decisions related to patients care, which lead to improve healthcare service quality and reduce cost (Raghupathi & Raghupathi, 2014).
The IBM Global Business service report has shown the value of analytics in healthcare, increasing in customers demand in todays business force the healthcare organization to improve quality of care, which require smarter decision making related to management, planning and improvement of the operations to satisfy the customers, which can be done through analytical mechanism of the data (IBM Global Business Services, 2012). An assortment of data using technological information system that gives an efficient expository structure can help clinicians gain from these events. Therefore implementing electronic IRS is critical especially in safety management. It provides important analytical trends of information that will help the management to investigate evaluate and provide corrective action plan.
Another study finding suggest that by implementing electronic IRS will minimize the barriers to report compare to paper base report by simplifying the report process, however supportive leadership is required to sustain and promote reporting through enhancing no Blame culture aiming to improve patients safety(Walsh et al., 2010).
The lessons gained from the IRS can be utilized to teach, illuminate, and keep different associations from encountering the same unfavourable occasions. Such a framework for sharing can happen in a nearby, territorial, national, or global level. For instance, the Canadian Global Patient Safety Alerts (GPSA) framework is a store of the case points of interest and lessons gained from unfriendly occasions.
In 2003, Johnson, C. in his study addressed that healthcare worker need to have snappy and prepared access (electronic or online) to the system. This framework should be simple to the point that staff can utilize it without intensive training. It is practical problem that need to be considered, it is often difficult to use printed reporting form, as the staff need to be motivated to fill it in, difficult to find it, finally to be handed over to the safety and quality manger. Many organizations have responded to this problem by introducing electronic based systems (Johnson, 2003).
Fast growing in healthcare organisations pressurize them to adopt developed information technology to promote safety and quality care in private and public sectors. For example using intranet reporting system is easy and accessible way, as the employees dont have to access the email to send message, its accessible for every one any time , with secure information and will reach directly to the right mangers (Le Duff et al.,2005) .
In line with these research studies, instead of making unfriendly occasion reporting framework more unpredictable, we ought to move to making reporting exceedingly simple and accessible.
- Resources you need/Access to primary and secondary data:
The essential information for this study will be gathered utilizing online study surveys. The primary source of information on current IRS will be gathered from hospital employees of different departments and specialities using questionnaire through email system.
In order to collect the primary data, access to the incident reports data collected before and after implementing the electronic IRS in hospital is required, which can be collected from quality department in the hospital where all related data are gathered and analysed, and it has been secured already.
Another primary resource is needed in order to conduct this research, access to the University database system to access journals, which will be available through EBSCO online database, along with access to other online sources of articles, literatures and healthcare conferences. It is also useful to access healthcare management related books electronically or as hard copies.
Then again, the optional information is concerned with the examination of writing materials covering the same topic will be referred to as secondary resources, such as information that can be gathered through published reports of some hospitals related to incidents report system which are available in their website.
For differing qualities and accurate results, the secondary information will be used in the procurement of extra information to the exploration work, it is essential to compare between the discoveries of the essential information and the outcomes got by other examination works by different researchers.
- References List
AbuAlRub, R. F., Al-Akour, N. A. & Alatari, N. H. (2015). Perceptions of reporting practices and barriers to reporting incidents among registered nurses and physicians in accredited and nonaccredited Jordanian hospitals. Journal of Clinical Nursing, Volume v24, pp. 19-20.
Buntin, M., Burke, M., Hoaglin, M. & Blumenthal, D. (2011). The Benefits Of Health Information Technology: A Review Of The Recent Literature Shows Predominantly Positive Results. Health Affairs, 30(3), pp.464-471.
Committee on Quality of Health Care in America, Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. New York: National Academies Press.
Davis, N. A. & LaCour, M. (2014). Health Information Technology. London: Elsevier Health Sciences.
IBM Global Business Services. (2012). The value of analytics in healthcare. United States of America: IBM Institute for Business Value, pp.1-15. [Online]. [Accessed on 25 Feb 2016]. Available at: https://www.ibm.com/smarterplanet/global/files/the_value_of_analytics_in_healthcare.pdf
Johnson, C. (2003). How will we get the data and what will we do with it then? Issues in
the reporting of adverse healthcare events. Quality and Safety in Health Care, 12(90002), pp.64ii-67.
Kaldijian, L.C., Jones, E., Barry, J.W., Hoffman, V.L., Levi, B.H. & Rosenthal, G.E.
(2008). Reporting medical errors to improve patient safety. Arch Intern Med, 168 (1), 40-46.
Le Duff, F., Daniel, S., Kamendj, A., B., Le Beux, P. and Duvauferrier, R. (2005).
Monitoring incident report in the healthcare process to improve quality in hospitals. International Journal of Medical Informatics, 74(2-4), pp.111-117.
Martowirono, K., Jansma, J., van Luijk, S., Wagner, C. & Bijnen, A. (2010). Possible solutions for barriers in incident reporting by residents. Journal of Evaluation in Clinical Practice, 18(1), pp.76-81.
National Academy of Sciences, (1999). TO ERR IS HUMAN: BUILDING A SAFER HEALTH SYSTEM. USA: Institute Of Medicine, pp.1-8. [Online]. [Accessed 02 March. 2016].Available at: https://iom.nationalacademies.org/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf.
National Agency for Patients Rights and Complaints, (2014). Key findings and
recommendations on Reporting and learning systems for patient safety incidents across Europe. Denmark: European Commission, Patient Safety and Quality of Care working group, pp.1-55. [Online]. [Accessed 27 Feb. 2016]. Available at: http://ec.europa.eu/health/patient_safety/docs/guidelines_psqcwg_reporting_learningsystems_en.pdf
Raghupathi, W. and Raghupathi, V. (2014). Big data analytics in healthcare: promise
and potential. Health Inf Sci Syst, 2(1), p.3.
Reznek, M. and Barton, B. (2014). Improved incident reporting following the implementation of a standardized emergency department peer review process. International Journal for Quality in Health Care, 26(3), pp.278-286.
Roehr, B. (2012). US hospital incident reporting systems do not capture most adverse events. BMJ, 344(jan13 2), pp.e386-e386.
Throckmorton, T. & Etchegaray, J. (2007). Factors affecting incident reporting by registered nurses: The relationship of perceptions of the environment for reporting errors, knowledge of nursing practice act, and demographics on intent to report errors.
Walsh, K. & Antony, J. (2007). Quality costs and electronic adverse incident recording
and reporting system. International Journal of Health Care Quality Assurance, 20(4), pp.307-319.
Walsh, K., Burns, C. & Antony, J. (2010). Electronic adverse incident reporting in hospitals. Leadership in Health Services, 23(4), pp.292-303.
Westbrook, J., Li, L., Lehnbom, E., Baysari, M., Braithwaite, J., Burke, R., Conn, C. & Day, R. (2015). What are incident reports telling us? A comparative study at two Australian hospitals of medication errors identified at audit, detected by staff and reported to an incident system. International Journal for Quality in Health Care, 27(1), pp.1-9.