So how does a healthcare organisation; which is filled with multiple interrelating processes; complex decision making, and with large numbers of the public accessing services, work towards improving quality?
Many literature reviews cite the following as essential components on how to increase the level of reliability; strong leadership, leaders who are not averse to hearing about incidents, whether they were near misses, or which caused actual harm. In order to achieve this, the organisation needs to encourage the development of an organisational safety culture. This culture will foster the need for prompt dialogue and debate; of questioning and listening, problem identification, knowledge transfer, and reflective post-audits.
Everyone within a healthcare organisation must be encouraged to take ownership of risk; to critically evaluate their working practices, to improve the environment for both the patients and the staff. One of the main components in achieving this high reliability environment is the introduction and management of reporting procedures. After all a ‘commitment to reporting demonstrates a commitment to patients and their safety’ [The NHS Confederation 2008].
So how do organisations improve levels of incident reporting? After all, if the organisation is not aware of risks, then action to improve and learn will not happen. However, it is a challenge to change culture, change staff mentality and encourage them to report information.
Give feedback to the staff: Staff need to see that the effort they make to report incidents is important and that this information can be used by the organisation to make services safer and improve quality. Without feedback, reporting can be seen as a bureaucratic process, rather than a powerful mechanism for change. It may be possible to acknowledge staff reports, which will motivate them to report more often, and make the individual feel that their input is important and valued.
Some organisations collate all the incident report information and analyse it to see that stories are highlighted and shared. Some use newsletters, which can be discussed at staff meetings or placed on notice boards. These newsletters can include case studies, patient stories, and trend analysis of a certain topic. By giving staff concrete examples that the organisation will respond and make changes for the better, an increase in reporting will be generated.
Focus on change, learning and improvement: Reporting tools are important for a reason – they are in place to alert the organisation to issues that may be hidden in the complexity of everyday healthcare work. Reporting is not about blame, about criticism, or about repercussions on individuals – it is essential in order to enable change, learning and improvement. Staff will not report if their peers, or the management, are judgemental in anyway, or if punitive measures follow. In the UK, ‘whistle blowing’ has become an important concept in recent years.
Engaging staff: This can be done by improving training and education. Training on the ‘what, how and why’ is key to increasing levels of reporting and getting meaningful data which can be analysed and actioned. An eclectic staff mix in training sessions, spanning across organisational boundaries, can be the key to improving the quality of patient care pathways.
It may also be useful to give staff a ‘prompt list’ on the sort of information they may wish to report. This prompt list or trigger list can be both generic and pertinent to the whole healthcare organisation; or it can be speciality specific – incident data that may be relevant locally, within specialties and departments. This incident data can be used at departmental management level to inform decision making, and to improve practices and processes.
Make it easy to report: Forms need to be as simple as possible, yet include information on follow up and analysis. Decisions need to be made about whether it is electronic or on paper, are all staff able to access a computer? Do you have the resources to input the data from numerous forms?
Lastly, but most importantly- make reporting matter….. High-reporting organisations demonstrate strong and visible safety leadership from their boards and senior managers. Investing in robust systems and using incident data to support decision making at the highest level can change and enhance organisations.