A culture of safety and reliability depends upon the prompt reporting of issues and risks. In a highly reliable culture, each person understands their responsibility to report concerns. At Sharp Healthcare, we use RLDatix for reporting clinical issues. Our goal is to increase the number of events reported in RLDatix so we can address issues and make improvements to reduce risks and promote safe, reliable care.
Problem: Staff and leaders have voiced concerns about the length of time it takes to complete a report and the number of fields required as barriers to reporting. Each unreported issue or event potentially represents an ongoing risk that may result in patient harm and staff dissatisfaction.
Project Goal: The RLDatix Steering Committee embarked upon a performance improvement project to optimize each of the fourteen forms in RLDatix with the goal of eliminating unnecessary fields and reducing the time to complete a form by 10%. Fourteen system-wide teams were assembled to review and optimize each form.
Impact: The overall result was a reduction in the median time to report an event by an average of 10.5% across all forms, which translates to a time savings of 336 hours a year!
Outcome Measures of Success
Measure 1. Decreased the time to complete a report: Over 20,000 events were submitted in 2018 and based on current volumes projected, volume for 2019 is even higher, and our staff’s time is priceless! Patient safety event reporting is vital to a high reliability organization. Leaders cannot address and fix problems of which they are unaware, and many past, current and future projects rely on reporting for baseline and improvement measurements. It is of utmost importance that reporting be easy and required fields be leveraged for patient safety and performance improvement purposes.
A median ‘time to submit’ baseline was taken across all forms from January 1, 2017 to April 30, 2017. Enhancement of forms was ordered based on a prioritization matrix. The following modifications were made:
- Removed 14 mandatory fields to complete on EVERY form common to all form types
- Auto-population of 3 fields (all forms) - Three fewer fields every reporter needs to enter
- Simplified forms by removing unnecessary fields: removed 155 specific event type options (categories submitters can choose when submitting an event). Group decision making was guided by field utilization reports (how often each item was chosen over 1 year)
- Utilization of skip logic (questions only appear based on answer of previous question) added to 4 form types – leaning out the form and removing unnecessary “noise”
- Overall changes once all forms modified (January 1, 2019 – August 30, 2019)
- Total Volume of reported RLs: 12,194
- Decrease in time to submit in 12 of the 14 forms enhanced.
- Median time to submit change in minutes: -1.1 minutes (average) (Figure 1)
On average we are saving 28 hours/month on event reporting or 336 hours / year!
Measure 2. Increase volume of RLDatix reports submitted: Decreasing the burden on staff submitting events illustrates Sharp’s commitment to encouraging event reporting. Over the last 4 years, Sharp has seen an increase in reporting year after year. The volume for 2019 is projected based on volume of reports to date for the year, and is expected to exceed prior years.
Measure 3. Increased staff satisfaction: The Culture of Safety Survey gives strong qualitative support confirming the impact of changes made to RLDatix.
Culture of safety survey comments in 2018:
- “The RLDatix system is still cumbersome and ‘frightens’ some staff away from completing one.”
- “I have personally found the event reporting system online to be confusing and difficult to use.”
- “To fill out in RLDatix takes too long and gets put aside because of how busy it gets.”
Culture of safety survey comments in 2019:
- “RLDatix submission forms are easier to fill out.”
- “I like the RLDatix system we have in place. We can keep track of events that can be harmful to staff and patients.”
- “Submitting an event is easy.”
Measure 4. Create alignment between RLDatix and reporting requirements to external organizations: Sharp HealthCare reports fall data to the Collaborative Alliance for Nursing Outcomes (CALNOC) to aid in advancing global patient care safety, outcomes and performance measurement efforts. The subject matter experts pulled together to enhance the RLDatix Fall form worked to better align field requirements with CALNOC’s needs, effectively eliminating the need for data analysts to access the chart of every patient who experienced a fall to gather needed information.
How did efforts and/or creativity go above and beyond expectations and exemplify the Sharp experience?
The man-power and time required to achieve this goal was massive! The complexity of the project and commitment by all (75) members deserves to be recognized. Steps included but were not limited to: identifying and scheduling reps from each site and the right subject matter experts, timing of the meetings, time to review the form, time to build, time to approve and time to create communications to inform staff and leaders.
Broad Project Scope
- Each meeting was comprised of subject matter experts within each category (general event type, i.e. Fall, Imaging, Security etc.)
- System wide – each site had at least one representative
- Multi-professional – each meeting had front-line staff, leaders, IT support and data analysts
- Multidiscipline – Registered nurses, data analysts, respiratory therapists, regulatory experts, patient relations, laboratory, security officers, and executive leaders were engaged in form enhancement
Spending the time to systematically analyze and enhance each form has resulted in both quantitative and qualitative gains. Time to report has decreased, reporting volume continues to rise, and front-line user satisfaction has improved. The committed members of this interdisciplinary and multi-professional team ensured the project’s success and have enabled continued growth towards high reliability.
Author: Samantha Crandall, System Patient Safety Specialist