The word “reporting” elicits a multitude of responses from boredom to frustration, and anxiety to excitement. Many of us don’t all breathe and dream stats or trend lines, and yet we spend hours preparing and scouring reports for meaning. So naturally, it’s easy to ask ourselves why are we documenting incidents in an Incident Reporting System (IRS) in the first place?
The reasons we report may not necessarily be the reasons that most people think. Due to voluntary biases, under-reporting, varied cultures and client/patient demographics, an IRS may not be able to tell us if we truly have less med errors than the previous year or whether we provide safer care than other organizations. A lot of data does not necessarily equate to good decisions; data can lack integrity and good data can easily be misinterpreted, leading to poor decisions. Without clear training and provision of definitions, the same values selected in forms can carry different meaning. Even if every form were to be filled out in complete and proper detail (e.g., number of med errors as numerator) and every question and value is interpreted in the same way across the organization, we would not be able to determine if the change between time 1 and time 2 is significant without an appropriate denominator fitting the population at risk (e.g., patient days, meds administered, etc.). If we compute the number of falls for a unit per 100 patient days, we still may not know if the change in rate between time 1 and time 2 is meaningful. Is the rate change within the range of inevitable change (it would be improbable to have the exact same rate quarter to quarter), or is there a meaningful phenomenon? If a change is significant, how do we derive meaning from it? The significant change could be attributed to: an increase/decrease in reporting of certain types of events, a true reduction/rise of preventable harm, other factors such as improperly trained staff, and quite possibly a result of an interaction among several variables. This all sounds quite complicated, and it is; but it’s something that must be embraced.
Working in the field of healthcare, we are committed to a set of ethical values that aligns with doing our very best to provide the best care possible—whether we are on the frontline or supporting those on the frontline. AN IRS affirms these values and a culture of safety and accountability by providing an outlet for staff to contribute to reducing preventable harm. For example, an IRS could facilitate positive reinforcement of those who report good catches: the intrinsic reward of knowing that the good catch you reported prevented several hundred potential med errors should make anyone want to continue documenting good catches. Some organizations even select a staff member on a quarterly basis who submitted a good catch. Reporting provides motivation to open dialogue about definitions and drawing a line for what incidents constitute preventable harm. Moreover, an IRS can allow leadership to hone in on specific types of events and develop a better understanding of the harm that could have been prevented. This understanding can then aid the development of hypotheses for why specific types of preventable adverse incidents are occurring. Activities can then be undertaken to try to further reduce preventable harm, and continued reporting then becomes necessary to test hypotheses.
Although an IRS is ailed with bothers of bias and underreporting, without the incidents we document and the reports we run, it would be difficult to capture the anecdotes and contributing factors that inspire our efforts, maintain a culture of safety and accountability, and build cases to make process and policy changes that could result in reduced preventable harm.