Many hospitals are sorting through difficult decisions regarding investments in systems to improve patient safety, including systems for error reporting. A common issue that has arisen among hospitals interested in the error reporting experience and success of Baylor Grapevine is the decision to use a “homegrown” product versus using a product from a national vendor. The purpose of this commentary is to articulate a framework for how hospitals might address such a decision.
In February 2000, Baylor Medical Center at Grapevine began working with DoctorQuality to improve the ease of incident/error reporting. The purpose of this effort was to increase the number of errors and incidents reported. It is generally accepted that incidents and errors are significantly underreported in hospitals. Underreporting occurs for a number of reasons—primarily, it is suspected, because of fear of punishment and the difficulty of reporting errors correctly. Improving error reporting is important for a number of reasons, the most important one being quality improvement. Through accurate error reporting, we can identify trends and target improvement opportunities.
Therefore, our management group felt that working with DoctorQuality on this project was meaningful work. A number of criteria should be considered when using an error-reporting tool; however, variables other than the tool must also be considered:
A very clear position of support from top management
Appropriate application of effective learning techniques
A well-planned communication effort
Ongoing feedback to users regarding data produced from the program
A meaningful reward and recognition program for users
The error reporting tool was implemented in August 2000. After over a year of experience with the product, several criteria have surfaced as being important. The most important criterion revolves around user satisfaction. Very simply, will employees use the system? It must be easy to use. For example, how difficult is the system to access? How many decisions must the user make along the way to correctly report? Also, does the user trust the system? Our system allows the report to be filed anonymously, if desired. This takes the punitive factor out of the picture. The user must trust that the reporting will be timely and, thus, relevant. These are all factors affecting user satisfaction.
Second, tool adaptability is important. Each organization is different. Upon implementation, several changes were identified that would improve the tool for our situation. For example, we needed more specific information on patient falls, a high-risk activity. DoctorQuality was able to make this change to the system. The ability to make changes to the product increased its effectiveness.
Third, the production and use of data are important. The data must be easy to use and analyze. Improvement activities can be discovered only if the data are readily available. It is also important to benchmark your data with that from other organizations, both internal and external to the health care system. It will be meaningful to compare information among hospitals to identify best practices.
Fourth, cost must be considered when selecting a system. The initial cost of the system is only one of the factors. What resource utilization is required for implementation and ongoing use? Additional salary expense because of poor implementation or difficulty of use can far outweigh any initial cost advantage. Also, the cost of ongoing maintenance of the system must not be overlooked. Maintenance includes data maintenance as well as data access.
Finally, what type of ongoing relationship is established with the vendor? Does the vendor have a track record of support for its product? Baylor Medical Center at Grapevine has been very satisfied with the support and innovation provided by Doctor-Quality. Recently, we have been approached about piloting a customer complaint tracking program, which will allow us to collect and trend customer complaints much as we track incidents. This will offer further improvement opportunities that we are excited about pursuing.
The criteria and other factors described above are all important when considering an error reporting system. Within Baylor Health Care System, a homegrown system is in use at Baylor University Medical Center, and the DoctorQuality system is in use at Baylor hospitals in Grapevine and Garland. The criteria I have detailed would be a good measuring stick to apply when evaluating the 2 systems. In addition, it would be important to look at outcomes from their use. The 2 most relevant outcomes are increases in error reporting at each facility and the sustain-ability of those increases.