Like many facilities, executives and risk managers at ValleyCare, a multi-facility healthcare system in the San Francisco Bay Area, knew that their paper-based process for managing incidents was inadequate. "Paper-based incident reporting was not only time- and labor-intensive, it did not allow us to easily identify patterns and trends from our incident reports," said Doreen Maples, the corporate compliance officer and director of quality, risk, and health information management for ValleyCare.

To gain efficiency and address its quality improvement gaps, ValleyCare applied information technology to the incident reporting process. "First, choosing a Web-based system was a prerequisite," said Maples, who led the project team. "Like many organizations, ValleyCare is strapped for IT resources. A Web-based system means that implementing and supporting it does not require any investment in new IT staff, hardware, or software," she continued.

At ValleyCare, nurses and other staff report incidents directly into a Web-based system instead of filling out paper incident reports. While the existing ValleyCare paper incident reports were quite detailed, employees often did not fill them out legibly or completely, which hindered quality improvement efforts. "The Web-based system guides incident reporters through answering the appropriate questions for a given type of incident. Working from the premise that you can only improve what you measure — and measure correctly — this has been a great benefit to our PI efforts," said Maples.

Another key factor in ValleyCare's choice to automate incident reporting was the speed with which Maples could receive feedback on patient safety initiatives. "Our paper-based process led to lag times between reporting and notification of up to seven days. Our Web-based system's real-time incident alert notification eliminated this delay and provided the flexibility to notify multiple parties in real time," Maple said.

With the system's graphing and reporting tools, ValleyCare can convert incident data into actionable knowledge. "With the statistical analysis built into many reports and graphs, we can incorporate graphs and reports from the system directly into leadership reports and PI projects," said Maples, who estimates the ability to simply copy and paste graphs, reports, and data into PowerPoint and Excel saves her team at least one day of work in preparing for each committee meeting.

In addition to improving decision support at the executive level, the system supports ValleyCare's overall goal of establishing a culture that prioritizes continuous quality improvement at all levels. "Our goal is to establish an environment where department managers have the tools to identify and fix systemic problems — versus relying on a 'quality department' to identify and report to them what issues have been identified," said Maples. "We have given them the tools to quickly and easily test multiple hypotheses, drill down, and compare their metrics with those of other departments. This would not have been possible with a paper or spreadsheet-based process."

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