Reports From the Field

Improved Safety Event Reporting in Outpatient, Nonacademic Practices with an Anonymous, Nonpunitive Approach

Journal of Clinical Outcomes Management. 2015 February;22(2)

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We implemented a project to significantly improve reporting of safety events in an outpatient, nonacademic 6-practice collaborative by using education, monthly audit, and regular feedback.

Methods

Setting

Novant Health Medical Group is a consortium of over 380 clinic sites, nearly 1300 physicians, and over 500 advanced practice clinicians. Clinic locations are found in Virginia, North Carolina, and South Carolina. Medical group members partner with physicians and staff in 15 hospitals in these geographic locations. Novant Health utilizes Epic (Epic Systems, Verona, WI) as an electronic health record. Safety event reporting is accomplished electronically in a single software program (VIncident, Verge Solutions, Mt. Pleasant, SC), used for all patients in our integrated care system (inpatient and outpatient facilities).

Intervention

We designed a quasi-experimental study enrolling a 6-practice collaborative of 3 family medicine practices, 2 pediatric practices, and 1 general surgery practice. These practices was selected because each had a proven physician leader and an experienced practice manager willing to participate in this initiative. We developed a compendium of patient safety events (see Appendix) that had been reported over time in our safety event reporting program. Historically, reports were made electronically in the program by a single reporter in clinics, and these reports were initially verbally communicated by a staff member or provider to the reporter.

Two of the authors (HWC and TC) met in March 2013 with the lead physician, practice manager, and patient safety coach at each clinic for approximately 1 hour. We discussed current reporting practice, delivered education for the safety event compendium, and detailed an anonymous, voluntary, and nonpunitive approach (stressing the use of the term “safety event” and not “error”) to reporting using a single page, 8-question paper report about the event. The report was not to be signed by the person completing the event data with placement in a drop box for later collection and electronic reporting as per usual practice in the clinic. We agreed that clinic leaders would stress to staff and providers that the initiative was nonpunitive and anonymous and that the goal was to report all known safety events, as an improvement project.

Patient safety coaches were selected for each of the 6 practices by the manager. Patient safety coaches are volunteer clinical or nonclinical staff members whose role is to observe, model, and reinforce pre-established patient safety behaviors and use of error prevention tools among peers and providers. Training requirements include an initial 2-hour training session in which they learn fundamentals of patient safety science, high reliability principles, coaching techniques for team accountability, and concepts for continuous quality improvement. Additionally, they attend monthly meetings where patient safety concepts are discussed in greater detail and best practices are shared. Following this training, each clinic’s staff was educated on the project, a process improvement team (lead physician, manager, and patient safety coach) was constituted, and the project was begun in April 2013. In quarter 3 of 2013, each practice team selected a quality improvement project based upon reported safety events in their clinic. We asked our medical group risk managers to continue event discussion with practice managers as usual, as each event is discussed briefly after a report is made.