Learning and improvement in healthcare becomes “real” when there is visible and measurable change. When we first implemented BC PSLS in 2008 we focused on a number of key areas: helping Reporters identify the types of patient safety events that should be reported, making the transition from paper-based report forms to a computerized system and adopting BC PSLS as the “standard” safety event reporting and management tool. Over the years we’ve had good success in these areas, which we know by the steady increase in reporting volume across the province.
The volume of safety events reported in BC PSLS provincially has been fairly stable with close to 10,000 safety events reported every month (blue line). The “Average Days to Final Approval” (red line) has dropped from 77 days (in 2012) to 14 days (in 2014).
Figure 1: Reporting Volume and Average Days to Final Approval
We then turned our attention to the impact of BC PSLS on “Handlers” – healthcare leaders with responsibility for safety event follow-up and investigation. We knew that Handlers would feel the most impact. They needed to learn new ways to communicate with Reporters who reported safety events and establish new workflow patterns/processes. Prior to BC PSLS for example, it was not unusual for managers to “glance” at paper report forms to assess their urgency, which often led to a steady build-up of “piles” of paper reports until there was time to finish processing them (usually once a month or less). This also resulted in “black holes” as Reporters were left wondering what happened.
With an electronic system like BC PSLS the best approach is to review, respond to, follow-up on and process event reports as close to “real-time” as possible to address problems quickly, maximize learning opportunities with staff and mitigate patient harm. It’s important to note that 60% of events reported in BC PSLS are “No harm,” meaning individual follow-up by Handlers, which takes more time, is typically not required. The value of “No harm” events lies in the ability to review this data in the aggregate to determine where processes are failing, or need to be improved. In other words, helping Handlers learn how to triage reports and process the “No harm” events in a timely manner frees up their time to focus on the few events that do cause patient harm.
At first we began to see a familiar pattern – a significant number of reports were accumulating in electronic piles as “overdue events.” Our first step was to understand the size of the problem and the reasons why. Our visualization tools helped us do that (bubbles). Handlers told us that competing/multiple demands, limited access to computers, unfamiliarity with BC PSLS, lack of support from leaders, change in processes and uncertainty of what was expected were all contributors to the increasing backlog of overdue events.
Identifying and understanding these barriers was a big help to HA Coordinators who then developed a number of strategies and approaches to help Handlers with their work. Their collaborative efforts have resulted in sustained improvements over time and established good working relationships going forward. It’s taken time to help Handlers get caught-up and manage the work associated with event response and follow-up, but thanks to the expert leadership of HA Coordinators, great strides have been made!
Here’s an overview of what each HA Coordinator had to say:
“In just six months we’ve gone from 6,000 overdue events to less than 2,000,” says Andrew Hiob, BC PSLS Coordinator at Interior Health (IH). “I think one strategy that’s working extremely well is our new ‘learning labs’ where I invite Handlers with a significant backlog to join me for a training session. We deal with their overdue events together and I’m there to answer questions as they come up. Plus I find that Handlers really appreciate this time because it allows them to focus on getting through their overdue events and get away from their other everyday distractions.”
“I work closely with new Handlers to build that relationship from the beginning,” says Jennie Aitken, BC PSLS Coordinator at Island Health (VIHA). “I offer one-on-one assistance by teleconference and use screen-sharing so I can show Handlers exactly how to manage events in BC PSLS, including event review timelines. I find this approach works particularly well for new Handlers who are first learning how to manage events, especially those events that originate in a different area. I help new Handlers to coordinate the follow-up piece so nothing gets missed. I also make sure I use very clear language about safety event follow-up so they understand why internal timelines are so important at Island Health.”
“Getting leaders on board has made a big difference to our overdue events volume at Northern Health, says Kirsten Thomson, BC PSLS Coordinator at Northern Health (NH). “I’ve started emailing a monthly report to the Chief Operating Officers (COO) in our three service areas. The report provides a summary of Handlers with outstanding events and each COO has been very good at encouraging Handlers to work through them, or come to me for help. I think this approach works well because it shows Handlers that leadership believes BC PSLS is an important part of patient care and our data must be up-to-date in order to make improvements. Our overdue events are definitely coming down and Handlers are more aware of ‘why’ this matters.”
“I’ve had a great response to my ‘overdue events’ emails,” says Terri Aitken, BC PSLS Coordinator at Vancouver Coastal Health (VCH). “Handlers tell me they like the reminder and they especially like to see progress when their overdue events go down. I often include graphs to highlight the drop in volume so they can see that the work they’re doing is making a difference to the quality of data we’re sharing with our leadership. Our overdue events are going down steadily and I think this trend will continue as Handlers become more familiar with this process and the significance of event review timelines.”
“Quality Directors have done a lot of work to help Handlers in different ways, such as talking about BC PSLS with Handlers at various meetings,” says Jyoti Ladhar, BC PSLS Coordinator at Provincial Health Services Authority (PHSA). “The PHSA Board is also very aware of BC PSLS and where we stand in terms of overdue events. Having that level of the organization engaged has made a huge difference in our volume of overdue events and established standards for how to meet event review timelines in BC PSLS. Our overdue volume is about 1,000 events – less than one-third what it was last year. Sometimes it’s good to have pressure from the ‘top’ because it demonstrates how important patient safety is to the organization and the quality of care we provide to patients.”
“I’ve seen a huge improvement with overdue events since I started sending reminder emails and ‘overdue reports’ to Program Leaders four months ago,” says Elena Cernicka, BC PSLS Coordinator at Providence Health Care (PHC). “Sometimes I’ll even follow-up by phone to speak with Handlers and setup a meeting to work on their overdue events together. I think it helps my Handlers to know that I’m here to help them and a lot of times they reach out me, which is great. Our Handlers are doing a great job with reducing their list of overdue events and the emails, together with the support of Program Leaders, are definitely making this work more of a priority for everyone at Providence.”
“The most important thing we’ve done at Fraser Health is to embed BC PSLS into all aspects of operations,” says Tammy Simpson, BC PSLS Coordinator at Fraser Health (FH). “Process timelines are critical. Once the data has been given ‘Final Approval’ it’s been clinically approved by our Handlers and is therefore a better source of data for trending, learning and working towards process improvements. Overdue events are really not an option. Timely safety event follow-up is encouraged by all levels of the organization, starting from the CEO on down and it spreads all the way through to each level of the organization. We also discuss BC PSLS and present the overdue events data to the Executive team on a regular basis. This level of transparency is very important at Fraser Health – it keeps patient safety and BC PSLS at the forefront of everyone’s minds.”
1. Check BC PSLS on a regular basis to see what events have been reported in your area
2. Move “No harm” events to “Final Approval” status as soon as possible so the data can be analyzed for learning and improvement
3. Follow-up as quickly as possible for events that resulted in “Harm” to the patient *Remember to record your findings and investigations in BC PSLS
4. Review aggregate reports of your BC PSLS data often to look for trends and areas for improvement
Final thoughts…
All health authorities have decreased their volume of overdue events in BC PSLS significantly. The Central Office team would like to acknowledge the excellent work of our HA Coordinators and Handlers across the province – congratulations on your success!
Timely safety event follow-up means we have a better overall picture of patient safety and the quality of care we’re providing throughout our healthcare facilities. As it becomes a daily routine to respond, review, follow-up and share patient safety information, healthcare becomes…“a culture of safety and learning.”
If you are a Handler and you have questions or need help with BC PSLS, please reach out to your BC PSLS Coordinator.