Question

Case: After a considerable investment of both money and time, executives at Leman Healthcare were delighted that the new incident-reporting system at Leman was now fully operational. The incident reporting system had been deployed across the health care system; frontline and management staff as well as physicians in both inpatient and ambulatory settings had been trained and were able to use the incident-reporting system to access patient information, document adverse events, and report as required to senior management, risk management, and the QI department. However, even with full system deployment, QI activities across the health system had not changed. The QI department had full access to the data warehouse that housed data collected through the incident-reporting system as well as data from the electronic health record (EHR) and other information systems, yet QI staff members were apparently not using these data. Instead, QI projects continued to follow historical patterns involving laborious efforts to develop queries and reports rather than use the new system’s immediate reporting capabilities to supply information for managers and to drive process improvement projects both locally and across the hospital system. Similarly, the potential for clinicians to use the newly accessible data was not being realized. Physicians were reluctantly compliant with requirements to use the incident-reporting system for documentation and reporting events, but the general consensus seemed to be that the system was just a way to point fingers at the medical staff. Despite efforts from the senior management team to work individually with clinicians to educate and explain the importance of error and near-miss reporting that would provide information to reduce errors, these physicians continued to view the incident-reporting system as a punitive tool, not as an opportunity for them to explore ways to improve their work. 1. In a narrative format, discuss the key facts and critical issues presented in the case.

Answer 1

When any new system is introduced in any organization whether it be a hospital or any organization it takes time to get used to it.There arouse a number of problems with the new system but if there is a problem then there is a solution too for that problem.

In this case we see that with a lot of effort a executives at Leman Healthcare were delighted that the new incident-reporting system at Leman was fully operational.This system is introduced so that the old methods which are mostly manually must be replaced with the new system whic was more sophisticated and used as a tool for a system which do not have any kind of flaws in it.

In a hospital there are various departments which have to work unitely so that the patients do not suffer .The system was developed to have a proper co-ordination in all the departments like frontline and management staff as well as physicians in both inpatient and ambulatory settings had been trained and were able to use the incident-reporting system to access patient information, document adverse events, and report as required to senior management, risk management, and the QI department.This was made with the view that eployees will take this system positively.

But the QI department of the hospital was not ready to accept this system they were sticked to the old manual manner in which there was flaws and the main flaw was lack of coordination among the departments.As discussed in this case that the QI department had full access to the data warehouse that housed data collected through the incident-reporting system as well as data from the electronic health record (EHR) and other information systems, yet QI staff members were apparently not using these data.This shows that the employees of the QI department are not ready to accept the chnages which are intoduced for there betterment only.

There were efforts made by the team members to educate the clinicians and the employee of the QI department but they are not ready to switch to the new system.According to them the system is not beneficial one rather it is a waste of time.