Selected Podcast
Encouraging Event Reporting in the Face of Adversity
In the aftermath of significant event, staff may be reluctant to complete patient safety reports. Tune in to hear Sandy Bledsoe discuss how to encourage event reporting in the face of adversity. To learn more about Sandy, and the work being done at Vanderbilt, go to www.vumc.org.
Featuring:
Sandy received her Bachelor of Science in Nursing from Harding University in 1981, her ARM designation in 1990 and her CPHRM designation in 2006. Additionally, she has had training in quality improvement and has a Master of Arts specializing in Conflict Management. She has contributed to two publications regarding learning and improvement from analysis of medical malpractice claims. Speaking engagements have included the American Health Law Association, CNA insurance company, the local chapter of CPCU, and the Willis Healthcare forum on topics such as Lessons Learned from the Fungal Meningitis Outbreak, Managing Physician Acquisitions, and Adding Value with Risk Management. She has been a guest lecturer to MBA and MHA students on the topic of managing healthcare conflict.
Memberships include the American Society for Healthcare Risk Management and the Risk and Insurance Management Society. In addition, she is a past board member of Alive Hospice and the Wayne Reed Christian Child Care Center and is a current board member of the Operation Andrew Group.
Sandy Bledsoe, B.S. Nursing, ARM, CPHRM, M.A.
Sandy Bledsoe is the Vice President of Risk and Insurance Management at Vanderbilt University Medical Center, having served Vanderbilt’s community in the Office of Risk and Insurance Management for over 25 years. Along with her staff of 17, she is responsible for all aspects of the risk management operations including risk financing, loss prevention, and claim management. In addition to traditional risk management functions, she advises the organization in its Enterprise Risk Management assessments and risk mitigation plans. One of her passions and the favorite part of her responsibilities is the resolution of disputes with patients and their families.Sandy received her Bachelor of Science in Nursing from Harding University in 1981, her ARM designation in 1990 and her CPHRM designation in 2006. Additionally, she has had training in quality improvement and has a Master of Arts specializing in Conflict Management. She has contributed to two publications regarding learning and improvement from analysis of medical malpractice claims. Speaking engagements have included the American Health Law Association, CNA insurance company, the local chapter of CPCU, and the Willis Healthcare forum on topics such as Lessons Learned from the Fungal Meningitis Outbreak, Managing Physician Acquisitions, and Adding Value with Risk Management. She has been a guest lecturer to MBA and MHA students on the topic of managing healthcare conflict.
Memberships include the American Society for Healthcare Risk Management and the Risk and Insurance Management Society. In addition, she is a past board member of Alive Hospice and the Wayne Reed Christian Child Care Center and is a current board member of the Operation Andrew Group.
Transcription:
Bill Klaproth (host): Welcome to the ASHRM Podcast, made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management. You can visit ashrm.org. That's A-S-H-R-M.org/membership to learn more and to become an ASHRM member. I'm Bill Klaproth.
And on this episode, we're going to be talking about encouraging event reporting in the face of adversity with Sandy Bledsoe, Vice President of Risk and Insurance Management at Vanderbilt University Medical Center. Sandy, thank you so much for your time. It is great to talk with you. And this is really an important topic, because reporting is so crucial. So as we start off, right to the big question, how do you develop a culture of reporting?
Sandy Bledsoe: Yeah. So, it's good to be with you. Thank you for asking me to talk about this. So really, here at Vanderbilt, it has been part of our embedded culture for a very long time. It comes from senior leadership at the beginning to encourage reporting. We've got a very robust occurrence reporting policy. We cover that with all new staff members, all new house staff who come in, the residents who come in. We've spent two and a half hours with the residents when they begin to just talk about the whole process, to talk about what happens when events are reported, what we do with that information. We also do that at orientation for our new faculty, our new employed physicians. So, it starts at the very beginning when people onboard with Vanderbilt and then, at every opportunity that risk management has, even if we're asked to talk about something else, we always add in a piece of "Please report, report, report." Our quality folks also help reinforce that message. And so, it's really embedded throughout the culture.
One of the other things that we started doing, which we were probably a little behind the curve on this to be honest, but a few years ago, we made it mandatory that there was documented followup for the events that were reported. And then, finally, what we're doing to just take it to the next level, I think a lot of us have had. We've heard the complaint, "Oh, I reported it in a black box and I never hear anything back." And so, we're developing more intentional feedback that we provide to our staff, so that people look at this information and we act on it and we take actions, based on what they report in addition to thanking them for reporting.
Bill Klaproth (host): Yeah. That is very good and very thorough. I like how you said that it's embedded in your culture and that it starts at the very beginning through the onboarding process and really comes from the top. You said senior leadership has really bought into this. Is that one of the keys to this, Sandy, is having leadership behind your back on this and also ascribing to this culture of reporting?
Sandy Bledsoe: Absolutely. I couldn't do my job unless I had the senior leaders of the organization understand and support the philosophy of the reporting process, even up to the board. The board appreciates it, understands it, and expects it, really. And the idea with us is the more reports, the better.
Bill Klaproth (host): So, Sandy, let me ask you this then. When it comes to this, as you said, you know, process of reporting, it's embedded in your culture, what did you do to encourage ongoing reporting in the settling of a serious nationally reported event? How did that work?
Sandy Bledsoe: So, we were very concerned about that at two different points when there was very public information about a serious event. And we did a number of things at that time, primarily through our operational leaders, although risk management and quality supported those initiatives. And so, we did a number of town halls, a number of listening sessions, tried to gain feedback from people about what they were concerned about, what they were worried about, what they might be angry about, and really took time to listen to our staff and respond to our staff. It was tough, especially early on in some of those very emotional sessions, but it was incredibly powerful and impactful to be vulnerable and to hear what our staff had to say about it, and for us to have an opportunity to respond to them in ways that were helpful and to be vulnerable in a way to say, "Yep, okay. We hear that. We're going to fix that" or "We hear that and here's why we can't fix that," and then, during those sessions, encouraged the reporting even if it's hard, and even in the face of it might be a little scary, to draw it all back to it's the foundation of our safety and quality improvement. And if we don't hear from our staff, then we can't make things better for our patients and our staff.
Bill Klaproth (host): And then, how did you measure it? What were your metrics when you were looking at this event?
Sandy Bledsoe: So, it's actually fairly easy to measure because we have data on reports monthly, daily. We can measure any time interval, the number of reports we are receiving and where they're coming from. And so after that event became very public, we started running reports to see if there was a downturn. And if there was a downturn, where might it be coming from and do we need to do some additional listening sessions with those staff, or do we need to go see them, hear from them, talk to them. But I am really pleased to say we didn't get a downturn. We did not have a downturn in reporting. We measured it on a weekly basis for a number of months, and the reporting numbers actually went up.
Bill Klaproth (host): Wow. How about that!
Sandy Bledsoe: Yeah. We were pleasantly surprised. And I think it was a testimony to our operational leaders being out there with our staff, listening to them and talking to them and providing feedback and follow up to them about concerns that were raised during those sessions.
Bill Klaproth (host): So, I know you said this is embedded in your culture. It's kind of a way of life, but things happen to fall off the radar and things slip as you know. Is there a challenge in maintaining that culture and what do you do to address that challenge of making sure everybody is staying up with this process of reporting?
Sandy Bledsoe: That is an ongoing challenge, especially coming out of COVID, and now that COVID is going to be with us forever, but coming out of that emergency, all of us dealing with staffing issues, all of us dealing with people who are extraordinarily busy and maybe tired and just stretched, it goes back to those fundamentals of what I've already mentioned. So, it's a constant message. It's not something that we say once and then never say it again.
And then, I think one of the things that is most important if we in our organizations can be intentional about providing feedback when those reports come in because that's the most important thing to our staff. "Are you hearing me? Are you listening to me?" And, "Oh, you did do something about that. I'm going to report this the next time as well." And then, to the extent that we can, make it a non-punitive system, right? Just encourage the reporting and we're going to use just culture in how we analyze reports and make systems changes when we can and communicate those.
Bill Klaproth (host): Right. So for someone listening to this who may not have a process of reporting embedded in their culture, is there a first step or can you give some tips or something that you learned along the way that you can pass along to someone to say, "Okay, this is something I learned. Make sure you do this"? Any tips you can pass along to us?
Sandy Bledsoe: So, number one tip is get leadership on board. I've been in this healthcare space for a very long time, and I won't say the number of years, but a very long time. And I remember early on there was this idea of managers or mid-level leaders saying, "Well, you know, you let me know and then I'll determine what needs to be reported," that has to be squelched and really not allowed. Staff members, whomever they are on the hierarchy, whatever their role is, should feel free to call risk management, call quality, put in an integrity line report, put in an occurrence report in whatever system you have. There should be no tolerance for a leader saying, "I'll determine what needs to be reported." And so, again, that starts with the senior leaders buying into that idea and not allowing people to make a decision about what can be reported and what's not. And then, it has to be easy. So, we're always looking for ways to remove barriers. So, we want to make it an easy-to-use system. So, we have our electronic system, and it's an icon on every clinical workstation. So, it's easy. Click the icon when you already might be in there working to report something.
The other thing we've learned is physicians and residents don't necessarily like to do that as well as they may want to talk to somebody. And sometimes it's really important to have that dialogue in real time. So, we have clinical risk managers who are on call 24/7, 365. And so, you can get to a clinical risk manager anytime of the day or night that you might need someone to report something, and we encourage that. And that number is published. Operators know what the number is. We have it on our voicemail if it's outside business hours, that type of thing, again, to remove any barriers. And then, I think it's really important if you have those conversations, that the conversations are helpful, encouraging, not judgmental. We tell everyone when we're talking to our customers, the staff that we're supporting, what we say is, "How can we help you?" It's intimidating to talk to us, just the nature of what we do. We try to remove any of that intimidation that we can by being very open and transparent and kind.
Bill Klaproth (host): That's wonderful and thank you for sharing that with us. And this has really been good, Sandy. Again, thank you for your time. As we wrap up, anything you'd like to add when it comes to encouraging event reporting in the face of adversity?
Sandy Bledsoe: It's an ongoing process and we can't ever let our guard down and say, "We've got it done." It's a journey and we need to get better. And I'm sure there are people who are listening to this who would be able to give us ideas about how they've been able to do it better. But I think it's continuous improvement and continuous thinking, that we have to remove those barriers. We have to continually encourage our staff and recognize where they might be coming from, and just providing them the support in a really tough environment.
Bill Klaproth (host): Very true and well said. Sandy, this has been great. Thank you so much for your time. We really appreciate it,
Sandy Bledsoe: Thank you for asking me. It was a pleasure being with you.
Bill Klaproth (host): And once again, that's Sandy Bledsoe. To learn more, please visit the Vanderbilt website at vumc.org. That's V-U-M-C.org. The ASHRM Podcast was made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management. You can visit ashrm.org/membership to learn more and to become an ASHRM member. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. I'm Bill Klaproth. Thanks for listening.
Bill Klaproth (host): Welcome to the ASHRM Podcast, made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management. You can visit ashrm.org. That's A-S-H-R-M.org/membership to learn more and to become an ASHRM member. I'm Bill Klaproth.
And on this episode, we're going to be talking about encouraging event reporting in the face of adversity with Sandy Bledsoe, Vice President of Risk and Insurance Management at Vanderbilt University Medical Center. Sandy, thank you so much for your time. It is great to talk with you. And this is really an important topic, because reporting is so crucial. So as we start off, right to the big question, how do you develop a culture of reporting?
Sandy Bledsoe: Yeah. So, it's good to be with you. Thank you for asking me to talk about this. So really, here at Vanderbilt, it has been part of our embedded culture for a very long time. It comes from senior leadership at the beginning to encourage reporting. We've got a very robust occurrence reporting policy. We cover that with all new staff members, all new house staff who come in, the residents who come in. We've spent two and a half hours with the residents when they begin to just talk about the whole process, to talk about what happens when events are reported, what we do with that information. We also do that at orientation for our new faculty, our new employed physicians. So, it starts at the very beginning when people onboard with Vanderbilt and then, at every opportunity that risk management has, even if we're asked to talk about something else, we always add in a piece of "Please report, report, report." Our quality folks also help reinforce that message. And so, it's really embedded throughout the culture.
One of the other things that we started doing, which we were probably a little behind the curve on this to be honest, but a few years ago, we made it mandatory that there was documented followup for the events that were reported. And then, finally, what we're doing to just take it to the next level, I think a lot of us have had. We've heard the complaint, "Oh, I reported it in a black box and I never hear anything back." And so, we're developing more intentional feedback that we provide to our staff, so that people look at this information and we act on it and we take actions, based on what they report in addition to thanking them for reporting.
Bill Klaproth (host): Yeah. That is very good and very thorough. I like how you said that it's embedded in your culture and that it starts at the very beginning through the onboarding process and really comes from the top. You said senior leadership has really bought into this. Is that one of the keys to this, Sandy, is having leadership behind your back on this and also ascribing to this culture of reporting?
Sandy Bledsoe: Absolutely. I couldn't do my job unless I had the senior leaders of the organization understand and support the philosophy of the reporting process, even up to the board. The board appreciates it, understands it, and expects it, really. And the idea with us is the more reports, the better.
Bill Klaproth (host): So, Sandy, let me ask you this then. When it comes to this, as you said, you know, process of reporting, it's embedded in your culture, what did you do to encourage ongoing reporting in the settling of a serious nationally reported event? How did that work?
Sandy Bledsoe: So, we were very concerned about that at two different points when there was very public information about a serious event. And we did a number of things at that time, primarily through our operational leaders, although risk management and quality supported those initiatives. And so, we did a number of town halls, a number of listening sessions, tried to gain feedback from people about what they were concerned about, what they were worried about, what they might be angry about, and really took time to listen to our staff and respond to our staff. It was tough, especially early on in some of those very emotional sessions, but it was incredibly powerful and impactful to be vulnerable and to hear what our staff had to say about it, and for us to have an opportunity to respond to them in ways that were helpful and to be vulnerable in a way to say, "Yep, okay. We hear that. We're going to fix that" or "We hear that and here's why we can't fix that," and then, during those sessions, encouraged the reporting even if it's hard, and even in the face of it might be a little scary, to draw it all back to it's the foundation of our safety and quality improvement. And if we don't hear from our staff, then we can't make things better for our patients and our staff.
Bill Klaproth (host): And then, how did you measure it? What were your metrics when you were looking at this event?
Sandy Bledsoe: So, it's actually fairly easy to measure because we have data on reports monthly, daily. We can measure any time interval, the number of reports we are receiving and where they're coming from. And so after that event became very public, we started running reports to see if there was a downturn. And if there was a downturn, where might it be coming from and do we need to do some additional listening sessions with those staff, or do we need to go see them, hear from them, talk to them. But I am really pleased to say we didn't get a downturn. We did not have a downturn in reporting. We measured it on a weekly basis for a number of months, and the reporting numbers actually went up.
Bill Klaproth (host): Wow. How about that!
Sandy Bledsoe: Yeah. We were pleasantly surprised. And I think it was a testimony to our operational leaders being out there with our staff, listening to them and talking to them and providing feedback and follow up to them about concerns that were raised during those sessions.
Bill Klaproth (host): So, I know you said this is embedded in your culture. It's kind of a way of life, but things happen to fall off the radar and things slip as you know. Is there a challenge in maintaining that culture and what do you do to address that challenge of making sure everybody is staying up with this process of reporting?
Sandy Bledsoe: That is an ongoing challenge, especially coming out of COVID, and now that COVID is going to be with us forever, but coming out of that emergency, all of us dealing with staffing issues, all of us dealing with people who are extraordinarily busy and maybe tired and just stretched, it goes back to those fundamentals of what I've already mentioned. So, it's a constant message. It's not something that we say once and then never say it again.
And then, I think one of the things that is most important if we in our organizations can be intentional about providing feedback when those reports come in because that's the most important thing to our staff. "Are you hearing me? Are you listening to me?" And, "Oh, you did do something about that. I'm going to report this the next time as well." And then, to the extent that we can, make it a non-punitive system, right? Just encourage the reporting and we're going to use just culture in how we analyze reports and make systems changes when we can and communicate those.
Bill Klaproth (host): Right. So for someone listening to this who may not have a process of reporting embedded in their culture, is there a first step or can you give some tips or something that you learned along the way that you can pass along to someone to say, "Okay, this is something I learned. Make sure you do this"? Any tips you can pass along to us?
Sandy Bledsoe: So, number one tip is get leadership on board. I've been in this healthcare space for a very long time, and I won't say the number of years, but a very long time. And I remember early on there was this idea of managers or mid-level leaders saying, "Well, you know, you let me know and then I'll determine what needs to be reported," that has to be squelched and really not allowed. Staff members, whomever they are on the hierarchy, whatever their role is, should feel free to call risk management, call quality, put in an integrity line report, put in an occurrence report in whatever system you have. There should be no tolerance for a leader saying, "I'll determine what needs to be reported." And so, again, that starts with the senior leaders buying into that idea and not allowing people to make a decision about what can be reported and what's not. And then, it has to be easy. So, we're always looking for ways to remove barriers. So, we want to make it an easy-to-use system. So, we have our electronic system, and it's an icon on every clinical workstation. So, it's easy. Click the icon when you already might be in there working to report something.
The other thing we've learned is physicians and residents don't necessarily like to do that as well as they may want to talk to somebody. And sometimes it's really important to have that dialogue in real time. So, we have clinical risk managers who are on call 24/7, 365. And so, you can get to a clinical risk manager anytime of the day or night that you might need someone to report something, and we encourage that. And that number is published. Operators know what the number is. We have it on our voicemail if it's outside business hours, that type of thing, again, to remove any barriers. And then, I think it's really important if you have those conversations, that the conversations are helpful, encouraging, not judgmental. We tell everyone when we're talking to our customers, the staff that we're supporting, what we say is, "How can we help you?" It's intimidating to talk to us, just the nature of what we do. We try to remove any of that intimidation that we can by being very open and transparent and kind.
Bill Klaproth (host): That's wonderful and thank you for sharing that with us. And this has really been good, Sandy. Again, thank you for your time. As we wrap up, anything you'd like to add when it comes to encouraging event reporting in the face of adversity?
Sandy Bledsoe: It's an ongoing process and we can't ever let our guard down and say, "We've got it done." It's a journey and we need to get better. And I'm sure there are people who are listening to this who would be able to give us ideas about how they've been able to do it better. But I think it's continuous improvement and continuous thinking, that we have to remove those barriers. We have to continually encourage our staff and recognize where they might be coming from, and just providing them the support in a really tough environment.
Bill Klaproth (host): Very true and well said. Sandy, this has been great. Thank you so much for your time. We really appreciate it,
Sandy Bledsoe: Thank you for asking me. It was a pleasure being with you.
Bill Klaproth (host): And once again, that's Sandy Bledsoe. To learn more, please visit the Vanderbilt website at vumc.org. That's V-U-M-C.org. The ASHRM Podcast was made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management. You can visit ashrm.org/membership to learn more and to become an ASHRM member. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. I'm Bill Klaproth. Thanks for listening.