Archive October 2019 XX, No. 10

Ideas That Work: See It, Solve It

Encourage Staff to Report Safety Concerns

Andrews Institute Ambulatory Surgery Center
EYEWITNESS ACCOUNTS You can uncover vulnerabilities and process gaps by making it easy for staff to report potential safety risks.

If you want your staff to relay safety concerns to you, you need to make it easy for them to report what they see. No one's going to fill out long, detailed forms. You also need to stress that your goal isn't to lay blame, but to prevent harm. Our near-miss reporting form — we call it a "Performance Improve-ment Opportunity Form" to give it a positive spin — does both. (You can download it at

It only takes a few minutes to fill out. Staff simply slap on a patient sticker, note the date and time of the event, and then describe the concern in as much or as little detail as they'd like. They have the option to sign the form or submit it anonymously. Once we receive the form, the risk manager (me) or the administrator follows up. We go into the daily huddles, audit the charts and determine what to change, if anything. The forms sometimes even lead to formal risk-cause analyses.

Barbara J. Holder, RN, BSN, CAPA
Andrews Institute
Ambulatory Surgery Center
Gulf Breeze, Fla.

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