The Influence of Strong Recommendations,Good Incident Reports and a Monitoring System over an Incident Investigation System for Healthcare Facilities

Abstract

Different industry sectors have developed numerous tools for risk management, from simple risk assessments to more complex tools like Failure Modes and Effects Analysis (FMEA) and incident investigation methodologies. Although the healthcare sector deals with a highly risky environment, little has been done in the risk management area if compared to other Industries and service providers with the same level of inherent risk. To overcome these deficiencies, some methodologies have been created to fill the existing gaps in healthcare facilities. One of these tools is the incident investigation and as with any risk management tool, it is highly dependent on the way its results are communicated to the institution's administration and employees. Another shaping factor of the success of the recommendations from an incident investigation process is the follow-up applied after the recommendations are put in place. Even strong systems can fail by not giving appropriate attention for human factors on the design and implementation of recommendations, reports and follow-up procedures. This paper will discuss the importance of the development of strong recommendations after an incident investigation; a specifically designed incident investigation report, appropriate to the characteristics and mission of the institution; as well as the necessary follow-up system for the verification and control of the presented recommendations. Factors like the institution support, employee involvement, strong recommendations and adequate follow-up on the recommendations must be taken into consideration in order to obtain good safety results after an incident investigation.

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