Note: This series contains translated excerpts and summaries from the original German-language guidance. The content, organization, and names of the parts and subparts in this series are not identical to that of the original guidance.
Part 6: Establishment of a Reporting and Learning System: Planning, Training, and Implementation
It is useful to test the CIRS system through implementation of a pilot program in a department(s) before extending the program to the entire institution. The pilot program will identify strengths and weaknesses that can be evaluated and addressed to stabilize the system prior to full implementation. The pilot program and rollout plan for full implementation should be developed together.
The Pilot Department(s)
Experience shows that there are different levels of safety culture within an organization. The pilot program should be implemented in departments that already have a proactive safety culture as well as an expressed interest in participating in a reporting and learning system. Pilot program planning must be coordinated with the department’s management and the employees should be informed about the planned pilot program early on.
The Implementation Team
It is important to find qualified employees within the organization who have a high level of trust and acceptance with their colleagues as well as patient safety and risk management expertise. Because the same criteria apply to members of the CIRS teams, the implementation team members can later be appointed to the future CIRS teams.
Training is required prior to the start CIRS and should be offered in regular cycles. CIRS training should also be incorporated into the training of all new employees. The planning phase should identify who is providing the training courses. For the training of top management, it may be useful to utilize external experts to increase acceptance and guarantee neutrality. Depending on the size of the institution and the resources available, further training can be provided by internal staff members who are trusted by the management and the employees (i.e. from the central team).
The content and scope of training depends on the target group being trained. The main target groups are:
- Implementation and CIRS team members
- All other employees involved in direct or indirect patient care (nursing, medical service, therapy, pharmacy, laboratory, blood bank, medical, etc.)
Training content should be conveyed in different depths and to varying degrees to prepare each target group for their future roles and tasks in the CIRS system. Training content for the various target groups are listed in the table below:
|Content||All Employees||Management Personnel||CIRS Teams|
|Objectives and purpose of the reporting and learning system||Operational knowledge||Operational knowledge||Leadership skills|
|Principles of the reporting and learning system||Operational knowledge||Operational knowledge||Leadership skills|
|Organization of the CIRS, workflow and further processing of the reports||Factual knowledge||Operational knowledge||Leadership skills|
|Contents of the reports (What should be reported?)||Operational knowledge||Operational knowledge||Leadership skills|
|Legal basis||Factual knowledge||Factual or operational knowledge||Leadership skills|
|Anonymization and de-identification in case processing||Factual knowledge||Factual knowledge||Leadership skills|
|Dealing with reported damages and controversial reports||Factual knowledge||Factual knowledge||Leadership skills|
|Case analysis (e.g., adapted to London protocol)||Factual knowledge||Factual knowledge||Leadership skills|
|Results and measures from the case analysis (feedback)||Operational knowledge||Operational knowledge||Leadership skills|
|Interfaces of the reporting and learning system||Operational knowledge||Operational knowledge||Leadership skills|
|Interdepartmental reporting and learning systems||Factual knowledge||Operational knowledge||Leadership skills|
In addition to CIRS training, employees should be informed generally about the planned implementation procedure, timeline, and system organization through information sessions prior to the start of CIRS. These information sessions help ensure transparency.
Depending on the implementation plan, CIRS will begin in the pilot departments or throughout the facility. CIRS teams should plan regular meetings and ensure that even with different duty rosters, the team is able to work (i.e. set a minimum team roster). In addition to regular meetings, meetings should occur as needed based upon CIRS reports. An additional confidentiality agreement or statute can support the work and discussion in the CIRS teams.
From the outset, a regular exchange between the different reporting teams and the central reporting system is essential to ensure the transfer of interdepartmental knowledge as well as the exchange of the reporting teams’ experiences.
Because CIRS in only an instrument of clinical risk management, the identified risks and preventive measures derived from the system need to be incorporated into the institution’s overall concept of quality and clinical risk management. This is the responsibility of the local CIRS teams.
Regular evaluations of the system give an early overview of CIRS implementation by exposing initial impressions about the acceptance and the effectiveness of CIRS and areas that need improvement. Likewise, it is helpful to inform employees transparently and continuously on the work of the CIRS system and the CIRS teams. If recommendations and binding measures are derived and implemented from CIRS reports, employees should receive prompt feedback regarding those recommendations and measures.
 Aktionsbündnis Patientensicherheit, Plattform Patientensicherheit, Stiftung Patientensicherheit (Hrsg., 2016): Einrichtung und erfolgreicher Betrieb eines Berichts- und Lernsystems (CIRS). Handlungsempfehlung für stationäre Einrichtungen im Gesundheitswesen, Berlin (available for download at http://www.aps-ev.de)