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 8: Participation in Inter-facility Reporting and Learning Systems
In addition to operating their own internal reporting and learning systems, health care institutions should also use cross-institutional, regional and/or national reporting and learning systems. Examples of such systems include the hospital CIRS network in Germany, CIRRNET in Switzerland or CIRSmedical.at in Austria. Networks of reporting and learning systems are highly relevant, because more and more health care institutions are realizing that they do not have to make every mistake themselves, but can learn from others’ mistakes. By creating a network of locally operated reporting and learning systems that includes different health care institutions, providers can take appropriate measures to prevent the occurrence of similar incidents in their own operations.
Reports from local reporting and learning systems can be merged and analyzed in much larger regional or national systems. The advantage of combining data into regional or national systems is the wealth of data that becomes available for analysis. A particular strength is its ability to identify error-causing patterns at a regional or even national level, which occur too rarely to be identified on the local level.
The main goal of a network is to learn from each other through the reciprocal willingness to share knowledge. Health care institutions should agree to this shared goal before they choose to join a network.
Networks offer participants the following benefits:
- Valuable synergies: use of reports for in-company learning purposes and professional and expert information exchange;
- Possibility of learning from each other and error prevention: insight into the reports and associated improvement measures of all network participants;
- Strength through cooperation: identification of cross-regional problem areas in patient safety and common approaches.
The requirements for participation are as follows:
- Commitment of management and definition of objectives regarding the purpose of participation in a network;
- Willingness to enter their own reports and improvement measures into the network;
- Definition of a minimum data set for forwarding to the network;
- Trust in network management (network identity);
- “Give and Take “principle: reports from the institutions will be forwarded to the network for the exchange of experiences and possible solutions;
- The affiliated institutions use the network by drawing on reports from other institutions for internal quality and risk management and, where appropriate, deriving and implementing prevention measures or using the reports for learning purposes.
IV. Country-specific Approaches
The Patients’ Rights Act of 20 February 2013 stipulates that participation in “cross-institutional error reporting systems which are particularly suitable for identifying risks and sources of error in inpatient care” shall be promoted by means of remuneration allowances. The requirements for these systems must still be determined by the Joint Federal Committee (as of June 2016).
The regulations of the Joint Federal Committee, which came into force on 21 July 2015 address the topic of participation in error reporting systems across institutions. In the quality report, you must specify whether a hospital uses a cross-institutional error reporting system in addition to the internal error reporting system. In addition, you must specify which cross-institutional system is used.
Since 2008, the Austrian Medical Association has been offering a nationwide anonymous error reporting and learning system (www.cirsmedical.at) across all institutions and based on voluntary participation. Health professionals have the opportunity to report incidents anonymously.
In Switzerland, there are isolated hospital networks or hospitals with different locations and medical associations which operate a local network on a smaller scale or a specialist level network. CIRRNET® is the only inter-institutional and supra-regional network of local reporting and learning systems in Switzerland. It is operated by the “Patient Safety Switzerland” and enables the affiliated health care institutions to network on an organizational and professional level for learning from mistakes.
The local CIRS reports forwarded to the CIRRNET® database are anonymised with the aim of making this wealth of experience available to all CIRRNET® participants involved. All CIRS reports are edited by the CIRRNET® management and published in the closed user area of the CIRRNET® homepage (www.cirrnet.ch). The CIRRNET® reports can be used directly and independently for learning in the local context. In addition, identified hot spots in the overall network are processed by CIRRNET® management and in cooperation with experts, practical recommendations for action (Quick Alerts®) are developed and published by Patient Safety Switzerland. CIRRNET® thus produces generally available knowledge to improve patient safety and to further develop the safety culture in the health care system.
Like all reporting and learning systems, CIRRNET® as a network is not an instrument for measuring, evaluating or monitoring the safety of service providers in Switzerland. CIRRNET® is a learning platform to collect, generate and disseminate knowledge. In this way, the culture of safety in health care facilities is sustainably developed into a culture that makes patient safety an integral part of patient care.
*This is the last part of this series. You can start with the first part here.
 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)