TPSC as an expert partner in patient safety

For a large hospital such as Amsterdam UMC, location AMC, it is a major challenge every day to steer all processes for external and internal stakeholders in the right direction. Its staff of more than 10,000 people treats 160,000 patients every year.

In addition to navigating the dynamics of patient care, the hospital also performs research and education. The AMC must meet a large number of internal and external quality requirements, and it maintains more than 120 safety committees to accomplish its quality and safety goals.

The AMC found the solution for its needs with the software of The Patient Safety Company (TPSC). With this software platform, the hospital got exactly what it was looking for: flexibility in the many features that help it to respond easily to external and internal changes, a high level of security, and compatibility with internal and external systems.

Why did AMC choose the TPSC platform?

Based on market research in 2007 among all the major suppliers in this field at the time, The Patient Safety Company software emerged as the most flexible, with the most feature options and building blocks. In addition, the platform was best able to guarantee privacy for the reporters and handlers who work within the system.

The most important conditions that the AMC required of the TPSC platform initially are summarized:

1. Flexibility;
2. User-friendliness;
3. Clarity;
4. Security;
5. Ability to link with other systems (compatibility);
6. As little downtime and data loss as possible.

The AMC has a total of about 7,000 (near) incident reports per year, divided into 12 different reporting categories. For every report created, the TPSC platform offers flexible solutions with the freedom to customize the outputs for interpretation.

To what extent does the platform meet expectations?

“Over the past 12 years, the software has delivered exactly what we wanted and expected. We have a flexible and fully-fledged reporting system. Each type of report has its own reporting process and handling, and the set-up it needs. The best part is that the software can be adapted to our work processes instead of having to adapt our work processes to the software. This is an absolute condition in terms of user-friendliness, which of course also benefits the willingness to report and to deal with it.” (Marcel Adema, Application Manager IMS)

How does TPSC Cloud software help with the daily challenges?

The AMC uses the software for the following example tasks, among others:

• Reporting and handling of (near) incidents;
• Reporting and handling of events;
• Reporting and handling of suspected child abuse and domestic violence;
• Reporting and handling of complaints, claims, and disciplinary proceedings;
• Registering and handling of occupational health and safety reports and aggression reports;
• Reporting and handling of deviations within and between laboratories;
• To introduce, monitor, and evaluate improvement measures.

The platform offers a great deal of support for retrospective risk analyses of the reported (near) incidents. The AMC can immediately see whether the measures to prevent a risk have worked, and whether the prospective risk analysis was therefore adequate.

The biggest and most important challenge, according to the AMC, is to align its safety committees for every type of report that is generated. For example, it coordinates more than 100 safety committees for care incidents alone. TPSC software allows AMC to find a common way to register events, handle the data, and report on undesirable outcomes. It is also important to be able to meet the wishes and requirements of all parties involved. This entails having good overviews, on the basis of which a risk matrix can be made, priorities can be set, and trends can be analyzed.

Space and freedom for your own wishes

Within its framework, the TPSC platform offers sufficient space and freedom to meet the wishes and requirements of all parties, without compromising on a generic workflow. Think, for example, of the varied workflows among laboratories. TPSC enables each to record its own laboratory-specific actions. Another example: Each medical department can create department-specific reports whereby they can only view their own data.

Flexible solutions

The biggest advantage of TPSC Cloud is that it can easily accommodate workflow changes or entirely new work processes. Thanks to the many options and building blocks, it is possible to respond well to both external changes (such as amended legislation and regulations) and internal changes (such as department shifts).

A high level of security

The advantage of a cloud solution is security: It meets the strict security requirements of the Security Architect as well as the strict privacy requirements of the Data Protection Officer. AMC cites other security-related advantages of the TPSC Cloud, including the following:

• Platform-wide, it shows which individuals have made a login attempt, as well as when and whether the login was successful
• For each app, the organization can set up to any desired level of detail who has access to which functionality, to which notifications and to which notification sections, and who can read, change and/or delete information
• Audit trails per report immediately provide insight into who has done what with the content of the report
• An app-wide audit trail clearly shows which functional adjustments have been made by the administrators and/or supplier, and when they were made

Compatibility within the IT landscape

TPSC Cloud uses various links with other AMC internal databases, a medication file link with the Electronic Health Record (EHR), and (until recently) with several national databases. In addition, using TPSC, the hospital can create all database connections it needs without the help of TPSC and without additional costs. For links with internal and external systems, the AMC has used HL7, SOAP, a file link, Surfconext/ADFS and an Office365 link. In addition, the use of XML links is also possible.

Follow up on improvement measures

The AMC has developed 13 apps on the TPSC Cloud platform, including six that are extra-large in size and encompass advanced workflows for, among other things:

• Care incidents
• Laboratory abnormalities
• (Patient) complaints
• Occupational health and safety reports
• Reports of domestic violence or child abuse
• Claims and disciplinary proceedings
• Security incidents
• Improvement measures

The AMC also uses an improvement-tracking module app to monitor the follow-up of the improvement measures resulting from the retrospective analyses. This app supports the implementation, follow-up, monitoring, and evaluation of the improvement measures.

What are the most important benefits of TPSC Cloud for your healthcare institution?

According to the AMC, the main added value of the TPSC Cloud is the flexibility it offers while maintaining adequate shielding and security of data, and the possibility to exchange data with linked systems. But there are even more advantages of the software:

The common thread is flexibility

A tailor-made approach can be built in for each type of report, by giving it its own app, with its own report form, its own workflow, its own role and rights classification, and its own design.

Clear reporting

In addition, the dashboard of each app clearly shows what the outstanding notifications are and, based on the seriousness, in which order they can best be handled. Generic reports can also be created for 100+ departments, in which each department only sees the messages it is allowed to see.

Complete and central insight

Each report in itself is a complete file, because it contains all the relevant information and because all actions during its processing can be performed within the file. For example, photos and sound clips can be added and it is clearly visible which steps the committees have taken, with whom and when, for example via email exchange.

Awareness

The TPSC Cloud software shows which unwanted events have occurred, how often they occur, and what their consequences were (and what the consequences could have been). This makes healthcare workers and management more aware of the current risks and indicates how they can be prevented or reduced in the future.

How is the collaboration with The Patient Safety Company?

“Not only is the software flexible, the employees of The Patient Safety Company are too. They are thoughtful and are always there for us.” [Drs. Liesbeth Flippo, Staff Advisor Health Support Department]

“The personal approach and the lines of communication are special, and no effort is too much for them. They always take the time to listen to our wishes and needs. Or they come up with good proposals themselves and are open to suggestions.

In the experience of the AMC, they then deliver good work within the stipulated period and provide regular feedback on the state of affairs. That way, you always know where you stand. TPSC employees keep to the agreements made and also keep promises. They are open, reliable, and honest, especially in the financial field, and they are willing to go the extra mile if necessary.

In addition, our regular TPSC consultant and a few people within TPSC know exactly how our organization, our platform, and our apps work so that we do not have to explain our story again and again. In short, TPSC offers very good value for money.”

What barriers do you experience with TPSC Cloud software?

According to the AMC, in some departments there was a misconception that the software can be used only for registering and reporting incidents—that it was nothing more than a registration system.

By showing the advanced workflows that the software can support, with the amount of building blocks and options, the AMS reports that users now see TPSC software as a flexible app that can be used as an advanced system with all kinds of business logic.

Beyond the incidents, complaints, deviations, and improvement measures that the platform is capable of handling, it can be used in other ways. Amsterdam UMC, location AMC, uses it for the registration of:

• Customers and employees;
• Incoming and outgoing goods;
• (Sick) leave requests;
• Employee training.

Initially, employees feared that the platform would be used as an employee tracking system, whereby staff could be held accountable for mistakes made. But by introducing the basic principle of “Reporting Safe Incidents” from the start (which prevents managers from gaining access to data that can be consciously or unconsciously discussed in annual interviews), the departments could be reassured.

What are the most important learning points for the hospital?

According to the AMC, they are most proud of the collaboration of 12 labs it brought together by using the same app. Before that, they didn't work together completely and were not even completely digital. The app provides a generic way of working, gives more uniformity, entails little or no manual work, and provides a greater overview. Simultaneously, the laboratories still have enough space and freedom to meet their own goals and requirements.

Every hospital or healthcare institution has a different organizational structure. Yet the lessons learned can be universal. Therefore, here are a few key learning points from the Amsterdam UMC, location AMC.

1. Start with a prototype app
   It didn't work for the AMC to develop all details in each app before launching it. The workflows and features only really came to life for users when they could see something tangible and concrete in front of them. As a result, the AMC first made prototypes based on its initial needs, which were then refined within each customer department.
2. Think carefully about the questions on the form
   It is important to first clearly list the form questions that are truly necessary for each phase of registering, handling, and reporting on incidents. It helps to consider in advance what information will be required to substantiate the General Data Protection Regulation. In addition, the AMC advises using the same formulation and question type on forms to the extent possible (for example, multiple-choice or text box). Doing so facilitates easier report preparation organization-wide for all types of reports, within all departments and divisions.
3. Provide user support
   It may sound logical, but an app can be successful only if there is enough support and the timing of its use is right. The possibilities within the TPSC Cloud platform can help to generate enthusiasm, but if you fail to prepare users and generate support for it, you will miss an important connection. Moreover, prepare your response to potential resistance before rollout. Trying to manage resistance after the fact can also create a missed opportunity.
4. Pay attention to near misses
   Near incidents can be experienced as less urgent, especially if the situations did not escalate. But experience shows that near incidents should be treated as urgently as "real" incidents, because barriers existed to prevent things from going wrong. It is precisely by strengthening these already-present barriers that you can prevent a recurrence (and more serious consequences) in the future.

Learn more about TPSC Cloud?

Do you have any questions about this Amsterdam UMC case study? Or any other questions about quality and risk management? Our specialists are happy to help you.

For more information about patient safety, our Patient Safety topic page offers a step-by-step plan.

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