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CIRS Guidance - Part 6: Planning, Training, & Implementation

I.  Planning

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.

II.  Training

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
> Management
> 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 shown in the following table

    

ContentAll EmployeesManagement 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 basisFactual
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.

III. Implementation

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.

Source: 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 www.aps-ev.de)

MedRisk Report by Mindy Nunez Duffourc