Healthcare Safety Incidents

Existing usability issues

• The existing reporting form required users to categorize the incidents according to an enormous taxonomy of 2000+ event types, organized into a hierarchy. Users had difficulty finding the correct path through the taxonomy, frequently “pogo-sticking” throughout the taxonomy to try to find how Quantros had categorized an event type. This information was required in order to save a draft of the report, so there was a high rate of abandonment.
• The form was not well organized. Critical questions did not come first. Similar information was not grouped logically. Users didn’t know how many questions remained (depending on the answers they selected, additional questions displayed).
• Questions and answer options on the form were often unclear. Sometimes this was due to ambiguous wording. Some questions were so poorly constructed that the hospitals did not rely on the answers, but the form still required an answer. Some questions had multiple choice answers which were very detailed and required users to carefully read paragraphs in order to differentiate between options.

How users’ issues were addressed

• Designed a new form for reporting incidents. The UX team defined personas and user scenarios, created interactive prototypes of the new form in Axure, and wrote user stories in Rally. We brainstormed with engineers and determined a way for the system to predict the most likely safety event category for the incident based on the user’s description of what happened. Top matches were displayed, allowing the user to either select one or to search/navigate the taxonomy for alternatives (a “smart classification” system).
• We organized the form into 3 sections. The first section was limited to crucial information only, and once completed, users could save and complete later. The second section was the Smart Classification, where the system suggested the event type based on the information in section one. Users were able to either select from the suggestions or navigate the taxonomy to select something different. We designed a new UI control which allowed very fast and flexible navigation of the 3-tier hierarchy. The third section of the form was dedicated to the specific follow-up questions for the selected event type. For instance, the questions posed for a patient falling were different from those for a medication mistake.
• Revised the taxonomy. This work was led by the chief medical officer, collaborating with other medical professionals to ensure accuracy. Duplicate terms were eliminated; similar but different terms were revised to make clear their differentiation; the number of top-level categories were reduced; new safety event categories were added.
• We reviewed all questions on the form and made improvements to wording, ensured the UI control was appropriate (i.e., checkboxes vs. radio buttons), and designed custom controls in some cases, such as providing illustrations to increase accuracy and speed up data entry. Content experts did a final review of questions in context of how they would appear on the form.
• The form to report was built with responsive design to ensure it worked on mobile tablets (standard equipment for nurses in many hospitals) or smartphones.