About 20 years ago, during a consulting visit to a long term care community, the Director of Nursing was sitting at a computer (rare back then) entering incident data into a spreadsheet. When I asked what she was doing, she said, "My QA reports are due today and I haven’t input any of the incident data. I usually take the reports home and update the spreadsheet, but I ran out of time."
When I reviewed the spreadsheet it was pretty impressive. It allowed me to identify trends and produce graphs and charts. It was all that and a bag of chips!
But there are serious issues with spreadsheets. Let’s talk about the pitfalls of using spreadsheets for tracking and trending incidents and accidents in our communities.
As I tried to get my head around the risks associated with spreadsheets, I decided to consult Google and was amazed at how many search results there were. Many of these articles and blogs are written by academicians who discuss both pros and cons of spreadsheets. Let’s take a look at the pitfalls and see how they impact what we do on a daily basis.
Risks of Using Spreadsheets
For many small organizations like the community above, Excel is a great tool to use and the downsides are manageable. However, for larger organizations—particularly those where the task of data collection is spread across several people and locations—the biggest challenge is the quality of the data.
Poor data quality can occur for several reasons.
- Data may simply be missing or reported late. Managing this often means using multiple spreadsheets. One template is sent to each person to enter their data and a master file is used to aggregate information from the different sources. I don’t need to tell you about the manager who is always late or has a tendency to rationalize situations. This is probably one of the biggest challenges when it comes to ensuring quality data.
- Once the templates are consolidated into the master file, tracking needs to tell us if all parties have entered their data. This can become increasingly difficult as your organization grows.
- It's easy to make errors when cutting and pasting or manually entering data from one source sheet into a summary spreadsheet. How do you feel about your DON taking incident reports home to input the data into a spreadsheet? Make you nervous? It should!
- There's a risk of inconsistent data being entered on the spreadsheet. It's not uncommon to have interrelated spreadsheet data scattered across different folders, offices, and communities. So even if you're sure you gathered all of the spreadsheet data, tracing the logic of formulas from one place to another can be difficult.
- There's also a risk of data entry errors. Scenario: The DON is sitting at her kitchen table entering data into a spreadsheet on her laptop. Sometimes it's hard enough just to watch the evening news when the family is home, so ensuring accuracy in data entry might be a leap!
- Spreadsheets aren't designed for collaborative work. Planning, forecasting, trending, reporting, etc. are all collaborative activities. This process usually requires information from different individuals at multiple communities, which can result in errors—including duplicate or erroneous data.
- In a spreadsheet environment, it can be very time consuming to extract data from different departments, consolidate it, and summarize the information to aid the community in making sound decisions. I’m not aware of a single community where staff are waiting for something to do. The ROI for graduating from a spreadsheet process to a web-based process speaks volumes!
- Because we know how susceptible spreadsheets are to errors, everyone involved in the information processing must be ultra careful to keep the integrity of the data intact. This adds hours to the process as staff are busy—and it can be daunting to find the time to sit in a quiet environment with sensitive HIPAA information.
- The end users of the typical spreadsheet usually aren't IT specialists and aren't familiar with storage and backup best practices. If a major disaster strikes, full data recovery can be very difficult, if not impossible. What if your system isn't backed up per expectations and data is lost—how does your QAPI committee manage their quality improvement efforts without the data?
You can have quality assurance reports with the push of a button. Imagine being able to identify negative trends in real time, allowing quality improvement efforts to be initiated. How about initiating a History of Past Non-Compliance when a negative trend is identified in real time?
This process is a great way to avoid citations—but only if it's initiated in a timely manner, and trending and reports show that the deficient practice was corrected. QA Reader can make that happen.
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