According to Multiple Sources

“There’s three sides to every story, babe: there’s yours and there’s mine and the cold hard truth.”

—Don Henley, Long Way Home

Ifthere is an upside to the mushrooming of “fake news,” it is the increasedawareness that reliance on a single source of information (even a trustworthysource) is inferior to seeking multiple perspectives. Facts or data points are(generally) more credible when derived from diverse data sets.

Inthe 1970s, Norman Denzin, a sociology professor, investigated the concept of triangulation—longused for navigation purposes—as a research technique. He and subsequentinvestigators understood that arriving at the same conclusion via differentpathways boosts our confidence that we are accounting for the bias orlimitations of any individual route. This is particularly poignant in the studyof patient safety, where a single safety study or report draws attention, or anisolated tragedy triggers calls for action before the breadth and depth of theproblem is understood.

Ofcourse, health care providers cannot simply ignore a single patient safety datapoint—or dismiss it as “fake news.” But raising alarm or directing resources toa potential problem that has not been verified or validated or triangulatedwith other data sources can be counterproductive. Enthusiasm for processimprovement or behavior change will wane without confirmation that that singleincident or data point is borne out by other information. Optimally, multipleinformation sources highlight a common, fertile issue or risk that paves theway for the sustained attention of multiple parties.

Fortunately,health care leaders have access to a rapidly expanding array of data sources totap into. In addition to malpractice data, many organizations (including PSOs) can employ incident reports, patient complaints,root cause analyses, and a whole raft of quality and regulatory metrics. Withsome forethought, the terms and taxonomies used to populate these databases canbe standardized (or mapped) so that apples can be compared to apples.

Whenfeasible, advanced analytic studies pulling from multiple data sets offer extraordinaryopportunities to tease out precise risk factors and hidden vulnerabilities. Butin many circumstances, you might just want to be able to point to the fact thatthree or four independent databases highlight the same broad problem area. At aminimum, triangulation puts your patient safety efforts on the right track tothe points where you need to dig deeper.

Additional Material

• The association between patient safety indicators and medical malpractice risk
• Examining proneness to malpractice claims
• Investigating selected patient safety indicators using medical records data
• The use of triangulation in qualitative research [abstract]
• What to do with healthcare incident reporting systems
• Patient complaints in healthcare systems: a systematic review and coding taxonomy
• EHR data better for sepsis surveillance than claims data