Report 2016-046 Recommendation 12 Responses

Report 2016-046: Board of Registered Nursing: Significant Delays and Inadequate Oversight of the Complaint Resolution Process Have Allowed Some Nurses Who May Pose a Risk to Patient Safety to Continue Practicing (Release Date: December 2016)

Recommendation #12 To: Registered Nursing, Board of

To ensure that it is able to accurately monitor the performance of its complaint resolution process and that it has accurate data to address its staffing needs, BRN should immediately begin working with Consumer Affairs to implement cost-effective input controls for BreEZe that will require BRN staff members to enter information into a complaint record in a way that is consistent with BRN's business processes, as well as to implement changes that would cause BreEZe to accurately identify the order in which activities occur.

Annual Follow-Up Agency Response From November 2019

To ensure the BRN is able to accurately monitor the performance of its complaint resolution process and has accurate data to address its staffing needs, the BRN worked with Consumer Affairs to implement cost-effective input controls for BreEZe which requires BRN staff members to enter information into a complaint record which is consistent with BRN's business processes and the BRN implemented changes that would cause BreEZe to accurately identify the order in which activities occur.

California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented

Annual Follow-Up Agency Response From October 2018

BRN's BreEZe subject matter experts worked with the DCA's business integrity analysts to develop activity code functionality to allow stop gap controls in the BreEZe system which will accurately identify the order in which activities occur. Prioritization of BreEZe activities is a global issue that will impact all DCA boards and bureaus that utilize the BreEZe system.

A System Investigation Request (SIR) was submitted by BRN on December 16, 2016 to DCA which was approved to go to the BreEZe vendor for scope-of-work review and approval. The BreEZe vendor returned the SIR with the scope-of-work approved and changes were then submitted as a work authorization to the BreEZe project Change Control Board to approve. The Change Control Board, comprised predominantly of leadership from Boards and Bureaus, approved the Work Authorization to be forwarded for Impact Analysis. The Impact Analysis was completed. The BRN continues to work towards updating the business process and evaluate the cost-effectiveness of implementing this practice.

The implementation of this type of change typically takes at least one year to complete. The enforcement user group approved the final system design for the work authorization in November 2017. The BRN subject matter expert completed the process to approve the final system design in May 2018. Based on this SIR's priority and level of effort, DCA anticipates implementing this change in Spring 2019.

California State Auditor's Assessment of Annual Follow-Up Status: Pending

1-Year Agency Response

BRN Breeze Subject Matter Experts (SMEs) worked with the DCAs Business Integrity Analysts (BIA) to develop activity code functionality to allow stop gap controls in the BreEZe system which will accurately identify the order activities occur. Prioritization of BreEZe activities is a global issue that will impact all DCA boards and bureaus that utilize the BreEZe system. Implementing stop gap controls requires approval from the following workgroups: DCA's Enforcement User Group and Reports User Group, BreEZe Vendor, and Change Control Board.

A System Investigation Request (SIR) was submitted by BRN SMEs on December 16, 2016, to DCA which was approved to go to the BreEZe Vendor for scope-of-work review and approval. Once the BreEZe Vendor returned the SIR with the scope-of-work approved, changes were then submitted as a work authorization to DCA's Change Control Board to approve the BreEZe stop gap controls. The Change Control Board approved the Work Authorization to be forwarded for Impact Analysis. This Impact Analysis is currently pending. The BRN will continue to work with these groups to update the business process and evaluate the cost-effectiveness of implementing this practice.

Per DCA, the implementation of this type of change typically takes at least one year to complete. The enforcement user group has approved the final system design for the work authorization as of November 2017.

Target completion date is September 2018.

California State Auditor's Assessment of 1-Year Status: Pending

6-Month Agency Response

BRN SMEs worked with the DCAs Business Integrity Analysts (BIA) to develop activity code functionality to allow stop gap controls in the BreEZe system which will accurately identify the order activities occur. Prioritization of BreEZe activities is a global issue that will impact all DCA boards and bureaus that utilize the BreEZe system. Implementing stop gap controls requires approval from the following workgroups: DCA's Enforcement User Group and Reports User Group, BreEZe Vendor, and Change Control Board.

A System Investigation Request (SIR) was submitted by BRN SMEs on December 16, 2016, to DCA which was approved to go to the BreEZe Vendor for scope-of-work review and approval. Once the BreEZe Vendor returned the SIR with the scope-of-work approved, changes were then submitted as a work authorization to DCA's Change Control Board to approve the BreEZe stop gap controls. The Change Control Board approved the Work Authorization to be forwarded for Impact Analysis. This Impact Analysis is currently pending. The BRN will continue to work with these groups to update the business process and evaluate the cost-effectiveness of implementing this practice.

Per DCA, the implementation of this type of change typically takes about one year to complete.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

BRN SMEs have worked with the BIAs to develop activity code functionality to allow stop gap controls in the BreEZe system which will accurately identify the order activities occur. Prioritization of BreEZe activities is a global issue that will impact all DCA boards and bureaus that utilize the BreEZe system. Implementing stop gap controls will require approval from the following workgroups: DCA's Enforcement User Group and Reports User Group, BreEze Vendor, and Change Control Board. A System Investigation Request (SIR) was submitted by BRN SMEs on December 16, 2016, to DCA which was approved to go to the BreEZe Vendor for scope-of-work review and approval. Once The BreEZe Vendor returned the SIR with the scope-of-work approved, changes were then submitted as a work authorization to DCA's Change Control Board to approve the BreEZe stop gap controls. The Change Control Board approved the Work Authorization to be forwarded for Impact Analysis. This Impact Analysis is currently pending. The BRN will continue to work with these groups to update the business process and evaluate the cost-effectiveness of implementing this practice. Per DCA, the implementation of the process typically takes about one year to complete.

California State Auditor's Assessment of 60-Day Status: Pending

All Recommendations in 2016-046

Agency responses received are posted verbatim.