Report 2016-046 Recommendation 5 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 #5 To: Registered Nursing, Board of

To ensure that BRN resolves complaints regarding nurses in a timely manner, by March 1, 2017, it should develop and implement formal policies that specify required time frames for each key stage of the complaint resolution process, including time frames for how quickly complaints should be assigned to the proper investigative unit or expert witness, and how long the investigation process should take. BRN should also work with DOI to establish a reasonable goal for the length of time DOI's investigators take to conduct investigations of complaints referred to it by BRN.

Annual Follow-Up Agency Response From November 2019

The BRN developed and fully implemented formal policies that specify required time frames for each key stage of the complaint resolution process, including time frames for how quickly complaints should be assigned to the proper investigative unit or expert witness, and how long the investigation process should take. BRN worked with DOI to establish a reasonable goal for the length of time DOI's investigators take to conduct investigations of complaints referred to it by BRN.

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

1-Year Agency Response

The BRN developed and implemented formal policies that specify required time frames for each key stage of the complaint resolution process, including time frames for how quickly complaints should be assigned to the proper investigative unit or expert witness, and how long the investigation process should take. BRN has worked with DOI to establish a reasonable goal for the length of time BRN and DOI's investigators take to conduct investigations of complaints referred to it by BRN.

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

Although BRN claims it has fully implemented this recommendation, it did not provide evidence demonstrating that it has. Until it does so, we will continue to assess the status of this recommendation as pending.

6-Month Agency Response

As of March 6, 2017, newly developed BreEZe reports are in full production. Staff is providing individual data reports to management on a monthly basis. Case processing timeframes and the completed case flow maps have been incorporated into the enforcement policy and procedure manuals.

In a meeting on February 10, 2017, with the Division of Investigation (DOI) management and the Board of Registered Nursing (BRN) Intake and Investigation Chief, an agreement was made to establish the Investigation timeframe goal for both DOI and BRN at 240 days. This agreement was confirmed in writing with all parties and documented in the Investigation Unit Procedure Manual.

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

BRN did not provide us with documentation to support its claim that it has fully implemented this recommendation.

60-Day Agency Response

Through collaborative efforts with DCA's BreEZe Business Integrity Analysts (BIAs), Executive management, SOLID staff, and BRN enforcement managers and staff, the BRN has developed the following business processes:

- A detailed workflow mapping of complaint intake and investigation business processes,

- Updated policies and procedures to direct staff action to ensure the assignment of cases to appropriate investigation unit or expert witnesses,

- Ongoing (bi-weekly) communication with BRN staff regarding process improvement and outcomes,

- Updated policies and procedures to include timeframe expectations for each stage of complaint and investigation resolution process,

- A robust set of milestone reports were developed and implemented to track each key stage of the complaint resolution and investigation processes to provide management with accurate data regarding case processing timeframes,

- An average of 240 days was established as a reasonable goal for DOI and BRN to complete the investigation process. BRN and DOI will continue to work collaboratively to examine ways to improve efficiencies.

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

Although BRN developed formal policies that specify time frames for some key stages of the complaint resolution process, it did not specify time frames for how quickly complaints should be assigned to the proper investigative unit. Further, BRN could not provide evidence demonstrating that these policies have been approved by, for example, the board or the executive officer, and have been distributed to staff.

All Recommendations in 2016-046

Agency responses received are posted verbatim.