Week Dec 6 to Dec 10

Type of experience: Onsite

Total hours this week: 6

Running total hours at this location: 6

Running total hours of all practicum experience: 6

Reflection:

For my first week at Sharp, I got to meet my supervisor Hazel Blackwood who is the

director of quality for the Sharp Rees-Stealy clinics in San Diego. We discussed various projects

that her department was working on and potential capstone projects that I can pursue. I was also

shown how to utilize touchworks and given a tour of the facility. The analysts use an application

called RL which stands for Real Learning, this is where Sharp employees submit any patient

safety events for review. Hazel suggested that I could go through RL and look to see if there

were any patient safety events that I was interested in and could conduct an investigation with

another
Week Dec 13 to Dec 17:

Type of experience: Remote and Onsite

Total hours this week: 8

Running total hours at this location: 14

Running total hours of all practicum experience:14

Reflection:

For this week of my practicum, I had the opportunity to meet the staff of the quality

department at Sharp. The quality department has two senior analysts that are tasked with

reviewing RL and ensuring that corrective actions were taken in order to prevent the events from

reoccurring. They also go out and conduct investigations if the problems has persisted several

times. There investigation involve talking to staff and going through the processes to identify

potential errors.
Week Jan 3 to Jan 7:

Type of experience: Remote

Total hours this week: 8

Running total hours at this location: 22

Running total hours of all practicum experience: 22

Reflection:

For this week of my practicum, I participated in RL chats and the daily Quality Analyst

huddle. The RL chats is a meeting that is put on two times a month that allows for Sharp

employees to learn more about how to use RL and how to properly report a patient safety event.

This was a great opportunity to interact with other Sharp employees and learn more about RL.

The daily quality analyst huddle is conducted every morning at 8am. The quality analysts and

lead patient advocate participate to discuss current RLs and tasks that need to be completed.
Week Jan 10 to Jan 14:

Type of experience: Remote

Total hours this week: 12

Running total hours at this location: 34

Running total hours of all practicum experience: 34

Reflection:

For this week at my practicum, I worked on some exercises regarding failure mode and

effect analysis and root cause analysis and participated in the daily quality analyst huddle. In

previous classes I have presented on failure mode and effect analysis and root cause analysis.

This has been a topic that I have been interested in and was glad that I was provided more

material to learn more about these methods. I was given several videos that gave an overview of

each topic and documents on how Sharp uses these methods. I also participated in the quality

analyst huddles, this week we discussed various safety events and I got more insight on what the

role of a quality analyst is.

Week: Jan 17 to Jan 21

Type of experience: Remote

Total hours this week: 8

Running total hours at this location: 42

Running total hours of all practicum experience: 42

Reflection:

For this week I only participated in the quality analyst huddle and met with Hazel to talk

about potential RL that could be my topic for my capstone. The quality analysts huddles are a

good way for me to understand how the analysts review safety events and also how they fill out

their root cause analysis forms. The analysts also provide a unique perspective because they are

previous nurses. Hazel and I also talked potential capstone ideas, I wanted to focus on a topic or

an event that is a reoccurring event. I wanted to have the opportunity to work on a project that

could be implemented by Sharp.

Week: Jan 24 to Jan 28
Type of experience: Remote

Total hours this week: 8

Running total hours at this location: 50

Running total hours of all practicum experience: 50

Reflection:

For this week I completed the student orientation and also participated in the daily quality

analyst huddle. For the student orientation we reviewed all the points on the checklist that was

provided from the school. Although the school requires a cerner orientation, Sharp Rees-Stealy

does not use cerner they use another application called touchworks. This was interesting to me

because Sharp is not just clinics but they also have several hospitals and I was unsure why they

did not all use the same application. I was informed then by my preceptor that Sharp is actually

going to be switching over to Epic next years. This topic was also brought up during the quality

analyst huddles because a lot of the suggestions and process improvement includes making

changes to the EHR, however there has been some pushback to these because they are switching

soon to Epic.
Week Jan 31 to Feb 4:

Type of experience: Remote

Total hours this week: 8

Running total hours at this location: 58

Running total hours of all practicum experience: 58

Reflection:

For this week at the practicum I participated in the daily quality analyst huddle and also

chose a capstone topic. The capstone topic was brought up in one of our quality analyst huddles.

Recently Sharp has seen an increase in errors at the labs with specimens that are time sensitive

being sent to the incorrect lab. The most serious RL that was reported was that a breast biopsy

took 39 hours to be sent to the correct lab when it should only take between 4-6 hours. A breast

biopsy has only 72 hours to be processed, if not processed this can cause harm to the patient.

This seemed like a great opportunity to investigate why the errors were occurring and what could

be done to improve the process.

Week Feb 7 to Feb 11:

Type of experience: Remote

Total hours this week: 10

Running total hours at this location: 68

Running total hours of all practicum experience: 68

Reflection:

For this week for my practicum, I got to participate in daily quality analyst huddles and

begin my capstone project by attending a radiology biopsy meeting. During the quality analyst

huddle we talked about my capstone projects and reviewed the RLs. Towards the end of the

week I got sit in and listen to a meeting involving leadership from the Copley lab and the clinics

lab. From this meeting I got some understanding of what the leader at the clinic lab thought the

process is for sending a specimen from the clinic to the Copley lab. The process is that once the

lab is prepped and ready it is taken by a courier from the clinic to the Copley lab. During this

time the Copley lab will receive a transfer list that tells them what specimens are on their way. If

the specimen has not arrived within in four hours then the staff at the Copley lab will begin to

call to check on the status of the specimen.

Week Feb 14 to Feb 18

Type of experience: Remote and Onsite

Total hours this week: 12

Running total hours at this location: Clinic: 6 hours Remote: 74

Running total hours of all practicum experience: 80

Reflection:

For this week at my practicum I participated in the daily quality analyst huddle and

visited the Mira Mesa clinic to follow a biopsy. For the first part of our investigation we wanted

to follow a biopsy from one of the clinics to get a better understanding of the process. We arrived

to the Mira Mesa clinic at 8am. After the biopsy is complete, it is then taken to the lab within the

clinic where it is packed and ready to be transferred. What we discovered is that it is not taken

directly from the Mira Mesa clinic to Copley but instead it is taken to another clinic. We also

learned the courier we have is an outside vendor and that there have been issues in the past with

them handling specimens. This was one failure point we identified early on was that it is being

taken to several different locations before it is taken to the correct one. Later in the day we went

to the Copley lab to understand the process of what happens once the biopsy is taken to the lab.
Week Feb 21 to Feb 25

Type of experience: Remote and Onsite

Total hours this week: 12

Running total hours at this location: Remote 80 In person: 12

Running total hours of all practicum experience: 92

Reflection:

For this week at my practicum, I participated in the daily quality analyst and did another

investigation at the Santee clinic for my capstone. What we learned from our experience at the

Santee lab was more of the learning gaps that are present for staff. We had the opportunity to talk

to multiple staff and leadership about the process. What we learned is that often times the people

handling the specimens are unsure where certain types of specimens are supposed to go. We also

identified some failure points within the EHR that could potentially lead to another error. There

are too many clicks to get the specimens the proper paperwork for the transfer and the process

also takes a long time. In the drop down section of labs, there are several labs that are not used

anymore and Copley has a different title in the EHR for selection. One other failure we identified

is that staff is continuously being rotated from working with the specimens to working with the

patients, one of the staff commented that it is really hard to remember where certain specimens

are needed to be sent because he is working in several different roles.

Week Feb 28 to March 4

Type of experience: Remote and Onsite

Total hours this week: 16

Running total hours at this location: Remote: 84 In person: 22

Running total hours of all practicum experience: 108

Reflection:

For this week during I conducted another investigation at the downtown clinic and also

participate in daily quality analyst huddles. For the first part of the week, we worked on my

capstone project by visiting another clinic. What we learned from this clinic was they created a

system to that helps staff with ensuring they are sending the specimen to the correct lab. The

created an area that has labeled tubs so that when staff is placing the specimen in the certain tub

they can double verify that they are sending the specimen to the correct lab. We also talked with

one to the lab technicians who shared her concerns and feelings about the current process and

provided her perspective on how things could be improved. She had suggested that we send the

specimens all to Copley and have them sort which lab they need to be sent to. After completing

our investigation at the downtown lab, we went back and visited the Copley lab and talked the

lead there about the current errors we were seeing in RL. The leader walked us through the lab

again explaining to us the process and also shared her opinion and thoughts on redirecting the

specimens all to Copley.

Week March 7 to March 11:

Type of experience: Remote

Total hours this week: 10

Running total hours at this location: 94

Running total hours of all practicum experience: 118

Reflection:

For this week during I aided in a mock audit at the Rancho Bernardo clinic as well as

participate in the daily quality analyst huddle. For the compliance audit, hospitals need to meet

specific standards and requirements. Once every year, an auditor comes to clinics and asks

questions to staff to make sure that the hospital is meeting the standards. This was another great

insight into the job of a quality analyst and also what the standards are that need to be met. We

first started off at the urgent care in the clinic and talked to the nurses there. We asked a few

questions that the auditor may ask and also shared how they can answer certain questions and

what to say if they are unsure of how to answer. Whenever a person did not know an answer or if

they saw anything that was not compliant, we would make note of the error and send it to the

leader of that certain department so that they could fix it and discuss with the staff the error.
Week March 14 to March 18:

Type of experience: Remote

Total hours this week: 10

Running total hours at this location: 104

Running total hours of all practicum experience: 128

Reflection:

For this week for my practicum, I participated in quality analysts huddles and also had

the opportunity to start working on my root cause analysis. For the root cause analysis you have

to conduct some literature review to see if there are any potential corrective action in the current

literature. This was a great opportunity to utilize the skills I have learned from my previous

classes. During my second semester in one of my classes I had to present on the topics of failure

mode and effect analysis and root cause analysis. It is great to be able to apply what I am

learning to a real scenario and demonstrate the skills I have. I also began to write out the several

failure points that were identified and began brainstorming ideas on how to correct them. My

capstone was brough up during the quality huddles, and we discussed with Hazel what were

seeing.
Week March 21 to March 25:

Type of experience: Remote

Total hours this week: 10

Running total hours at this location: 114

Running total hours of all practicum experience:138

Reflection:

For this week for my practicum, I participated in quality analysts huddles and also had

the opportunity to work on my root cause analysis with the other analysts. One of the other

analysts was working on an RCA of her own and we were able to share ideas had have

suggestions from Hazel on how to approach certain failures. One thing that I learned that is

important to remember is how to phrase your corrective actions. The job of the quality analyst is

to not provide solutions but rather identify failure points and provide suggestions for leadership

so that they can use the information and create and action plan of their own. I think this approach

is the most effective because it allows leadership to become more involved with their staff and

take matters into their own hands rather than have someone else just do it for them.
Week March 28 to April 1:

Type of experience: Remote

Total hours this week: 10

Running total hours at this location: 124

Running total hours of all practicum experience:148

Reflection:

For this week at my practicum, I participated in daily quality analyst huddles and worked

on my RCA. We are currently trying to have a meeting with leadership to go over our findings

from our investigation and also present our RCA to the leaders so that they can begin creating

action plans for their clinics. The two main suggestions that we have created are that they send

the specimens all to Copley and have Copley send them to the correct labs and also make

changes to the EHR. Copley is the main lab and most specimens are needed to end up at Copley

and only a few are needed to be sent to the other lab Pacific Rim. Once we have set up the

meeting we will then be able to discuss this with leadership.

Week April 4 to April 8:

Type of experience: Remote

Total hours this week: 10

Running total hours at this location: 134

Running total hours of all practicum experience: 158

Reflection:

For this week at my practicum I participated in the daily quality analyst huddles. I had the

opportunity to listen in on the meetings and hear them discuss other RL and hear the status of the

meeting we want to have with leadership. I am still working on finishing up my RCA and will be

sending that to them for the analysts to review. I was also provided the opportunity to participate

in another facility audit for next week with another quality analysts.

Week April 11 to April 15:

Type of experience: Remote and onsite

Total hours this week: 14

Running total hours at this location: remote:141 onsite:29

Running total hours of all practicum experience: 172

Reflection:

For this week at my practicum, I continued to participate in weekly audits and I also got

to perform another site audit with the quality analyst and compliance officer. The site audits are a

great opportunity for me to see more Sharp Rees-Stealy locations and how they differ from one
another. Some of the sites have several floors and are much bigger where as other sites are just

one specialty. Another great part of doing the site audit is we got see which floors are ready for

when the surveyors come and who stills needs to work on the questions. I would like to work in

quality and seeing how the analysts approach these site audits was very insightful.

Week April 18 to April 22:

Type of experience: Remote

Total hours this week: 15

Running total hours at this location: remote:156

Running total hours of all practicum experience: 187

Reflection:

For my second to last week of the practicum, I participated in quality analyst huddles and

reviewed my capstone presentation with my advisor. The quality analyst huddle reviewed some

updates regarding my capstone project. Two of the senior analysts I was working with were able

to talk to the director for the service of excellence. This department focuses on implementing the

recommendations we have made and measuring the success. Throughout the week I continued to

work on my presentation for the capstone. Hazel my advisor reviewed my slides and gave me a

few suggestions to add to my corrective actions. It was great to hear from her that some of my

ideas may be used to improve the workflow process.

Week April 25 to April 29:

Type of experience: Remote

Total hours this week: 13

Running total hours at this location: remote:169

Running total hours of all practicum experience: 200

Reflection:

For my final week of the practicum I participated in quality analyst huddles and worked

more on my capstone project associated with the practicum. This was a great week to wrap

things up. Although I was unable to see the what suggestions we made to leadership be

implemented, it was great to see the process and participate in the RCA. I accepted a position at

another company working in their quality department. I am excited to use the skills and

knowledge I have learned.