The Power of a Questioning Mindset: How One Nurse's Insight Sparked a National Innovation

Is Your EHR Hiding a Major Risk? Why We Scrapped Our Safety Flowsheets

In healthcare, we place immense trust in our tools, especially those embedded in our Electronic Health Records (EHR). Every day, frontline clinicians use standardized flowsheets to assess patient risk, and we, as leaders, trust that the data they generate is reliable. But what if it's not? What if a tool designed to ensure safety is actually built on a foundation of flawed science?

That was the question we dared to ask about our clinical assessments for sexual safety in our inpatient psychiatric units. The answer we found has changed everything.

The Challenge: Questioning the Status Quo

Our teams were using standard Epic flowsheets to assess a patient's risk of exhibiting sexually inappropriate behavior and their risk for sexual victimization. It was a routine part of care. But a literature review and expert opinion raised a critical question: were these tools actually measuring what we thought they were measuring?

The Answer: A Resounding, Data-Driven "No"

We conducted a rigorous psychometric analysis of the flowsheets, and the results were alarming. The tools weren't just imperfect; they were structurally flawed.

• They Were Not Reliable: Both tools showed poor internal consistency, with Cronbach's alpha scores around 0.5—well below the accepted threshold of 0.7. This means the questions in the assessments weren't consistently measuring the same concept.

  
  

• They Lacked Focus: Our analysis revealed the tools were multidimensional, meaning they were measuring multiple, jumbled concepts at once instead of a single, coherent risk factor.

  
  

• Their "Predictive Power" Was an Illusion: The scales correlated strongly with their own final risk ratings, but this was a circular relationship. The score was simply a function of the tool's flawed design, not a validation of its ability to predict actual patient behavior.

  
  

Digging deeper, we discovered a national gap: there was no existing, validated tool for assessing acute sexual safety risk specifically for an inpatient psychiatric population. The tools that existed were designed for forensic settings or outpatient use, not for the unique challenges of acute care.

The Takeaway for Leaders

This is the beauty and power of research in a clinical setting. It's the courage to pause and say, "This doesn't seem right," followed by the determination to build something better.

We are now in the process of developing and validating two new clinical tools from the ground up—tools that we aim to prove are psychometrically sound and truly predictive. This initiative, born from a simple question, has the potential to become the new national standard, benefiting countless patients and clinicians. It proves that empowering a culture of inquiry isn't just a talking point; it's your most effective strategy for mitigating risk, enhancing patient safety, and fostering the kind of career-defining innovation that transforms our entire industry.