Authors: (including presenting author): :
KWOK YT (1), LI MN (2), LEUNG PMQ (2), HAU LM (1)
Affiliation: :
(1) Quality & Safety Division, NTWC, (2) Nursing Services Division, NTWC
Keyword 1: :
Incident Management
Keyword 2: :
Rapid response
Keyword 4: :
Communication
Introduction: :
Timely response to clinical incidents is the cornerstone of a robust patient safety culture. Traditional incident management often suffers from time lags between reporting and investigation, potentially leaving risks not timely managed. To address this, NTWC moved from a passive reporting model to an active, on-site response mechanism. From Aug 2023 to present, the Rapid Incident Management Team (RIMT) was established to bridge the gap between frontline staff and cluster management, ensuring that safety governance is visible, accessible, and immediate.
Objectives: :
(1) To ensure prompt investigation and management of clinical incidents. (2) To cultivate a "Just Culture" by facilitating immediate, two-way communication between management and frontline staff. (3) To establish a direct "Board to Ward" governance loop where operational difficulties are resolved swiftly by cluster management.
Methodology: :
The RIMT is a multidisciplinary task force comprising members from Q&S Division and NSD. Each morning on every working day, the RIMT conducts immediate site visits to relevant wards or units within 1 hour after Q&S reviewed the reported incidents. Instead of remote asking for incident details, the team engages in direct face-to-face communication with frontline staff to understand root causes and encourage them to voice out suggestions for improvement proactively. The team also conducts an analysis of commonalities and recurrent incidents across different departments to identify systemic patterns. These investigation findings are consolidated and reported at the Cluster Daily Brief at noon (within 3 hours after Q&S review), which attended by the CCE, HCEs, SD(Q&S), GM(N)s, GM(AS), SM(Q&S) and corresponding duty officers. This structure allows the "Board" to provide immediate directions and resource allocation to resolve systemic issues, effectively shortening the decision-making cycle.
Result & Outcome: :
The proactive presence of RIMT has accelerated the identification of latent risks and the implementation of corrective actions. The clinical incident rate per 1,000 bed-days in NTWC decreased significantly from 1.16 in 2023 to 0.87 in 2025, representing an overall reduction of 25% in clinical incidents over the past two years. The RIMT model demonstrates that visible leadership and rapid, on-site engagement are powerful drivers for patient safety. By closing the loop between the "Board" and the "Ward" on a daily basis, we have successfully transformed incident management from a retrospective administrative process into a dynamic, real-time risk reduction strategy.
