report writing -doh investigators...

Effective Report Writingfor Investigators

Gabrielle K. Gabrielli, Ph.D.

Florida Dept. of Health

2015

Ground Rules

1. Turn any cell phones or other electronicsto the off or silent position.

2. Participate to the fullest of your ability.3. Listen actively.4. Keep an open mind.5. If you break any rules, you sing.

Agenda

• 1300 - 1330 Introductions, ground rules, learningobjectives, icebreaker, why topic is needed

• 1330 - 1400 Essential elements of investigativereports

• 1400 - 1430 Importance of documentation• 1430 - 1500 Critical thinking skills for investigators• 1500 - 1530 Professional writing refresher• 1530 - 1645 Application of skills• 1645 - Conclusions

Learning ObjectivesBy the end of this session, investigators will be able to:

• Describe essential elements that must beincluded in investigative reports.

• Ensure that documentation is accurate anddefensible.

• Use critical thinking skills to assimilate volumesof information and summarize relevant facts.

• Apply report writing techniques to writesuccinctly, factually, and professionally.

Essential Elements InInvestigative Reports

A Complete Report

When did it occur? Where did it occur? Who was there? Who else may have relevant information? How did it happen? Who did or said what? In what order? Why did it happen? Are notes, documents, phone messages,

emails, video, or other evidence needed?

Accurate and DefensibleDocumentation

What is Defensible?

• Information provided must be accurateand complete.

• Documentation must clearly supportjustification for recommendations.

• Information provided is objective.• If someone unfamiliar with the case read

the evidence, they would draw the sameconclusions.

New IR Form

• Majority paragraphs changed to check boxes– subject notification, license status, patient

notification, legal representation• No summary of records• Alleged violations box should only reference

the Statute number, not Statute language• Synopsis box includes predication paragraph

(synopsis), statement from subject (ifapplicable) and note of any address change.

IR Form

Documentation Exercise

• Let’s take a look at some sample IR formsto determine if they are accurate anddefensible.

• Quietly review the two forms handed out.• Note any issues with the cases.• Note any errors by circling them, then

count the number of errors.

Accurate and Defensible?

Accurate and Defensible? NO.

Accurate and Defensible?

Accurate and Defensible? YES!

• Avoid drawing conclusions.

• State facts rather than opinions.

• Provide information to support findings.

Prove It

Using Critical Thinking Skills

Critical Thinking Exercise

The following combination of letters represents asentence from which one particular vowel hasbeen removed. If you can figure out what thatvowel is and re-insert it eleven times, in elevendifferent places, you will be able to determine whatthe sentence is saying.

VRYFINXMPLARXCDSWHATWXPCT

Importance of Critical Thinking

• Critical thinking was identified in researchas one of the most important skills neededfor job success, and one that is lacking inthe new workforce.

• Critical thinking was rated as the # 1 skillof increasing importance over the next 5years.

What is Critical Thinking?

Negative thinking? No

Unlike negative thinking, critical thinking ispositive, friendly, constructive, andproductive.


Creative thinking? No

In contrast, critical thinking is about makinga judgment rather than thinkingimaginatively.


Problem solving? No

While critical thinking, like problem solving,requires evaluative steps, it does not seek tofix a problem or solve anything.


Thinking hard? No

Critical thinking requires making a judgment,and then verifying that judgment in amethodical way.


Critical thinking is a skill that can be learnedand used to evaluate arguments- or reasonsand the conclusions that follow them.



• Requires evaluative steps, but it doesnot seek to solve a problem

• Is positive, friendly, constructive, andproductive

• Is about making a judgment rather thanthinking imaginatively

Critical thinking requires making a judgment,and then verifying that judgment in amethodical way.


To verify judgments, you must look forevidence.

What Constitutes Evidence?

Evidence is objective information used tomake and support a conclusion. It is notbased on:

– Assumptions: Focusing on past events topredict future events

– Perception: Focusing on how things appearrather than observing objectively

– Emotion: Focusing on how a situation makesyou feel rather than the evidence


• DataFacts and statistics collected for analysis


• Facts– The patient left the facility at 7:00 p.m.– The patient had four visitors in the last

month.– This toilet was reported to be leaking in

March.– This facility upgraded its air conditioning

system last month.


• Observation– I can see water stains on the ceiling.– The patient looks pale and weak.– There are several bruises on the patient’s

arm but none in the area reported.– This air conditioning unit has not been

repaired.


• Testimony– “I do not like it here.”– “I bruise easily because of my medication.”– “I can never get warm in this house.”– “She refuses to eat in the dining room.”

Habits of Critical Thinkers

1. Focus on most relevant information2. Ask the right questions3. Distinguish facts from falsehoods4. Make informed decisions5. Prioritize what is needed6. Learn quickly and apply what they’ve learned7. Don’t make assumptions

Critical Thinking Exercise

Let’s take a look at some samplestatements to determine which onesrepresent evidence-based critical thinking(fact) versus assumption.

Identifying Critical Thinking

This report is probably a false alarmbecause the last one on this facility was.

Fact or Assumption? Why?

Assumption (Focusing on pastevents to predict future events)


This woman wears shabby clothes soshe is probably poor.


Perception (Focusing on howthings appear rather than thetruth of a situation)


This witness makes me uncomfortableso something is clearly wrong.


Emotion (Focusing on how somethingmakes you feel rather than the facts)

This report mentions a leaking roof in thegroup home, so I need to verify that.


Fact - critical thinking (objectivelyfocusing on how to gather evidence toverify or refute a claim)


Exercise

Which letter does not belong?

k mq w

The practice of critical thinking requires:•Asking questions as a way to explore aproblem or evaluate a claim or argument•Having an attitude of curiosity without anagenda that seeks to find evidence of truth•Using evidence-based reasoning to reviewa situation before making a conclusion


This critical thought process- evidencegathering that leads to a conclusion- is

Inductive Reasoning

Evidence

ReviewAnalysis

Evaluation

Conclusioncalled inductivereasoning. Evidencesupports theconclusion.

Its opposite- deductive reasoning- posits atheory (or conclusion) and then looks forevidence to support it. This practice works

Deductive Reasoning

Conclusion(hypothesis)

well for testing ascientific hypothesis,but is not appropriatefor yourinvestigations.

EvidenceEvidenceEvidence

Group Activity

• Read your assigned scenario.• Discuss the issues with your group.• Determine what evidence is important and

relevant to the case.• Determine what information provided in the

scenario is not needed.• Select one person in your group write on the

easel paper and another person in your groupto report what critical thinking skills you usedto sift through the information.

Scenario AThe Consumer Services Unit (CSU) received a complaint that Mary Chenis operating an optical establishment in South Florida and providingoptical services without a license.

The complainant stated she paid Ms. Chen for prescription glasses thatleft her with uncorrected vision. The complainant also purchased a pair ofnon-prescription designer sunglasses from Ms. Chen. The complainantconfirmed with a licensed optician, Dr. Claude St. Charles, that herprescription glasses are not prescription. When she requested a refundfor the “prescription” glasses, Ms. Chen refused. The complainantpurchased a new set of glasses from Dr. St. Charles.

A search of the licensure database confirms Ms. Chen is not licensed noris the establishment. Both she and the optical establishment haveapplications for licensure pending approval. Ms. Chen submitted herapplication for licensure 10 days after the CSU received a complaintregarding her and her establishment. This is a possible violation of SS456.065 F.S. and 484.013 F.S.

Scenario BInternally reported information suggests Jason Stark, a physicianassistant, failed to report a change in supervision per Florida Statute458.347(7)(e). The statute requires a licensed physician assistant tonotify the department in writing within 30 days of changes to theirphysician supervision.

Mr. Stark received his nursing license in 2008 and his physician assistantlicense in 2011. He is currently up-to-date on his continuing educationrequirements.

A copy of the Supervision Data Form submitted by Mr. Stark shows thathe changed supervising physicians on August 1, 2012. He did not notifythe Board of Medicine until December 15, 2013. He claims his form waslost in the mail.

The physician assistant licensure renewal period ends May 1, 2015. Thisis Mr. Stark’s first failure to timely report changes in supervision.

Scenario CThe Consumer Services Unit (CSU) received internally generatedinformation via Nursys that Dr. Walter Gardner was disciplined effectiveFebruary 2, 2014 in Georgia for failure to maintain adequate or accuraterecords and filing false reports or falsifying records. Dr. Gardner signedout 30ml of Dilaudid, 30ml PCA and 1mg Hydromorphone that was notdocumented as administered or wasted.

The State of Georgia’s investigation revealed Dr. Gardner did not wastemedication with a witness present. News media outlets report Dr.Gardner may be selling the medication; however, he claims someonestole the medication while he was out of the office.

Dr. Gardner entered into an Agreed Order with the State of Georgia. In2012, he entered into a Settlement Agreement with the State of Florida’sBoard of Medicine for misconduct. The Agreement ordered him to pay$12,350 in fines and administrative costs. He recently relocated toAlabama to start a new practice.

Qualities of Critical Thinkers

1. Curiosity2. Creativity3. Rationality4. Self-awareness5. Humility6. Open-mindedness7. Discipline8. Objectivity

Remember that evidence is the basis of anyconclusion.

Using Critical Thinking

Evidence

ReviewAnalysis

Evaluation

ConclusionCritical thinkinginforms, guides,and directs theinquiry process.

Writing Succinctly, Factually,and Professionally

Writing

• Organization• Tone• Clarity• Spelling• Grammar• Punctuation

Disclaimers

• Language changes frequently.• There is rarely only one correct way to

write something.• Different style guides (APA, MLA, etc.)

sometimes conflict with one another.• When in doubt, consult the DOH Style

Guide and your supervisor.• Nobody is perfect!

Some New Words in Dictionary

• Crowdfunding• Selfie• Gamification• Tweep• Catfishing• Freegan• Poutine• Unfriend

Merriam-Webster, 2014

Volunteer, please?

If emale and leturs r writon with speelingand gramitckal misteaks, u mite git themeening, but the messige is not asaffectiv or easily reedible.

Commonly Mistyped Words

• James Smith, Manger

Lie versus Lay

• The important distinction is that layrequires a direct object and lie does not.So you lie down on the couch (no directobject), but you lay the report down on thetable (the report is the direct object).

• Lay is the past tense of lie!

Homophones

• Accept/Except• Advise/Advice• Capital/Capitol• Effect/Affect• Passed/Past• They’re/Their/There• Wear/Where• Whether/Weather• Which/Witch• Who’s/Whose

Frequently Confused Words

One Word or Two?

Exercise

Make any corrections needed on the handout.

Noun Strings

• Temporary legislative consumer healthprotection regulations

changes to• Temporary regulations to protect

consumer health in legislation

Negative Constructions

• Over the last three years, I have notnoticed a decrease in state expenditures.

changes to• Over the last three years state

expenditures have remained the same.

Passive Voice

• The medication was prescribed by Dr.Flores.

changes to• Dr. Flores prescribed the medication.

Identifying Passive Voice

• Look for a form of the verb “to be”:am, are, is, was, were, be, been, being

• Look for past participles:–ed or –en. Also, held, made and kept.

• If both parts are present, you have passivevoice.The records were (verb to be) allegedly falsified (pastparticiple) by the pharmacist.

Titles

• Pharmacist James Foster• James Foster, pharmacist• Our executive director, Anita Jones

Dangling Participles

• His printer broke while ordering the phone.• While ordering the phone, his printer

broke.should be

• While he was ordering the phone, hisprinter broke.

Avoid Dangling Modifiers

• After receiving your documents, the invoicewas missing.

should be• After receiving your documents, I

determined that the invoice was missing.

Proofreading

• Take a break between writing andproofreading.

• Read out loud.• Read slowly.• Read backward.• Put yourself in the reader’s shoes.• Ask others to proof your work.• Accept constructive input.

Technology

• Don’t Rely on Technology toProofread for You.

• Software tools in Word:– Click Tools.– Click AutoCorrect Options.– In the Replace box, type manger.– In the With box, type manager.– Click Add.– Click OK.

What I Learned from Journalism

K.I.S.S.

“The most valuable of all talents is that ofnever using two words when one will do.”

Thomas Jefferson

Be Concise

• One idea per paragraph• 2-4 sentences per paragraph• 2-3 paragraphs per email• No more than 3 concepts per email

Spelling

• Examine each word individually.• Read every line backward.• Pay attention to commonly confused

words.• When in doubt, consult a dictionary

Grammar

• Ensure subject/verb agreement.• Ensure pronoun reference/agreement- Look

for the words it, this, they, their, and them.• Use parallel structure.• Avoid dangling modifiers, sentence

fragments, and run-on sentences.• Don’t use passive voice.

Punctuation

• Apostrophes- Look especially at words ending in “s” to seeif an apostrophe is required.

• Commas- Ensure usage after conjunctions used toconnect sentences, after independent clauses, to set offparenthetical elements and quotes, and to avoid confusion.

• Colons- Use before a list that is preceded by a clausethat can stand by itself.

• Semicolons- Use when connecting two sentences orindependent clauses; when beginning the secondindependent clause after a semicolon, do not use a capital.

• Periods- Ensure that all sentences have a period andthat all fragments do not.

Learning ObjectivesBy the end of this session, investigators will be able to:

• Describe essential elements that must beincluded in investigative reports.

• Ensure that documentation is accurate anddefensible.

• Use critical thinking skills to assimilate volumesof information and summarize relevant facts.

• Apply report writing techniques to writesuccinctly, factually, and professionally.

Post-Session Website

Your portal is at:http://gabrielleconsulting.com/dohinvestigativereport2015

[email protected]

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