Report 2016-046 Recommendation 12 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 #12 To: Registered Nursing, Board of

To ensure that it is able to accurately monitor the performance of its complaint resolution process and that it has accurate data to address its staffing needs, BRN should immediately begin working with Consumer Affairs to implement cost-effective input controls for BreEZe that will require BRN staff members to enter information into a complaint record in a way that is consistent with BRN's business processes, as well as to implement changes that would cause BreEZe to accurately identify the order in which activities occur.

6-Month Agency Response

BRN SMEs worked with the DCAs Business Integrity Analysts (BIA) to develop activity code functionality to allow stop gap controls in the BreEZe system which will accurately identify the order activities occur. Prioritization of BreEZe activities is a global issue that will impact all DCA boards and bureaus that utilize the BreEZe system. Implementing stop gap controls requires approval from the following workgroups: DCA's Enforcement User Group and Reports User Group, BreEZe Vendor, and Change Control Board.

A System Investigation Request (SIR) was submitted by BRN SMEs on December 16, 2016, to DCA which was approved to go to the BreEZe Vendor for scope-of-work review and approval. Once the BreEZe Vendor returned the SIR with the scope-of-work approved, changes were then submitted as a work authorization to DCA's Change Control Board to approve the BreEZe stop gap controls. The Change Control Board approved the Work Authorization to be forwarded for Impact Analysis. This Impact Analysis is currently pending. The BRN will continue to work with these groups to update the business process and evaluate the cost-effectiveness of implementing this practice.

Per DCA, the implementation of this type of change typically takes about one year to complete.

  • Estimated Completion Date: January 2018
  • Response Date: June 2017

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


60-Day Agency Response

BRN SMEs have worked with the BIAs to develop activity code functionality to allow stop gap controls in the BreEZe system which will accurately identify the order activities occur. Prioritization of BreEZe activities is a global issue that will impact all DCA boards and bureaus that utilize the BreEZe system. Implementing stop gap controls will require approval from the following workgroups: DCA's Enforcement User Group and Reports User Group, BreEze Vendor, and Change Control Board. A System Investigation Request (SIR) was submitted by BRN SMEs on December 16, 2016, to DCA which was approved to go to the BreEZe Vendor for scope-of-work review and approval. Once The BreEZe Vendor returned the SIR with the scope-of-work approved, changes were then submitted as a work authorization to DCA's Change Control Board to approve the BreEZe stop gap controls. The Change Control Board approved the Work Authorization to be forwarded for Impact Analysis. This Impact Analysis is currently pending. The BRN will continue to work with these groups to update the business process and evaluate the cost-effectiveness of implementing this practice. Per DCA, the implementation of the process typically takes about one year to complete.

  • Estimated Completion Date: Unknown
  • Response Date: February 2017

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


All Recommendations in 2016-046

Agency responses received are posted verbatim.