Impact of Implementing an Operational Variance Reporting (OVR) System on Transparency, Reporting Behavior, and Operational Resolution Efficiency in a Tertiary Care Hospital: A Pre–Post Observational Study

Abstract

Operational failures in healthcare systems, including equipment malfunctions, information technology disruptions, supply shortages, and workflow bottlenecks, frequently interfere with clinical processes and hospital efficiency. Although such failures may not always lead directly to patient harm, they contribute significantly to treatment delays, staff workload, and operational inefficiencies. Many of these disruptions remain underreported due to fragmented reporting mechanisms and limited transparency within healthcare organizations. Operational Variance Reporting (OVR) systems have emerged as structured reporting platforms designed to improve the identification, documentation, and management of operational disruptions affecting patient care processes. This study aimed to evaluate the impact of implementing a hospital-wide OVR system on reporting transparency, staff reporting behavior, and operational resolution efficiency in a tertiary healthcare institution. A pre–post observational study was conducted at a tertiary academic medical center. Operational incident data were collected from two consecutive 12-month periods: the pre-implementation phase (January–December 2024) and the post-implementation phase following deployment of the digital OVR platform (January–December 2025). All operational incident reports submitted by clinical and non-clinical staff were included in the analysis. Primary outcomes included reporting frequency, reporting timeliness, and incident resolution performance. Secondary measures included incident category distribution, report completeness, near-miss reporting, and operational downtime indicators. Statistical comparisons between study periods were performed using appropriate parametric and non-parametric tests, while interrupted time-series analysis was used to evaluate reporting trends over time. A total of 412 operational incidents were documented during the pre-implementation period compared with 1,038 incidents after OVR implementation, representing a 152% increase in reporting frequency (p < 0.001). Reporting timeliness improved significantly, with the proportion of incidents reported within 30 minutes of detection increasing from 22.6% to 52.1% (p < 0.001). Report completeness also improved substantially, with fully completed reports rising from 47.6% to 83.2%. Near-miss reporting increased from 1.9% to 6.1%, indicating improved safety culture and transparency. Operational response efficiency improved significantly, with median acknowledgment time decreasing from 118 minutes to 36 minutes and mean resolution time declining from 9.4 hours to 4.1 hours (p < 0.001). Monthly operational downtime decreased by 46.6%, and the proportion of incidents resolved within the defined service-level agreement increased from 28.2% to 59.0%. Implementation of the OVR system significantly enhanced operational transparency, staff reporting behavior, and incident resolution efficiency. The findings suggest that structured operational reporting platforms can strengthen organizational awareness of operational disruptions and support proactive system improvement within complex healthcare environments.