Case Study: Nebraska Medicine

See how Nebraska Medicine improved environmental safety and organizational efficiency in healthcare.

Nebraska Medicine and its academic partner, the University of Nebraska Medical Center (UNMC), have the world’s leading experts on infectious diseases and have dealt with viral outbreaks such as Ebola and SARS, since their biocontainment center opened in 2005. “The Nebraska Method” for biopreparedness set a new global gold standard in special pathogen health security, and their expertise is sought worldwide and officially sanctioned by the U.S. federal government.

Nebraska Medicine is the state’s largest hospital and has been named best in the state by U.S. News & World Report for nine years in a row. For seven straight years, Nebraska Medicine has also been named to Becker’s Hospital Review’s list of 100 Great Hospitals in America.


As part of their ongoing commitment to being a high-reliability organization, Nebraska Medicine’s Office of Health Professions Education (OHPE) aimed to enhance its current efforts to identify and alleviate potential workplace hazards across its two hospitals and 40 specialty and primary care health centers that employ approximately 8,000 medical staff and 1,000 doctors.

Nebraska Medicine completes weekly environmental rounding audits to ensure environmental safety for patients and colleagues, and to comply with regulatory requirements. Unit or department managers or their designees are responsible for identifying any potential workplace hazards, such as improperly stored gas containers, broken ceiling tiles, etc.

Prioritized based on risk level and the order received, support tickets are then created and monitored for completion. The manual process of entering and merging this audit data took on average 20 minutes for each of the roughly 250 observed areas each month. Reporting on these audits was decentralized and had a significant lag time in data entry due to the manual process.

Nebraska Medicine wanted to improve efficiency in recording and reporting the audits, identify areas for immediate remediation to attain higher compliance, and realize a quicker turnaround time to intervention.


The OHPE team used Xapimed (a mobile observation checklist app outfitted with xAPI) and Watershed’s Learning Record Store and Analytics Platform as the solutions to:

  • make this process more efficient;
  • have centralized, shareable, real-time access to the data; and
  • measure interventions and their effect on subsequent observations and safety reports.

Xapimed is already being used for other observational assessment types of workflows, so including this audit was a natural fit to centralize more regulatory reports.

Employees enter and track audit data into xapiappis. (Note: This photo was taken prior to COVID-19, which is why facial masks aren't present.)

Instead of the typically manual process of transferring observational data into a spreadsheet, consolidating the various areas of data that were taken over time, and then analyzing that data, data from the checklist now feeds asynchronously into Watershed’s Learning Record Store. Thus, auditors, directors, and OHPE can run a report or access preconfigured dashboards and results in Watershed without manual error or delay.


Nebraska Medicine’s weekly environmental rounding program allows the health system to identify and report all potential workplace hazards in a consistent, trackable manner. This program increased awareness and accountability that contributes to Nebraska Medicine’s organizational goal to create a highly reliable and safe environment in which to provide care. OHPE and the Facilities department have seen not only higher compliance of staff regularly collecting the data, but also directors proactively reviewing compliance reports in Watershed and initiating interventions.

Furthermore, since launching the automated environmental rounding program using Xapimed and Watershed in February 2020, the turnaround time for collecting and presenting this data has decreased by more than 50 percent. Finally, because of their novel approach in creating this environmental rounding program to track potential hazards, the OHPE and Facilities team was awarded a national safety organization grant in December 2020.

‟As a new nurse manager who is also new to Bellevue Medical Center, a Procedural Services colleague says the environmental rounding has helped her know what to look for when a [regulatory] surveyor is visiting. I have learned the proper people to contact when I need an item addressed in my department and it has also helped me educate staff on the service request process and how to place work orders. I feel like before we were reactionary when it came to facility or service requests, especially before and after a [regulatory] survey. The list of work requests would pile up and take more time to address than if we had reported issues as we found them.”

—Nurse Manager, Nebraska Medicine, on the environmental rounding program

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