This form allows healthcare provider organisations who currently use eForms to report to the
NRLS, or have never reported to the NRLS, to express their interest in becoming a DPSIMS Beta
pilot site.
It asks questions on:
Your organisation/healthcare provision
Your technology and IT resourcing
This information will be used to select a diverse range of sites, best placed to help us understand
the breadth of challenges and variation the new system will need to support.
We use the term "organisation" but are also seeking expressions of interest from independent/sole-
worker providers of healthcare: we need providers of all types for this pilot phase, so there are no
wrong answers. There are, however, some requirements for participating providers, as laid out in
the accompanying Briefing Pack. Please read this carefully before submitting your response.
If you are from a provider who currently uses an LRMS to report to the NRLS, please do not
complete this survey, but the one designed for your group:
Further information about the DPSIMS project is available here:
A summary of the Alpha phase progress is available here:
And a short video about the project is available here:
Information about this survey
Expressions of Interest for DPSIMS Private Beta Sites - NRLS eForm Users and those who
have never reported to NRLS
About your organisation/healthcare provision
Expressions of Interest for DPSIMS Private Beta Sites - NRLS eForm Users and those who
have never reported to NRLS
1. Please enter your ODS code:*
2. Are you interested in piloting the new PSIMS across the whole of your organisation, or in one specific
Across the whole organisation
Don't mind
In one specific site (please specify)
Email Address
Phone Number
3. Who is the main contact for this expression of interest?*
4. What type of healthcare provider are you? (Primary, Secondary, Tertiary, Community, Mental Health,
Pharmacy, etc)
5. Who do you provide services to?*
NHS patients only
NHS and Private patients
Private patients only
6. If necessary, would your organisation be willing to commence DPSIMS Beta Pilot work during known
periods of Winter Pressures? (The team will strive to commence the piloting in early-mid November, but this
may not be possible)
Yes, we'd prefer to start in November but would be willing to start work during December, January or February if necessary
We'd prefer to start in December - February anyway
No, we'd need to start in November, or from March onwards
7. Do you acknowledge that senior leadership-level support will be required for this work?*
8. Do you acknowledge that participation in the DPSIMS Private Beta will require disruption to processes,
practice and systems, in order to support the iterative development of the new tools. (This may include
things like changes to the way incidents are recorded, to risk- or data-management process, and to the
systems used for collection of this information)
9. Can your organisation commit to collecting and sharing feedback on the new tools with the DPSIMS
Beta team, to aid iterative development?
About your ICT
Expressions of Interest for DPSIMS Private Beta Sites - NRLS eForm Users and those who
have never reported to NRLS
10. Which main software systems do frontline and clinical staff in your organisation use on a daily basis?*
11. Are there any restrictions to internet access within your organisation?*
Don't know
Yes (please give details)
About your engagement and influence
Expressions of Interest for DPSIMS Private Beta Sites - NRLS eForm Users and those who
have never reported to NRLS
12. In the last year, roughly how many incident reports has your organisation submitted to the NRLS?*
We have never submitted incidents to NRLS
I'm not sure
Please enter a number:
13. Private Beta will run in two-week "sprints" or test cycles. If selected for participation, could your
organisation commit to proactively seeking out multiple (~10 or more) real incidents to submit per sprint?
(Test/dummy data can be used, but the preference is for real incident data)
Yes, we can aim for ~10 (or more) real incidents per two-week sprint
No, we will struggle to identify 10 incidents per fortnight so may have to provide test data
14. Has your organisation been involved in DPSIMS work before now? (e.g. attended workshops, taken
part in user testing in Alpha, etc)
I'm not sure
Yes (please specify)
15. Is your organisation involved in any large-scale patient safety initiative (e.g. Patient Safety
I don't know
Yes (please specify)