PRQ Red Flags: Why Your Pre‑Review Questions Might Be Waving at You
In the world of healthcare quality and performance improvement, the PRQ (Pre‑Review Questionnaire) is the quiet hero—or the quiet saboteur—of regulatory readiness. Like a polite friend who clears their throat before telling you something is terribly wrong, a PRQ often reveals early warning signs of documentation gaps, process failures, or lurking compliance monsters. These red flags, when ignored, have a tendency to grow teeth.
But fear not—spotting PRQ red flags doesn’t require clairvoyance, only curiosity, critical thinking, and a healthy respect for patterns.
1. The “Nothing to See Here” Red Flag
If every answer in a PRQ is a perfect “Yes,” “Always,” or “We do that consistently,” it’s generally not a sign of excellence—it’s a sign someone is trying to manifest perfection through optimism.
Research on organizational compliance shows that overly positive self‑reported data often signals underlying quality blind spots (Pronovost, Morlock, & Sexton, 2020). Perfect self‑ratings suggest lack of insight, lack of auditing, or lack of participation—none of which win medals during accreditation surveys.
Translation: If everything is green, something is probably very red.
2. The “Copy‑Paste Culture” Red Flag
Consistency is wonderful—except when the wording is identical across multiple departments, years, or questions. When the “evidence of compliance” reads like a Ctrl+C/Ctrl+V greatest hits album, it’s a strong sign that staff may not fully understand the processes they claim to perform.
Documentation quality is directly linked to patient safety outcomes (Singh & Sittig, 2021), and copy‑paste habits weaken accuracy, validity, and accountability. If the PRQ sounds like a broken record, it likely reflects a broken workflow.
3. The “Too Vague to Audit” Red Flag
Phrases like “We follow policy,” “Staff are trained,” and “We ensure compliance” might sound confident, but they offer no measurable evidence.
Accrediting bodies consistently emphasize the need for specific, operational, and auditable descriptions of processes (Joint Commission, 2023). The absence of details—who does what, when, how, and how often—is a classic PRQ red flag.
If you can’t audit it, you can’t defend it.
4. The “Outdated Policy Parade” Red Flag
A PRQ that cites:
retired policies
superseded protocols
old version numbers
the 2017 pressure‑injury guideline someone forgot was replaced
…is quietly screaming for help.
Outdated references indicate poor document control systems, which are known contributors to regulatory deficiencies and safety events (Carayon et al., 2020).
If the PRQ reads like a museum catalog, it’s time for an archeological dig into your policy repository.
5. The “Data? What Data?” Red Flag
Statements like “We monitor this closely” without attaching:
run charts
dashboards
audit results
trend analyses
action plans
…are a red flag shaped like a bar graph.
Performance improvement frameworks emphasize that measurement is the backbone of accountability (Institute for Healthcare Improvement [IHI], 2022). No data = no story = no compliance.
6. The “Mythical Workflow” Red Flag
Sometimes the PRQ describes processes that:
don’t match actual practice
contradict frontline staff reports
or require magical staffing ratios that haven’t existed in a decade
This is the gap between “work as imagined” and “work as done,” a well‑documented challenge in safety science (Hollnagel, 2018). The bigger the gap, the redder the flag.
Conclusion: PRQ Red Flags Are Not Failures—They’re Invitations
Red flags are not signs of doom—they’re opportunities for improvement, insight, and organizational honesty. When recognized early, PRQ red flags guide leaders toward:
stronger documentation
improved communication
better compliance
and ultimately safer patient care
In healthcare, ignoring red flags rarely makes them go away—but addressing them turns a PRQ from a compliance chore into a powerful improvement tool.
References
Carayon, P., Wetterneck, T. B., Rivera‑Rodriguez, A. J., & Hundt, A. S. (2020). Human factors systems approach to patient safety. BMJ. https://doi.org/10.1136/bmj.m124
Hollnagel, E. (2018). Safety-II in practice: Developing the resilience potentials. Routledge.
Institute for Healthcare Improvement. (2022). Science of improvement: How to improve. https://www.ihi.org/resources/pages/howtoimprove/scienceofimprovementhowtoimprove.aspx
Joint Commission. (2023). Comprehensive Accreditation Manual for Hospitals. Joint Commission Resources.
Pronovost, P. J., Morlock, L. L., & Sexton, J. B. (2020). Improving the value of patient safety reporting systems. Journal of Patient Safety, 16(3), 189–196. https://doi.org/10.1097/PTS.0000000000000588
Singh, H., & Sittig, D. F. (2021). Improving health information technology and patient safety. Journal of the American Medical Association, 325(12), 1151–1152. https://doi.org/10.1001/jama.2021.1023
