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Managing the scope and impact of root cause analysis recommendations
Rick Iedema1, Christine Jorm, Jeffrey Braithwaite
1Centre for Health Communication, Faculty of Humanities and Social Sciences, University of Technology Sydney, Broadway, Australia. r.iedema@uts.edu.au
Journal of Health Organization and Management
|July 8, 2009
Summary
Root cause analysis (RCA) recommendations often yield variable quality and limited practice improvement, requiring significant management effort. Realigning expectations for RCA
Area of Science:
- Healthcare Management
- Patient Safety
- Quality Improvement
Background:
- Mandates for reporting clinical errors and near misses are increasing due to public awareness and litigation.
- Health policy makers in industrialized nations are driving the adoption of error investigation protocols.
- Root Cause Analysis (RCA) is a key method being implemented for practice improvement.
Purpose of the Study:
- To evaluate the perceived value of Root Cause Analysis (RCA) recommendations for enhancing clinical practices.
- To understand senior health managers' views on RCA as a method for practice improvement.
- To analyze the effectiveness of RCA in driving tangible improvements in healthcare settings.
Main Methods:
- Discourse analysis of interview data from a Health Safety Improvement Program evaluation.
- Interviews were conducted with nine senior health managers involved in clinical practice improvement.
- Data were systematically arranged into overarching themes to identify key insights.
Main Results:
- RCA recommendations are perceived as variable in quality and constrained by numerous factors.
- Vetting RCA recommendations imposes considerable extra work on senior management.
- RCA contributes only minimally to organizational and practice improvement efforts.
Conclusions:
- RCA necessitates significant time and negotiation, with recommendations potentially not meeting improvement expectations.
- Expectations for RCA's impact may need reorientation, acknowledging its role in fostering communication about clinical processes.
- Healthcare managers face increased communicative and emotional labor managing complexities within post-bureaucratic initiatives like RCA.
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