Root Cause Analysis Template

A medical practice may use a root cause analysis (RCA) process as a systematic approach to identifying the underlying causes of adverse events, errors, or near-misses in patient care. The goal of RCA is not to assign blame but to uncover the fundamental issues that contribute to the problem, enabling the practice to implement effective solutions to prevent recurrence.

When to use root cause analysis:

1. Adverse events: RCA is often initiated after a significant adverse event, such as a patient injury, unexpected death, or any incident that results in harm to a patient. The practice conducts RCA to understand how the event occurred and to prevent similar incidents in the future.
2. Near misses: RCA can also be used when a near miss occurs—an event that could have resulted in harm but was prevented either by chance or timely intervention. Analyzing near misses helps identify potential weaknesses in the system before they lead to actual harm.
3. Quality or safety concerns: When there is a pattern of errors, decreased quality of care, or safety concerns, RCA can help identify the root causes of these issues. For example, if multiple errors are linked to the same process or equipment, RCA can reveal why these issues are happening and how they can be corrected.
4. Regulatory requirements: Sometimes RCA is mandated by regulatory bodies or accreditation organizations when specific types of incidents occur. The practice may be required to perform RCA as part of a compliance effort.

How to use root cause analysis:

1. Assemble a team: Form a multidisciplinary team that includes individuals who are familiar with the processes involved in the incident. The team may include healthcare providers, administrators, and support staff.
2. Define the problem: Clearly describe the adverse event or near miss, including the circumstances surrounding it. This step involves gathering all relevant data, such as patient records, witness statements, and any physical evidence.
3. Identify causes: Use tools such as the "Five Whys" or fishbone diagrams (Ishikawa diagrams) to systematically explore the causes of the event. The goal is to move beyond immediate or surface-level causes to uncover deeper, systemic issues.
4. Develop action plans: Once the root causes are identified, the team should develop corrective actions to address these issues. Action plans should be specific, measurable, achievable, relevant, and time-bound (SMART).
5. Implement and monitor: Implement the action plans and monitor their effectiveness. This may involve changes in processes, additional staff training, or modifications to equipment or environment. Regular follow-up is essential to ensure that the corrective measures are working as intended.
6. Document and share findings: Document the entire RCA process, including the findings and the action plans. Share these findings with relevant stakeholders to promote transparency and continuous improvement.

The "five whys" is a tool used in root cause analysis (RCA) to help identify the root cause of a problem by asking "why" multiple times — typically five, but sometimes more or fewer depending on the situation. The idea is to dig deeper into the cause of an issue until the underlying problem is uncovered, rather than stopping at symptoms or surface-level explanations.

How the five “whys” work:

1. Identify the problem: Start by clearly stating the problem or issue that needs to be analyzed. This is the first "why."
2. Ask "why" the problem occurred: Ask the first "why" to determine why the problem occurred. The answer to this question should lead to the next "why."
3. Ask "why" again: Continue asking "why" based on the answer to the previous question. Each subsequent "why" question digs deeper into the cause.
4. Repeat until the root cause is identified: Continue this process until you reach the root cause of the problem. Typically, this takes about five iterations, but it can be more or fewer depending on the complexity of the issue.
5. Identify solutions: Once the root cause is identified, you can develop corrective actions that address this underlying issue.

Key points to remember:

• Depth over breadth: The 5 whys process encourages you to dig deeper into a single cause-and-effect chain rather than jumping to different causes.
• Focus on process, not people: The aim is to identify and correct flaws in processes, not to assign blame to individuals.
• Flexibility: Sometimes fewer or more than five "whys" are needed. The goal is to reach the root cause, regardless of how many iterations it takes.