Letter to the Editor

What are best practices for conducting a root cause analysis?

I am responding to the article, “Best Practices for Conducting an RCA: Are There Any?” (September/October 2014; www.psqh.com/september/october-2014/). I suggest it would be more aptly titled, “The Best Ineffective Practices for Conducting an RCA.” If I were a lay reader of this article, I would likely conclude that root cause analysis (RCA) is ineffective based on the limited literature search performed within the healthcare space.

What can I learn from this paper that would allow me to make my current RCA efforts a best practice? What was the take-away intended by the authors?

Technical performance of properly executed RCA is well documented in non-healthcare sectors. This is especially true in heavy manufacturing, where I have spent 29 years as an RCA investigator, trainer, speaker, and author. I believe that by not including research from other industries to prove the bottom-line effectiveness of properly conducted RCAs, the authors leave the reader believing RCA does not work in general.

I agree with the authors that RCA is not working in healthcare. Its effectiveness is not being measured by the very agencies that require it to be done. In healthcare, the effectiveness of RCA has traditionally being measured by its ability to be compliant. There has been only minor-to-moderate improvement in patient safety since the IOM report was published in 2000, which further supports the view that our current RCA efforts are not proving to be effective.

There are a number of published articles that delve into the reasons why current RCA attempts in healthcare are not effective. The authors cite many of these. I also provided insight into this years ago via a video titled “Why Current RCA Efforts are Not Meeting Expectations” (http://www.reliability.com/rca/). Reasons can range from issues related to the tools/processes, training, analyst competence, and/or to management support/expectations for results. Human factors, human performance, and systems engineering play major roles in the effectiveness (or lack thereof) of effective RCA. I did not see those issues mentioned in this paper.

Since there are few if any mandatory, measurable expectations for the effectiveness of RCA in healthcare, it should not be a surprise that such information is not readily available through a literature search. A better question would be, “Why doesn’t Leadership define demonstrable metrics for the performance of their RCAs and direct correlations to their bottom-line?”
 
Robert J. Latino
CEO, Reliability Center, Inc.
Hopewell, Virginia

The authors’ reply:

We thank Mr. Latino for his insightful comments. It was not our intent to delve into the use of the RCA process by other industries. We were specifically targeting the healthcare industry and the challenges to the RCA process within that domain. The article was not intended to imply that the overall use of the RCA was ineffective, but rather it was intended to prompt more attention to the lack of effectiveness in the process in the healthcare sector. Mr. Latino’s concerns are valid; we highlighted the lack of evidence in the literature for supporting a best practice methodology for the RCA in the healthcare industry alone.

Shea Polancich, PhD, RN
Linda Roussel, DSN, RN
Patricia Patrician, PhD, RN
The University of Alabama at Birmingham
School of Nursing