Root Cause Analysis And Failure Mode And Effect Analysis In Healthcare Management

General purpose of conducting root cause analysis (RCA)

In healthcare management system, organisational improvement plays an essential role that provides the opportunity to every part of the facility to become better, safer, faster and more efficient (Peerally et al., 2017). The purpose of this paper is to present the general purpose of root cause analysis and the Failure Mode and Effect Analysis under the light of a case study while considering the quality of leadership as an essential part of process improvement plan.

The root cause analysis is a systematic approach to examine the situation and to find out the cause and flaws behind a particular error that caused and adverse event. The six steps of root cause analysis are identifying what happened, determination of what should have happened, determination of causes, developing casual statement, generating a list of recommended action and sharing the briefly documented experience (Taylor et al., 2014). Identifying the occurrence refers developing a basic report of event in a linear or structured format. Determination of what should have happened emphasises the comparison of the incident with the ideal situation. After comparison, determination of cause is essential as third stem where the investigation team look and connect the underlying factors and their contribution to the outcome. It can be done by fishbone analysis, Ishikawa or five why strategy. In the fourth step, the team needs to develop a statement that directly can imply the causes and effect relation. The recommendation or improvement activity plan is a contingency plan that can prevent the event to occur again (Rojas et al., 2016). Finally, the summery of incident and the causes have to be shared with all the key players to make them aware and sincere about their further activities.

In the given scenario, the basic description of the incident is that an old patient with severe leg pain was admitted in Emergency Department where 1 RN, 1 RPN and 1 general practitioner were present. After the collapsing the pulse, the patient was referred to a higher facility hospital and the brain death occurred. The patient must receive proper and continues care from the nurses. The root cause behind this is the negligence of nurse J due to increasing number of patient in Emergency Department. The lack of proper training for the acute situation could cause these issues. Therefore as recommended activity the healthcare facility can initiate critical care training for existing and new nurses that could help to improve their ability to deal with this type of situation. Apart from that, a critical care protocol can also be initiated to ensure that no further inconvenience will occur. Finally, a report of whole incident should be published for the caregivers of that facility.

The process improvement plan requires agreement of all the key player of the healthcare system. However, in most of these cases a noticeable amount of key players become less interested and even oppose against new changes. Therefore, the healthcare facility has to minimise the resistance force from workers and system. It can be done by developing the sense of significance within the workforce while keeping a strong monitoring and controlling process (Moradi-Lakeh & Vosoogh-Moghaddam, 2015). As per the Lewin’s change management, theory the process improvement plan consists of three basic steps namely Unfreeze, Change and Refreeze. In the unfreeze phase the management has to motivate the caregivers and nurses to the new changes and improvement plan. This can be possible by creating the sense of urgency towards helpful interventions. In change phase, the training can be given and the new critical care plan can be imposed in their regular practice. It will help to improve the proficiency of all the workers for the holistic growth of effective patient handling capacity. After imposing the change, the refreeze phase will enable the management to ensure sustainability of the new changes (Liu et al., 2015). It can be done by proper feedback collection, communication, monitoring and controlling process.

Failure Mode and Effect Analysis (FMEA)

The FMEA is a systematic procedure or framework to assess the risk of failure and to develop the process of improvement. In healthcare facilities, FMEA is very common tool of improvement planning. The FMEA implementation process consists of seven steps namely recruiting the team, team communication, having list of failure modes in the system, prioritisation of risk factors numerically, evaluating the results and utilising the risk priority number for effective implementation (Carayon et al., 2014). In the following section the FMEA Process implementation plan has been given for chosen scenario.

Steps in the process	Failure Mode	Failure Causes	Failure Effects	Likelihood of Occurrence (1-10)	Likelihood of Detection (1-10)	Severity (1-10)	Risk Priority Number (RPN)	Action to reduce occurrence of failure
1	Unexpected death of patient can occur	Improper monitoring and negligence	Competence level of the facility will reduce	5	6	8	240	Proper training and development of the nurses
2	Unable to deliver care for all inbound patients	Lack of provisions	The reputation of the healthcare facility will be affected	8	2	5	80	Increasing the provisions through refurbishing the facilities
3	Inefficient recovery rate of the patient and increased hospice stay	Poor care giving service and lack of integration	The overall number of patient will reduce	6	4	5	120	Imposing proper emergency and critical care giving protocols
4	Lack of  information about the patients and available workforce	Poor information integration within the system	Improper medication and other care can lead to severe damage to the patients	5	3	4	60	Improve the communicational competence
							500

Along with implementing new changes to improve the overall quality of the service providing, testing is anther essential part that can ensure that management that the existing improvement process is capable to making effective changes. The testing operation can be done through using direct and indirect monitoring process. The direct monitoring process can be executed through supervising the efficiency of the new imposed protocol and changes (Phillips et al., 2016). At the same time, as indirect monitoring process, survey can be conducted among the patients and interview can be conducted among the healthcare workers. Feedback from the patients can help to identify the flaws in the system and the feedbacks from the worker can help to identify the potential changes that need to be made by the management within the existing system. This feedback collection can be done repeatedly to monitor the eventual changes in the current system.

The professional nurses have the responsibility to promote quality care within the fellow workers and to motivate them towards healthy and effective practices. Promoting the quality care cannot only improve the proficiency of the other nurses and it also improves the patient’s outcomes as well. At the same time, the leadership has a huge effectiveness within the overall change management and process improvement activities (Joshi et al., 2014). To promote the quality care the senior professional nurses should conduct various motivational programs among the workforce. Apart from that, during the supervision they can promote the healthy practices within the junior caregivers through verbal motivation. Maintaining the friendly relationship with mutual respect is also essential for an effective leadership in nursing care. In this given scenario the professional nurses has to present herself as an ideal example of caregivers to the subordinate workers. Making a ideal example of competence and proficiency will influence others to improve their practice as well.

The improvement of professional nurses through the procedure of RCA and FMEA can only be possible if every one of the caregivers can take their own responsibilities sincerely. I can be possible with effective transitional leadership where the leader can develop the acceptance among the workers while make sure of their consistent improvement (Nica, 2015).  Therefore, in this current scenario the basic leadership qualities should be supervising capability, capability of developing mutual integration, ability to teach and train others and sharing the core values as well as ethics of healthcare improvement plan.

Conclusion:

From the above discussion, it can be said that the root cause analysis is a systematic approach to examine the situation and to find out the cause and flaws behind a particular error that caused and adverse event. Along with that, The FMEA is a systematic procedure or framework to assess the risk of failure and to develop the process of improvement. It can be also concluded that, to promote the quality care the senior professional nurses should conduct various motivational programs among the workforce.

References: 

Carayon, P., Wetterneck, T. B., Rivera-Rodriguez, A. J., Hundt, A. S., Hoonakker, P., Holden, R., & Gurses, A. P. (2014). Human factors systems approach to healthcare quality and patient safety. Applied ergonomics, 45(1), 14-25.

Joshi, M., Ransom, E. R., Nash, D. B., & Ransom, S. B. (Eds.). (2014). The healthcare quality book: vision, strategy, and tools. Chicago: Health Administration Press., 4(10), 637.

Liu, H. C., You, J. X., You, X. Y., & Shan, M. M. (2015). A novel approach for failure mode and effects analysis using combination weighting and fuzzy VIKOR method. Applied Soft Computing, 28, 579-588.

Moradi-Lakeh, M., & Vosoogh-Moghaddam, A. (2015). Health sector evolution plan in Iran; equity and sustainability concerns. International journal of health policy and management, 4(10), 637.

Nica, E. (2015). Moral leadership in health care organizations. American Journal of Medical Research, 2(2), 118.

Peerally, M. F., Carr, S., Waring, J., & Dixon-Woods, M. (2017). The problem with root cause analysis. BMJ Qual Saf, 26(5), 417-422.

Phillips, J. M., Stalter, A. M., Dolansky, M. A., & Lopez, G. M. (2016). Fostering future leadership in quality and safety in health care through systems thinking. Journal of Professional Nursing, 32(1), 15-24.

Rojas, E., Munoz-Gama, J., Sepúlveda, M., & Capurro, D. (2016). Process mining in healthcare: A literature review. Journal of biomedical informatics, 61, 224-236.

Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ Qual Saf, 23(4), 290-298.