If 100 healthcare executives were polled about their definitions of “root cause analysis”, there would be 100 different answers. Here in is the problem, understanding the intent and power of Root Cause Analysis (RCA). For this reason, RCA is viewed as having either limited or phenomenal value to an organization. This article will seek to strip away the labels associated with RCA brands and focus on the processes, their results and how they are communicated (or miscommunicated) to executive management. Effective RCA efforts can fail because of their inability to demonstrate their value to the bottom-line of the organization.
Due to Affordable Care Act, RCA compliance is no longer going to be an acceptable measure of effectiveness. Currently, RCA compliance does not ensure patient safety. Hospitals are no longer being paid for the consequences of the errors they committed while the patient was in the hospital.
From a CEO’s standpoint, this means we either have to find additional revenue streams to compensate for the consequences of the errors or we have to stop the errors from occurring and impacting the patient. The logical conclusion is to strive to reduce the errors and protect the patient from harm.
When patients enter a hospital they already have some illness they are worried about; they shouldn’t also worry about the hospital making their condition worse due to errors!
This blog will be presented in a 3-part series based on the following:
Root Cause Analysis: An Executive’s Perspective
Many healthcare executives today read and hear about RCA, but few could delineate the steps in their own RCA process used at the sharp end of their organization. RCA effectiveness is rarely on the executive’s dashboard of Key Performance Indicators (KPI). Executives are typically strategists and RCA analysts are usually tacticians, so this would explain the gap in understanding between the macro and micro views of RCA.
However, executives have to determine the value of RCA based on its impact on their organization. What is “impact” in this case? Is it a measure of patient safety and/or dollars on the bottom-line? Traditionally, as business people, we are prone to watch the dollars on our income statements (IS) and balance sheets (BS) to measure the impact of initiatives on our executive dashboards. After all, this is one of the primary measures of the effectiveness of the executive to the Board, fiscal responsibility. It is not the only one, but certainly it is a primary one.
If an executive is going to support RCA as an initiative, they are going to have to understand the value, benefit and magnitude of the initiative to the organization, when these benefits will be realized and how the benefits will be measured. With an initiative as esoteric as something intangible like RCA, this can be a difficult task yet well worth the effort in the end.
For the most part, based on experience, it would be difficult today to find executives who could cite a direct correlation between their RCA efforts on the sharp end and line item(s) in their income statements. This is where efforts have to be focused to narrow the gap between the analysts implementing their RCA efforts and the manner in which they report results to their executives.
RCA analysts should strive to better understand how their RCA efforts will be assessed by their executives so they can report in such a manner that demonstrates the true effectiveness of their efforts. This will aid in their efforts to be understood by their organization, their ability to quantifiably impact patient safety and to justify further funding to expand their current efforts and purchase new technologies to make them more efficient.