Root cause analysis

Root cause analysis (RCA)

What is RCA?

Root cause analysis (RCA) is a way of conducting an investigation into an identified problem that allows the investigator(s), and other people, to understand the root or fundamental cause of a problem so that it can be corrected.

In the AROMA project, we have also used peer review as a way of looking at problems; RCA focuses on using a structured systems approach instead of only looking at clinician behaviour and attitudes. By using the RCA approach we can ensure that participants gain a clear picture of the problem or critical event. People involved in the critical incident need to be part of the RCA process where the steps need to be carried out in the right order. Once all of the investigation is done, actions can be put into place and evaluated.

Who should do RCA?

Root cause analysis (RCA) is a group exercise, where the input of the team helps in creating a balanced and full picture of what happened. A person who understands RCA should facilitate RCA critical incident reviews. This will ensure that all causal and influencing factors are identified and effective solutions considered.

How do I carry out a RCA?

RCA principles can be applied to all problem-solving activities. A full RCA would normally be applied to high risk or high impact events. The process can be resource-intensive, so that a decision on proceeding with this type of analysis needs to be considered carefully. The RCA process involves several steps:

• Describing the event and what took place
• Organising the RCA team
• Gaining a clear picture of the process leading to the adverse event
• Understanding the causes of variation
• Selecting risk reduction strategies
• Going through the PDCA cycle (Plan, Do, Check, Act)

An effective RCA is the application of good investigative techniques and good 'drilling' techniques.

What are RCA tools?

There are several tools that fall under the umbrella of RCA, these can include:

• Cause and Effect Diagrams
  
  Representing relationships between the effect and possible causes influencing it.
• Flow Charts
  
  Create a pictorial summary of the flow of steps in the process which helps in identifying what the process or system does.
• Why-Why Diagrams
  
  Help create a disciplined approach to drilling down to the root causes. This is often used after a cause and effect chart.
• How-How Diagrams
  
  Help create a disciplined approach to action planning by ensuring that all actions are identified at the outset and will be acted upon.

Limitations of RCA

While RCA can be an effective tool for investigation, it may be difficult to identify whether the root cause established through analysis is the actual cause of the incident.

Hindsight bias may influence the analysis, as will organisational concerns. This is a time-consuming and labour-intensive exercise especially as you will need to call upon many players involved in the incident. The results will be qualitative rather than quantitative. It is therefore prudent to carefully select which incidents you decide to carry out a RCA on.

Key points

Things to remember

• It is important to select the right team for carrying out an RCA; members should have knowledge of the process and be able to help explore the why, what and how
• Don't jump in with solutions: the problem and solution may not be obvious
• Make sure you are aware of the causal relationships
• Suggest improvements that you can implement and that are owned and signed up to by your team
• Having a facilitator with experience in the process will make things easier; this includes someone who knows about process, tools and facilitation
• Practising the techniques of RCA will ensure that your maintain the skills
• Only take responsibility for actions over which you have control: you should not agree an action plan for something you can't implement

RCA Resources

Further information and resources

The following additional resource is available to help you with Root Cause Analysis:

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