What makes RCA different from, say, risk assessments or ‘Never Events’ reporting? In simple terms, RCA is the investigation and analysis of the difference between what actually happened and what should have happened – according to practice policies or acceptable practice. It’s used to methodically identify the root cause of incidents rather than simply addressing the results. The process continues through the stages of generating recommendations, implementing solutions and compiling a report.
Gathering and mapping
The starting point is recording at what stage and how the incident was detected. The former might be during a proactive risk assessment or at some stage in a patient’s journey. How the incident was detected could be many ways from various patient or staff observations, by monitors or alarms, by an audit or a complaint. The national patient safety agency (NPSA) offers a useful 27-point checklist on their website – some of which you can delete as being not relevant to general practice. This information is then mapped onto a timeline spreadsheet.
Identifying problems and contributory factors
Now you need to identify and note care and service delivery problems relating to the incident. To these you add contributory factors – classified by headings such as patient factors, staff factors, communication, organisational factors and so on. Again, the NPSA’s website has a checklist with subheadings within each heading and ‘components’ for each of them – more than 150 in total, an indication of the level of analysis required.
Solutions can be classified as barriers, control measures or defences against a reoccurrence of the incident and then further defined as human action (e.g. checks), administrative (e.g. protocols and procedures), natural time, distance or placement (e.g. isolating a patient) and physical (e.g. X-ray controls accessible from behind a screen). Solutions should always make it easier to get things right than wrong; consider consulting other practice teams to see how they approached similar incidents and, when you write a report of the RCA, do so with a broad audience in mind – team members, patients and the general public, your CCG, the Department of Health and so on.