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RCA2: Tools to Help Prevent Harm



When it comes to protecting patient safety, there are many different tools and techniques that healthcare organizations can use to minimize harm. It is critical for organizations to prioritize patient safety initiatives in order to avoid high costs and reduce the prevalence of preventable harm.

Root Cause Analysis for Healthcare 

According to the Center for Patient Safety, adverse events in hospitals cause more than 770,000 injuries and deaths each year. The cost to the U.S. healthcare system is as high as $5.6 billion annually. 

Root Cause Analysis (RCA) is a widely used method to analyze serious adverse incidents in healthcare.  The goal of an RCA is to identify any underlying problems in processes that increase the likelihood of an error. RCAs should be conducted with a non-punitive approach that focuses on learning rather than blame. When done effectively, an RCA can identify factors that contributed to an adverse event so that measures can be put in place to prevent similar incidents from happening in the future. However, this method is often not standardized and can have limited success if using outdated processes, such as tracking on paper or Excel.  

To improve the effectiveness of the RCA process, the National Patient Safety Foundation assembled a group of experts to examine best practices surrounding RCAs with the goal of preventing future harm. The process has been renamed Root Cause Analysis and Action, or RCA2 (RCA “squared”) to ensure that efforts will result in the implementation of sustainable, systems-based improvements. 

How Does the RCA2 Process Work?

The purpose of an RCA2 review is to identify system vulnerabilities so that they can be eliminated or mitigated. The RCA2 process involves specific activities that start with defining which incidents and close calls are worthy of further review. The review is not to be used to focus on or address individual worker performance, but instead seeks to better understand underlying systems-level issues. It is important that RCA findings are never used to discipline, shame, or punish staff. The focus should be on learning from mistakes to prevent future harm

A risk-based prioritization system should be put in place so that staff can credibly and efficiently determine which hazards should be addressed first. Severity categories may be ranked based on factors such as the extent of the injury, length of stay, level of care required, or estimated costs. For instance, an event that requires surgical intervention would be considered a higher priority than an event that only requires first aid treatment, and would be escalated to the risk management team for further review. For an RCA2 to be effective, staff members must also be educated on the importance of incident reporting , events, and near misses, and should receive training on the appropriate process for doing so. 

The RCA2 process outlines specific guidelines for follow-up actions, including setting task deadlines and assigning the person responsible for completing each action item. If an RCA2 is required, the review needs to be initiated as soon as possible following the event. The more quickly actions are implemented, the less risk there is for additional patient injury to occur. Active participation by organizational leadership is also embedded into the review process through a series of meetings and interviews. RCA2 team members prioritize discovering what happened, why it happened, and what can be done to prevent it from happening again. It’s important to have an interdisciplinary team conducting the RCA2 process to bring diverse perspectives to the table.

The final steps of the process include implementation of action items and identifying a method for measuring effectiveness. Feedback should be provided to the organization and staff involved to further learning and improvements.  Implementing a software solution is an effective way to streamline the RCA2 process with central channels for team communication, drill-through reporting, and real-time dashboards and analytics to easily track areas of risk.

RCA2 is an essential tool for improving patient safety, reducing future incidents, and lowering the total cost of risk in healthcare organizations.

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