[MUSIC] You've previously learned that root cause analysis is based on the principle that problems can be best solved by rectifying the root causes as opposed to other methods that focus on addressing the symptoms of the problems, and that through corrective actions the underlying causes can be addressed so that recurrence of the problem can be minimized. This week you'll learn about root cause analysis in more detail as well as how to apply a tool to identify causal factors of poor or sub optimal health service performance. You will also learn about how such an approach has enabled health service transformations and explore some of the lessons learned from global initiatives in this area. Root cause analysis is quite a popular and frequently used technique that helps people answer the question why a certain problem has occurred. It's quite simply the application of a series of logical common sense techniques in a systematic way, which is quantifiable and documented to understand and resolve underlying causes of a problem. It's used in many disciplines. In medicine and health, especially, you'll find it being applied quite often in patient safety and quality, particularly in relation to adverse patient events. To conduct a root cause analysis you set out to determine what happened or identify and understand the problem, to determine why it happened or to identify the root causes, and to figure out what to do to reduce the likelihood that it will happen again, or to outline corrective action and monitor. The root cause analysis process follows five steps. Step 1 is problem definition. You need to be accurate and specific here as this will be the building block of what's to come. If you identify the problem inaccurately, your proposed Ssolutions will not be as effective. Step 2 is data collection. Here it's all about collating evidence about the problem and its impact. A complete analysis of the situation is necessary before you can move on to explore factors that contribute to the problem. So to maximize the effectiveness of your root cause analysis, you should bring together everyone such as experts and frontline staff who understand the situation. People who are most familiar with the problem can help lead you to a better understanding of the issues. Step 3 is to identify possible causal factors. This step includes finding the sequence of events that led to the problem, the conditions that allowed the problem to occur, as well as other problems that may contribute to the occurrence of the central problem. Very frequently people identify one or two factors and then stop, which is not enough. It's therefore important to dig deeper into the problem to find out as many causes as possible instead of just stopping at the surface. At this step, try your best to find as many causal factors as possible. You can use a number of different tools to help you identify causal factors such as the five whys, the cause and effect diagram, which is also known as the fishbone diagram, brainstorming, process analysis mapping and flow charts, or Pareto Analysis. There are also others. These tools are designed to encourage you to dig deeper at each level of cause and effect. The first three I mentioned, the five whys, the cause and effect diagram, and brainstorming, are the most commonly used, and I'll share an example of one of them in a few minutes. Step 4 is identify the root causes. This means finding out why the causal factors exists and the real reasons behind the problem that occurred. You can use the same tools as used in step 3 to identify the causal factors to look at the roots of each factor. Step 5, the final step, is recommend and implement solutions. This step includes finding a solution or solutions to prevent the problem from happening again, outlining and identifying the possible risks involved in the implementation of the solution, and actually implementing it. Now let's explore one of these techniques in a little more detail, the five whys. Five whys was actually created by Toyota, the Japanese car manufacturer, as they developed their manufacturing methodologies. It forms a critical component of their problem-solving training and is part of the Toyota production system. It's also used in Six Sigma, which is a management technique intended to improve business processes by greatly reducing the probability of error to occur. By repeatedly asking the question why, use five as a rule of thumb but you can ask more times if relevant, you can peel away the layers of a problem to get to the root causes. It can help you determine the relationship between different root causes of a problem, and it's quite a simple tool to use. So let's see how using the five whys technique can help get to the bottom of the following problem, which has been flagged up in one of the NHS trusts in the UK, considerable delay in the diagnosis of skin cancer. We'll start by asking, the patient's diagnosis of skin cancer was considerably delayed, why? One of the reasons uncovered is that the excision biopsy report was not seen by the surgeon. We ask again, why? The report was filed in the patient's notes without being seen by the surgeon. Why? It was the receptionist's job to do the filing. Why? The junior doctors were busy with other tasks. Why? The root cause is that the doctors' other tasks were seen as more important than filing, which led to the overarching problem of the diagnosis being delayed. Solutions and recommendations were then put in place and the reporting system was changed so that a copy of all biopsy reports will be sent to the consultant surgeon responsible for the patient and no reports are filed unless they're signed by a doctor. This technique, amongst others I mentioned, has been and continue to be used to identify root causes for sub optimal health service performance. Next, I will share with you some examples of how countries went about identifying causal factors for sub optimal health service performance as well as some overarching common bottlenecks and root causes of sub optimal health service performance. To summarize, root cause analysis is the application of a series of logical, common sense techniques in a systematic way, which is quantifiable and documented to understand and resolve underlying causes of a problem. Root cause analysis follows five steps, problem definition, data collection, identification of the causal factors, identification of the root causes, and recommendations, which include implementing solutions. It's important to remember that when you identify the causal factors make sure to dig deeper into the problem to find out as many causes as possible. [MUSIC]
