rca

A root cause is the cause or causes that if addressed, will prevent or minimise thechances of an incident recurring.Root cause analysis is a methodology that enables you to ask the questions Howand Why in a structured and objective way, to reveal all the influencing and causalfactors that have led to a patient safety incident. The aim is to learn how to preventsimilar incidents happening again, not to apply blame.The same techniques can be used to investigate incidents as well as near-misses, asthere are lessons to be learned from both.A RCA approach to incident investigation will achieve a number of benefits (NPSA2004, Step 6). These include:Providing a structured and consistent approach to incident investigationShifting the focus away from individuals and on to the system to help build anopen and fair cultureIncreases awareness of patient safety issuesHelping engage patients in the investigationDemonstrating the benefits of reporting incidentsFocussing recommendations and change as a result of identifying the rootcause(s) of an incidentThere will usually be a facilitator who co-ordinates a RCA. Other people may beinvolved as members of the team gathering and exploring information about anincident. The people who were actually involved in the incident may also be part ofthe process, for example, by being interviewed.