Problem solving using the RCA and prioritising in planning

Once a nation is free it must also be free to work …….

A pay cheque maketh a living,

BUT work maketh a life. J Tibane

Activity

What is your vision as a DCST for your district?

10 minutes

The challenge model

Measu

rable resu

lts (ap

pro

priate in

dicato

rs)

DCST VisionImprove maternal neonatal and child

health outcomes in South Africa

Challenge/opportunities = Identified problems/challenges

Current situation = COMPLETED SITUATIONAL ANALYSIS (Based on the MSH Challenge Model)

Root cause analysis of selected priority problems

Priority actions

• Equity considerations• Feasibility

• Acceptability to community• Appropriateness

(effectiveness) • Cost effectiveness

NB Focus on one challenge at a time

Workplan• Targets• Time frames• Resources

etc

A root cause analysis involves asking "Why?" coupled with the determination to find answers that will help permanently resolve or at least improve the situation being dealt with.

WHY!

"Why did the problem happen?". If the answer tells you how to fix the problem but not how to prevent it in the future, then you need to keep asking why.

Root cause analysis is not for the faint-at-heart

Asking probing questions and searching for answers about why things went wrong can make you unpopular, especially if your investigation involves other teams and other managers.

RCA steps

Collect information (situational analysis)

Categories

Causal factor charting

Root cause identification

Recommendations

RCA showing collective responsibility

Assessment done by Haroon Saloojee

Division of Community Paediatrics

"I'll be the first to say someone's head must

roll, but in this instance there is no

basis to fire any human being or

subject anyone to disciplinary

procedures. There is no clear evidence.”

Klebsiella was found in almost all the

feeding bottles, which had not been cleaned

properly.

“Some of the things that parents raised with us were that their children were left with vomit un-

cleaned, babies were left to lie in wet and soiled

incubators, ...same syringes were used more than once ...

nurses not responding to their calls while they were busy gossiping

about each other.  These issues are going to be

followed up”

“The team that has done all these things is known by all the parents and the

CEO knows them.  Where disciplinary

measures have to be taken, they will be

taken”

A gap analysis – asking why?

High MMR in District A

Late ANC attendance

Ishikawa diagramsMeasurements PersonnelMaterials

EquipmentMethodsEnvironment