The Value of a Root Cause Analysis (Liability Landscape‪)‬

In recent years, a special focus of the Centers for Medicare & Medicaid Services, as well as the healthcare industry in general, has been the need for providers to ensure safe resident environments. By using a systematic approach to identify and evaluate hazards and risks, implementation of effective interventions can reduce or eliminate these dangers altogether. Such an approach is not easy, as it requires purposeful analytical skills and a thorough understanding of the investigative process that usually involves a root cause analysis. If conducted properly, a root cause analysis will enable the investigator to (1) isolate the circumstances that increased the risk of an accident or incident from occurring; (2) determine who or what was involved in the situation; and (3) assess whether the facility might have control over the causes of the event. Once an investigator has identified a root cause, implementing effective interventions should be easy. Please analyze the following circumstances to see what problems and contributory causes you can identify, as well as the changes you would make if this situation occurred in your facility.