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QI toolkit: identifying improvement opportunities

The first step in making an improvement is to identify where a problem exists, maybe from a clinical audit review, or there is an opportunity to enhance patient care.

Here are some tools that can help you to fully understand why a problem has occurred and what might need to be done to remedy it.

Root Cause Analysis

When incidents happen, it is important that lessons are learned to prevent the same incident occurring elsewhere. Root Cause Analysis (RCA) investigation is a well-recognised way of doing this. It is used to identify areas for change and to develop recommendations which deliver safer care for your patients. It seeks to:

  • Determine what happened
  • Understand why it happened
  • How to reduce the likelihood that it will happen again.

The RCA process has five steps:

Root Cause Analysis

RCA using ‘five whys’

By asking the question ‘why?’ you can peel away the layers of an issue to get to its root cause. It can uncover the root cause of a problem that has occurred during a project or programme. It not only uncovers glitches in the delivery, but also issues with organisational or team processes.

Reasons for a problem can often lead into another question. You may need to ask why more than five times to get to the origin of a problem. Remember to:

  • Avoid assumptions and encourage your team to keep drilling down to the real root cause of a problem
  • Focus your resources in the correct areas and make sure the right action is taken
  • Ground your answers in fact, avoiding listing events that might have happened.

RCA 5 whys

‘Five whys’ in action – a practical example

Root cause – there is no equipment maintenance schedule. Setting up a proper maintenance schedule helps ensure that patients should never again be late due to faulty equipment. This reduces delays and improves flow. If you simply repair the trolley or do a one-off safety rail check, the problem may happen again sometime in the future.

The ‘five whys’ technique uses counter-measures, rather than solutions. This makes sure that action(s) prevent the problem arising again, rather than a solution which just deals with the situation.

RCA using the cause and effect diagram

This tool will help you to spot, sort and display possible causes of a specific problem. The fishbone diagram illustrates the relationship between the outcome and the factors that influence it.

fishbone diagram

The problem is placed at the head of the fish, then major categories or process steps are placed at the end of the bones. Be flexible with the categories chosen. To identify causes under each category, review existing data and consider, ‘Why is this happening?’

Repeat this approach for each category until you drill down to the root cause.

Hints and tips

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