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Question
Root cause analysis (RCA) is a structured method used to analyze serious adverse events. Initially developed to analyze industrial accidents, RCA is now widely deployed as an error analysis tool in healthcare. A central tenet of RCA is to identify underlying problems that increase the likelihood of errors while avoiding the trap of focusing on mistakes by individuals. RCA thus uses the systems approach to identify both active errors (errors occurring at the point of interface between humans and a complex system) and latent errors (the hidden problems within healthcare systems that contribute to adverse events). Directions: Student will identify a current problem or issue occurring on a nursing unit or within a healthcare organization. Student will identify at least two stakeholders and interview them to determine the root causes of the problem. (Student may present only 1 stakeholder for draft submission).
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