Root Cause Analysis Template Healthcare

Use the Healthcare Root Cause Analysis Template to investigate issues in hospitals, aiding in identifying underlying causes and improving patient outcomes.

Root Cause Analysis Template Healthcare



Patient Safety Analyst

1. Is the need confirmed with the Medical Director of Patient Safety (MDPS)?


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2. Is the initial event/chart review completed?


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3. Is a folder (electronic and paper) for RCA documents created?


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4. Is the event entered into the Access database?


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5. Is the RCA Tracker updated?


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6. Is it verified that appropriate leadership is notified?


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7. Are the Directors of Risk Management and Billing contacted about AHEs and SEs?


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8. Are copies of work standards and checklists obtained for the investigation meeting as appropriate?


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Administrative Assistant Of VP/Chief

1. Is the coordination and scheduling of the investigation meeting, including the VP/Chief, Medical Director of Patient Safety, Patient Safety Analyst, and Local Area leadership, completed within two business days?


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Patient Safety Analyst, Vice President And/or Chief, And/or Medical Director Of Patient Safety

1. Are arrangements made to meet in the event area for an initial understanding of the situation?


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2. Are efforts made to determine if care, procedures, and/or provider/staff are on hold?


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3. Are key leaders identified to participate in the investigation with the patient safety analyst?


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4. Is the email link to the "Process at a Glance" sent to area leaders?


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5. Is a timeline for the investigation completion created, and is the RCA date negotiated?


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6. Is communication with the patient and family ensured as appropriate?


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7. Are considerations made to determine if additional PNHS leadership needs to be notified?


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8. Is the CAP owner identified, and is their information entered into the RCA Tracker?


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Patient Safety Analyst And Investigation Team

1. Is the chart reviewed?


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2. Are staff members interviewed?


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3. Are the critical and contributing staff, as well as the supervisor/manager (or designee) for the RCA draft attendee list identified?


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4. Are policies/procedures and work standards reviewed?


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5. Is a literature search completed as appropriate?


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6. Has the area leader reviewed staffing levels and returned the Root Cause Analysis (RCA) Investigation – Unit Staffing Review document to the patient safety analyst?


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7. Are conversations with staff around the RCA process and safe meeting environment initiated?


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8. Is the final attendee list submitted to the Vice President/Chief Administrative Assistant, along with the Root Cause Analysis (RCA) Meeting Details template?


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Vice President And Investigation Team

1. Has one assisted and supported in the creation of the final attendee list?


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Administrative Assistant Of VP/Chief

1. Is the final attendee list from the Patient Safety Analyst received?


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2. Is the RCA meeting scheduled as calendars permit or for the date and time specified by the Patient Safety Analyst and VP/Chief?


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3. Are the Adverse Health Event and Sentinel Event RCA meetings scheduled within seven business days of discovery, and all other RCAs scheduled within 21 business days?


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4. Are Outlook invitations sent to attendees utilizing the RCA meeting details?


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5. Is a conference room scheduled for the specified date and time, and is the correct room setup ensured?


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VP And VP Administrative Assistant

1. Are attendee availability reviewed three days before the meeting to discuss "critical" vs. "optional" attendees, ensuring a "go, no-go" decision is made?


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2. Is the assigned Patient Safety Analyst notified regarding the RCA "go-no-go" decision?


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Patient Safety Analyst

1. Is the "go-no-go" decision for the RCA meeting from the Vice President/Chief's Administrative Assistant received (at least one day prior)?


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2. Is the RCA Tracker updated with the date of the meeting and any additional information?


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3. Is the Last Word reviewed and the timeline of the event finalized?


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4. Is the timeline shared and reviewed with area leaders for feedback before the RCA?


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5. Are materials and tools for the RCA, obtained including copies of work standards?


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6. Has one huddled with the Medical Director of Patient Safety regarding the RCA?


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7. Has one huddled with the area manager/leader and coordinated who will present the event summary?


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RCA Meeting

1. Is the root cause established?


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2. Is the CAP follow-up meeting date set?


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3. Is the CAP owner identified?


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4. Is the event in the Access database completed?


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5. Are the VP/Chief, Medical Director of Patient Safety, and Patient Safety Analyst huddled to review if the RCA process is effective with the attendees present?


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Patient Safety Analyst

1. Has the Corrective Action Plan (CAP) summary emailed to the entire RCA group?


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CAP Owner, Patient Safety Analyst, Local Area Leadership, And Content Experts

1. Is the implementation plan document completed?


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2. Is the RCA area audit results form completed?


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3. Are the needs for Change Management support identified including the responsible part or additional communication?


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4. Has the Corrective Action Plan (CAP) been emailed to the VP/Chief and Medical Director of Patient Safety for final approval?


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Administrative Assistant Of VP/Chief

1. Is a thank-you note sent out via email, handwritten note, or Ovations to all participants on behalf of the VP/Chief?


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Final Steps

1. Is the remainder of the information entered into the Access database?


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2. Are the CAP Summary, Implementation Plan, and Area Audit saved to the specified folders?


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3. Is the RCA updated with available information?


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4. Is the Clinical Board of Governors (CBOG) preparation completed?


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5. Has the Patient Safety Analyst Project Manager been met and handed off measures and the Implementation Plan?


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6. Is the paper file folder placed in the appropriate cabinet?


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Checklist by GoAudits.com – Please note that this checklist is intended as an example. We do not guarantee compliance with the laws applicable to your territory or industry. You should seek professional advice to determine how this checklist should be adapted to your workplace or jurisdiction.

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