Success Cause Analysis: Focus on the Positive

Organizations often respond to adverse events and near misses by performing a root cause analysis (RCA). RCA is a systematic method to review an adverse event or near miss to identify the factors that contributed to the event to prevent it from happening again. The RCA process has long been the primary method that organizations use to improve patient safety. Undoubtedly, studying unfavorable outcomes can provide valuable insight into the systemic issues contributing to bad outcomes—but this often comes at a price. By focusing solely on adverse events and unfavorable outcomes, staff morale and motivation can suffer.

But what happens when everything goes right? Or when injury was avoided by an alert staff member who made a “good catch”? Most of the time, healthcare is delivered safely and outcomes are good, but often there is no formal process to research and analyze the factors that contributed to those successful outcomes or good catches.

Success cause analysis (SCA) uses the systematic approach of an RCA to understand the factors that led to a favorable outcome. The goal of the SCA is to learn how success was achieved, reinforce decision-making, and learn how to improve outcomes even further. Focusing on the positive rather than the negative can promote congeniality and enhance team engagement in the organization’s patient safety initiatives.
 
The traditional view of safety (Safety-1) in critical industries like aviation was that system components either worked correctly or incorrectly. This binary view allowed incident investigators to search for the “cause” of a particular issue and to “fix” the problem.

But modern systems are less binary—they are more complex and involve human interaction and adaptation. When things go right, especially in a fast-paced, rapidly evolving healthcare environment, it is because humans can adapt to the conditions in which they are working.

The new approach to safety (Safety-II) focuses on the ability of a system, including the humans operating within it, to succeed under variable conditions. This approach assumes that the adaptive capacity of humans enhances the flexibility and resilience of their work systems. The Safety-II system requires tools like the SCA to look for and analyze positive outcomes.

 

Risk Recommendations: 

While the RCA remains an important performance improvement tool, the SCA can interject a unique perspective into an organization’s patient safety efforts and improve staff morale and engagement in the process. Consider the following when evaluating whether to introduce an SCA program to your organization:

Do your homework. Research the theory behind the SCA process and the ways it can benefit your organization. Learn what models, tools and resources other organizations have used to develop and refine their SCA programs. Collaborate with other organizations to share and discuss the practices that will work best at your own organization. Share key learnings with the governing body, leadership, and other thought leaders in your organization.

Assess organizational capacity. Assemble an interdisciplinary team to determine whether your organization has the resources, capacity, and ability to build and support an SCA program. Like RCA programs, SCA programs require an investment of financial and human resources. Staff the SCA program with adequate numbers of highly trained and/or experienced team members. Factor the cost of acquiring, creating, and maintaining documents related to SCA processes into the program budget.

Know the law. Consult an attorney to ensure that the SCA program and process complies with applicable state and federal law and that it is properly integrated into the existing quality assurance/improvement, risk management and/or patient safety plan. Confirm that all documents related to the SCA process contain sufficient language to maximize the desired protections afforded under relevant state law. Explore with your attorney how you can safely share successes both within your organization and with outside organizations, such as patient safety organizations.

Map a process. Plan the implementation of an SCA process that: 

• Provides guidelines for event reporting, including near misses and good catches.
• Outlines criteria for event review.
• Identifies an interdisciplinary SCA team.
• Maintains accurate records and designates where to keep them.
• Ensures confidentiality of all phases of the process.
• Creates a written SCA policy and procedures.
• Integrates the SCA process into the organization’s quality, risk or patient safety activities.
• Describes how to share key learnings within the organization.

Implement the plan. After the plan is finalized and approved, notify staff of the start date, and implement the SCA program as planned. Encourage buy-in by educating staff about the purpose, value, and process of SCA and distinguishing it from the RCA process. Ensure that all involved staff are aware of their respective roles and responsibilities.

Evaluate regularly. Identify quantifiable measures to track program progress and success. Share data and key learnings with the appropriate quality, risk or patient safety committees to facilitate process improvement. Regularly review and evaluate the program and improve it as necessary.
When adverse events occur, critical event evaluation with an RCA is essential. But when things go well, SCA can help organizations understand the factors that contribute to success, and in doing so, boost morale and staff engagement.