RCA and FMEA: Improving Patient Outcomes and Quality Care

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Running head: RCA and FMEA
Task 2 (1217)
RCA and FMEA

RCA and FMEA
Table of Contents
A. Explain the general purpose of conducting a root cause analysis (RCA)...................................4
100 A1. Explain each of the six steps used to conduct an RCA, as defined by IHI.......................4
100 A2. Apply the RCA process to the scenario to describe the causative and contributing
factors that led to the sentinel event outcome..................................................................................4
B. Propose a process improvement plan that would decrease the likelihood of a reoccurrence of
the scenario outcome.......................................................................................................................5
B1. Discuss how each phase of Lewin’s change theory on the human side of change could be
applied to the proposed improvement plan......................................................................................5
C. Explain the general purpose of the failure mode and effects analysis (FMEA) process............6
C1. Describe the steps of the FMEA process as defined by IHI.....................................................6
C2. Complete the attached FMEA table by appropriately applying the scales of severity,
occurrence, and detection to the process improvement plan proposed in part B............................7
D. Explain how you would test the intervention from the process improvement plan from part B
to improve care................................................................................................................................8
E. Explain how a professional nurse can competently demonstrate leadership in each of the
following areas:...............................................................................................................................8
• Promoting quality care..............................................................................................................8
• Improving patient outcomes......................................................................................................8
• Influencing quality improvement activities...............................................................................9
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RCA and FMEA
E1. Discuss how the involvement of the professional nurse in the RCA and FMEA processes
demonstrates leadership qualities....................................................................................................9
References......................................................................................................................................10
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RCA and FMEA
A Explain the general purpose of conducting a root cause analysis (RCA)
Root Cause Analysis is a kind of systemic approach to solving different problems. Certainly
three major purposes of conducting Root Cause Analysis (RCA) are a physical cause, human
cause, and organizational cause. To identify system flaws and prevent errors to happen, RCA
plays a critical part in an organization. In the case of negligence or willful harm, an RCA is not
applicable. The central feature of RCA includes a focus on system causes rather than blaming.
Moreover, by conducting Root Cause Analysis (RCA), critical system errors can be identified
and resolved (Latino & Latino, 2015).
A1. Explain each of the six steps used to conduct an RCA, as defined by IHI.
Step 1: Identify what happened
In this step, the team needs to clarify information about the event by making a flowchart of what
happened.
Step 2: Determine what should have happened
The team should recognize what happened in ideal conditions by comparing information of the
flowchart.
Step 3: Determine causes
The team must determine direct causes including all contributory factors in this process.
Step 4: Develop casual statements
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