Q: When should the facility conduct a root cause analysis, and when should we conduct a performance improvement plan (PIP)?
A: Issues that have the potential to cause harm may prompt a root cause analysis (RCA). Examples include medication errors, falls, bruises, fractures, staff turnover and elopements.
While an RCA is often the first step of a PIP, the two are different processes.
RCA is a systematic analysis that helps uncover vulnerabilities by identifying the underlying causes of a problem. The goal is to prevent recurrence. In contrast, a PIP is a concentrated effort focusing on a particular problem. Facilities use PIPs to examine and improve care or services.
Sometimes, RCA is a simple problem-solving exercise. For example, a facility bought new bed sheets and afterward noted an increase in skin problems. The RCA determined the sheets were lower quality and caused skin issues.
Other times, an RCA can require significant investigation and research to determine a true root cause. For example, when skin issues occur overnight, the initial impression might be the performance of night shift staff. But in one instance, an RCA revealed several contributing factors, including insufficient staffing, knowledge gaps in performing routine hygiene, and increased environmental humidity.
An RCA may uncover numerous contributing factors that require more in-depth investigation. With that information, the facility might also launch a PIP to address those underlying causes. To ascertain the true root cause of a problem, a facility must consider all possible causes.
RCA and PIP are distinct processes that can each help facilities mitigate the risk of problem recurrence.
From the october 2024 Issue of McKnight's Long-Term Care News
