Joint Commission Provides Tips for Conducting Effective Root-Cause Analyses

February 20, 2013 | Strategic Insights for Health System


After conducting a root-cause analysis, the involvement of hospital leadership is essential to implement and sustain the strategies identified in the corrective action plan, states an article published in the February 2013 issue of the Joint Commission’s theSource. The article examines the steps involved in conducting an effective root-cause analysis and provides strategies to help organizations implement the necessary changes identified in the analysis. The Joint Commission’s sentinel event policy requires accredited healthcare organizations to respond to sentinel events with a thorough and credible root-cause analysis and action plan. According to the agency, an individual root cause is rarely sufficient to lead to a failure. Alternatively, the interaction of several root causes is likely to be the true precipitator of a sentinel event. Because of this, many organizations are moving away from the term “root-cause analysis” and starting to use terms such as “causal-factors analysis,” which imply the existence of more than one causal factor. For many organizations, the transition from analysis to corrective action can be difficult. To facilitate this, the article offers several strategies.

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