kim task 2.docx - C489 Task 2 Western Governors University A Explain the general purpose of conducting a root cause analysis(RCA The general purpose of

kim task 2.docx - C489 Task 2 Western Governors University...

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June 23, 2020 C489 Task 2 Western Governors University
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A. Explain the general purpose of conducting a root cause analysis (RCA). The general purpose of conducting a root cause analysis is to review past events to determine the causes of the events and then initiate a plan to correct the events and to keep them from happening again if possible. The ultimate goal of conducting a RCA is to determined what occurred, why it occurred, and how it occurred. When conducting a RCA it helps an individual with figuring out what or who cause the event and how to prevent the event from happening again by putting a plan together to prevent the problem from occurring again and prevent future harm. A1. Explain each of the six steps used to conduct an RCA, as defined by IHI. Step one that is used to conduct an RCA is to determine what happened. Once the team has identified what happened the individual/team, the team then try to describe what happened in the best most accurate term. The information gathered must be documented as accurate as possible as well as providing detail information what led to the event. In this step, the individuals involve should not be the one collecting the information on what happened. Flow charts are sometimes used to clarify the data by drawing pictures of the event in the order that it occurred.
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Step two in the RCA is the step in which the team collaborate with what should have happened in a typical workplace. This information can be compared to the flowchart from step one. Step three the team will factor in everything that contributed to the event. To do this the team should ask “why” five times. By asking the “why” the team should be able to determine the causes of the event. In this step, a fishbone diagram is used to explore and lay out the possible causes of the event. Step four involved in conducting a RCA is developing casual statements. When the team develops a casual statement or statements it should link the cause that was determined in step three to its effect and then back to the main event that initiated the RCA altogether (IHI, 2019). The casual statements help explain how the current factors led or contributed to the wrongdoing of the patients and staff. In this step you have the cause, the effect and the event. Step five of the RCA is to bring all the data that was gathered by creating a list of recommended action to prevent the events from reoccurring again. The list could include educating the staff, ways to simplify a process, developing new policies and many more depending on the event that led to the RCA. The last step which is step six is to write a summary and share it within the facility or department. This is an opportunity to share how things can easily go wrong and prevented. This step also displays the next steps in improvement.
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