Root Cause Analysis—Starting Out With A Problem, Part I
Nursing care facilities are faced with a myriad of problems daily. In addition, solving problems in nursing care facilities is often far from simple solutions. However, those that work in long-term care administration have often heard of the phrase-looking for the root cause. Its use in long-term care has often become cliché. This in turn has led to root cause analysis often viewed as an easy approach that can be used in a cursory manner to find solutions to problems that arise in the nursing care center. However, finding a cause is often predicated on identifying the problem. It is at this very early stage of problem identification, in which the problem is poorly defined, that root cause analysis goes awry, leading to failure in finding a cause or solution to a problem.
Often individuals are so enamored toward finding a cause that the cause becomes their ultimate goal. Although this is not a problem in itself, the problem exists when one puts the cart before the horse. Many will fail to miss the most important starting point-identifying and defining the problem clearly. This sounds quite simple, yet problem definition and clarification is often quite difficult and entered into often too cursory. In working with students and workers alike I have found that it is often very difficult for them to define the problem, and when the contextual nature of the problem becomes more complex, the difficulty in clearly delineating the problem becomes compounded. In looking for cause one of the biggest mistakes people make is taking problem formulation and development too lightly.
The reason that identifying the problem clearly and accurately is so important is that it drives everything else that follows. Without a clearly stated problem you become a ship sailing without a particular destination; a ship that may touch many ports and areas of land without ever knowing if the port that you have entered or the land that you touched is the correct point of destination. As Chaffee (2004) stated, "The first step in solving problems is to determine exactly what the central issues of the problem are. If you do not clearly understand what the problem really is, then your chances of solving it are considerably reduced"(p. 87).
As health care professionals we face a panoply of issues with graded complexity as well as different levels of urgency. However one has to always be sure that the problems that we are struggling to solve are actually the problems that are the issues. Problem identification is the first step toward finding the cause of any issue, yet we have often been taught to define problems is a hasty, ambiguous, and often very generalized fashion. Furthermore, we have come to accept ill-structured problem statements without challenge, whether it is from political candidates, bosses, or experts in other areas giving their opinions on topics they know very little about. Moreover, a well-defined problem is more than just an opinion, but a structured, analytical premise that has examined alternatives, and with it leads to a well-grounded starting point for continued investigation and analysis.
One does not have to be a seasoned scientist to determine root cause, but one does have to be a seasoned practitioner who exercises their skills regularly in this area. Root cause analysis is a skill that needs to be learned and practiced. It is more than just asking questions, but asking the correct questions, look at pertinent alternatives, and developing a clear problem that will hopefully lead toward finding the ultimate cause to a particular issue. In upcoming postings I will look at this issue further in parts II and III. Feel free to offer any feedback that you have on this topic.
Chaffee, J. (2004). Thinking critically-A concise guide. Houghton Mifflin Company, Boston.