Root Cause Analysis in Primary Care course for GPs
This session focuses on applying root cause analysis (RCA) in general practice. RCA is a systematic incident investigation method that can be used to identify the underlying systems factors that led to a patient safety incident. This session was reviewed by Suchita Shah and last updated in February 2015.
Learning Objectives
By the end of this session you will be able to:
- Explain the meaning of key terms that are used in root cause analysis (RCA)
- Describe the benefits of using RCA methods to investigate patient safety incidents that occur in general practice
- Identify best practice in carrying out RCA investigations
RCA is important because the methodologies it provides enable those staff carrying out the incident investigation to think beyond human error. That is to say, to focus not only on what went wrong and how it happened, but also to identify why an incident occurred. So, in terms of Reason’s Swiss Cheese model, RCA promotes the identification of latent conditions, as well as active errors.
Dr Jane Carthey is a Patient Safety and Human Factors Specialist who has worked in the NHS for 13 years, both at a local Trust level and for a national agency. Dr Carthey has applied human factors methodologies to understand the causes of incidents in healthcare in acute and primary care settings. Her expertise includes incident reporting, organisational and team safety culture, observational data collection, incident investigation, prospective risk assessment and improving communication between patients and healthcare staff when things go wrong.
Christine has worked as a GP in Nottingham since 1988.
Through her undergraduate work at the University of Nottingham as Community Sub Dean and postgraduate work as part of Health Education East Midlands, she has been involved in the delivery of education to both medical and multi-professional audiences with a particular emphasis on Quality Improvement and Patient Safety.
She represents Vale of Trent on the RCGP Council.
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