ISHIKAWA DIAGRAM hospital examples3/18/2024 ![]() ![]() The main question of an equity-focused RCA should center on the role the health system plays. Actions (or inaction) taken by the healthcare team as it relates to care of the priority population.Īsking the right questions when a health system, health plan, or governmental organization uses an equity lens in conjunction with their RCA will yield better results. Taking the time to strengthen those relationships will not only benefit the provider organization but also the overall health of the communities served. A sustained, long-term, reciprocal relationship must be built on trust and open, honest communication where power is shared. See the Roadmap’s Essential Elements for more information about partnering with patients and communities.Įffectively partnering with patients and communities requires making a commitment that extends beyond soliciting feedback in focus groups and surveys. The children and their families will have critical information those within the health system may not be aware of about why the inequity is occurring and how it can be addressed. Using the example from the 5 Whys exercise, one might conclude that it is important to partner with Black children with asthma and their families. The issues most relevant to the priority population. Below, find issues to consider as your team begins completing its fishbone diagram: Fishbone Diagram It also makes it easier to visualize and share the findings. Creating a Fishbone Diagram: Points of ConsiderationĪ fishbone diagram provides a framework that helps teams identify and organize the potential causes of a specific health or healthcare inequity in a single chart. You might also reference “Conducting A Root Cause Analysis with an Equity Lens: Key Considerations” which outlines various topics and ideas to consider for different levels of the healthcare system as you apply an equity lens to your RCA. The “Diagnosing Root Causes With an Equity Lens” Resource document provides critical information to guide you through the RCA process. ![]() When conducted properly, an RCA requires investing time and resources to gather information and perspectives from multiple types of key stakeholders. To get at the root of why an inequity occurs, consider engaging your inner five-year-old by repeatedly asking one simple question: Why? Why ask “Why?”Īn RCA isn’t one singular action, but rather a set of actions. Inequities happen for many reasons, but they are often related to lapses in communication, cultural biases, and discrimination such as racism, heterosexism, classism, ageism, etc. However, because it likely affects all patients, it does not explain the difference in the organization’s ability to help Black children stay out of the hospital compared to other children. Giving care teams more time for asthma education is important to address. While conducting their RCA without an equity lens would certainly raise important opportunities to improve the quality of asthma care for all children, it would not necessarily address the inequities specifically experienced by the organization’s Black children with asthma.įor example, the organization might ask, “What is keeping us from being successful at keeping Black children with asthma out of the hospital?” In answering the question, one of the team members might note that care teams at the health system lack adequate time to teach children and their families about asthma management. Black children seem to be the most significantly affected, particularly in terms of needing inpatient treatment. Say a healthcare organization recognizes that there are healthcare disparities among the children they serve with asthma. Let’s take as an example children with asthma. An equity lens is a filter that helps identify the issues that contribute to the difference in quality of care and outcomes. RCAs can be used to identify opportunities to reduce and eliminate health and healthcare inequities by applying what AHE calls an “equity lens”. They provide a framework that helps teams identify and organize a problem’s potential causes and specific drivers. Different tools such as process-mapping, the “5-Whys,”and a Cause-and- Effect Diagram (e.g., the Fishbone Diagram) are used to conduct an RCA. RCAs are typically used in healthcare to identify general opportunities to improve quality of care and outcomes. RCAs identify the fundamental or deepest reasons for unwanted conditions or outcomes and use those findings to make changes to minimize reoccurrence. AHE Roadmap / Diagnose Root Causes Diagnose Root Causes Root Cause AnalysisĪ Root Cause Analysis (RCA) is often used in quality improvement efforts to understand why undesirable incidents occur. ![]()
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