When it comes to quality and safety improvement, healthcare leaders spend plenty of time analyzing adverse events and what led up to an unfavorable outcome. At NYC Health + Hospitals, leaders are beginning to apply that same level of rigor when things go right.
"What we've been advocating for is the idea of moving away from a more reactive culture to a more systematic, proactive culture" to advance patient safety, Komal Bajaj, MD, chief quality officer at the New York City-based health system's Jacobi hospital, told Becker's. In line with this, the health system has started conducting success cause analysis to better understand the factors that contributed to a favorable outcome — a twist on a common methodology used to review safety failures.
Root cause analysis is one of the most widely used methods in healthcare to review serious adverse events, according to the Agency for Healthcare Research and Quality. The Joint Commission requires accredited facilities to use RCA, and many states require the method be used after serious patient safety events. While the approach has an established place in identifying missteps, studies have called into question RCA's ability to drive sustainable systems-level solutions that lead to measurable improvements on patient outcomes.
Meanwhile, relatively few organizations have processes in place to learn what led to a favorable outcome and how to integrate strategies to promote safe outcomes in the future. This is where success cause analysis comes in.
"There are millions of things that go right every day" that healthcare organizations stand to learn from, Dr. Bajaj said. Success cause analysis is a structured approach to do that, and it is resonating well with staff, she said.
In January, she was among the authors of an Institute for Healthcare Improvement blog that described a fictitious scenario in which success cause analysis was performed, with parallels to similar types of real cases that have been studied. The case involves a patient who experienced a serious anesthetic reaction in an outpatient clinic located on a hospital campus. From the administration of specialized medications to the escalation of care, the care team's response went seamlessly, leading to a quick recovery that allowed the patient to be discharged several days later.
After reviewing the entire process, two factors stood out as having led to a favorable outcome: a prominently displayed sign detailing the escalation process and the outpatient team's regular participation in simulations. Those two changes were then hardwired into other outpatient clinics that are on a hospital campus.
"Oftentimes what we'll find [through SCA] is even things that seem heroic, there were cultural and system factors that led to that behavior or impact," Dr. Bajaj said.
Success cause analyses are not integrated into every corner of the health system — at least not yet. The health system intentionally did not put strict requirements around how many or in what situations SCA should be used when introducing the idea. Instead, they are being done more informally, sometimes simply in the form of a conversation to unpack and learn from a successful outcome.
"It's a work in progress," Dr. Bajaj said. "The point is to start somewhere."
Leaders at NYC Health + Hospitals are finding the approach is emerging as a way to involve front line staff, patients and families — who are not always involved in root cause analysis — into quality and safety processes. Additionally, it's a way to give employees who do lead RCA work a chance to be involved in the positive outcomes, Dr. Bajaj said, which can ease some of the third victim syndrome that may occur among teams that are involved in reviewing negative events.
The concept has garnered significant interest from peers at other healthcare organizations, Dr. Bajaj said. Many have reached out expressing interest in implementing mechanisms to learn from successful events.
"Even if you do one success cause analysis a year, it's a great start," she said. "Organizations in theory know how to do this because they have machinery to do event analysis. … That's kind of my goal in general. Don't re-create the wheel. Use existing processes and procedures to make things better."