How to Analyse Incidents in Healthcare
A systematic analysis and classification of incidents is essential to improve quality and safety in your healthcare organisation. There are various methods, which can be divided into two different approaches: retrospective versus prospective.
A retrospective analysis looks back on what happened. It is a structured approach that leads to finding basic causes of (near) incidents.
A prospective risk analysis helps you understand how systems or processes can fail. This knowledge can be used to anticipate potential errors.
Below we discuss several methods of incident and risk analysis:
- SIRE method
- Ishikawa (fishbone diagram)
- PRISMA analysis (root cause analysis)
- FMEA (prospective risk analysis)
- FRAM-analysis (process visualisation)
SIRE focuses on incidents with serious consequences or incidents that occur frequently. SIRE offers a toolbox including the following analyses: Timeline analysis, Process analysis and Barrier analysis. The results of SIRE need to justify the relatively high labor intensity.
The SIRE method can be fully implemented within the TPSC CloudTM platform. The specific components can also be chosen as individual analyses.
- Timeline analysis: provides a chronological record of events and helps with the reconstruction of an (near) incident.
- Barrier analysis: means to identify the barriers that prevent a process from derailing or failing.
- Process analysis: a three-step tool to describe processes and trace errors.
The Ishikawa diagram is a tool for drawing a cause and effect diagram to identify the actual cause of a problem. It is also often referred to as a fishbone diagram. Ishikawa is an accessible method to achieve quality improvement in your organisation.
Make an Ishikawa diagram in roughly 3 steps:
- Name the problem and place it at the head;
- Describe the major causes for the problem on the first branch of the fishbone. These can be different categories such as people, materials, procedures, environment or others determined by yourself;
- Divide the major causes in various sub causes by asking yourself why something happens or what causes it.
PRISMA stands for Prevention and Recovery Information System for Monitoring and Analysis. This root cause analysis method (RCA) has its origins in the chemical process industry, where the method is used to detect errors and improve processes. Nowadays, PRISMA is also used in other sectors such as healthcare. In a PRISMA analysis, incidents are displayed in a so-called Cause Tree, so that the events can be mapped schematically. In this visual representation the underlying factors and circumstances are easy to read. The in-depth analyses result in effective improvement measures.
With PRISMA, incidents are analysed in three steps:
- A cause tree is used to describe the incident (see previous figure);
- The root causes, which are identified for each incident by the cause tree, are classified according to technical, organisational and human factors;
- A PRISMA profile, consisting of the causes of a large number of incidents, is used to map effective improvement measures with a so-called classification/action matrix.
It is interesting for a quality officer to keep a database with the root causes that occur regularly. The root causes need to be displayed in terms of percentage, not in numbers. When analysing approximately 30 to 50 incidents with the PRISMA method, it is possible to identify the root causes with a peak and subsequently deploy targeted improvement actions. Following that, new PRISMA analyses will show whether the peak has been reduced and if the improvement actions have worked.
An additional advantage of the PRISMA method is that employees feel they are being listened to after reporting an incident. This method clearly shows that reports are being taken seriously. The question of guilt is less relevant because the deeper underlying causes are made visible. This also has a positive influence on the employees’ willingness to report. In addition, thorough research into the causes and the subsequent communication contribute to awareness.
The Failure Mode and Effects Analysis (FMEA) is a systematic and proactive analysis of as many products, services and processes as possible to identify potential failure modes in a system as well as their causes and effects. This prospective risk analysis consists of different variants, focused on different types of processes. It is used in the healthcare industry, but also for the production and design of products.
FMEA focuses on the how and why of failure, not WHETHER it will fail. FMEA can be used to estimate the impact of potential failure modes and measures can be devised to reduce failure modes from emerging or to limit their effect.
The FMEA analysis involves viewing and examining the following:
- Go through the process step by step (and create a flow chart)
- Failure modes (what can go wrong)
- Causes of failure (why did something go wrong)
- Consequences of failure (what is the possible result of an error)
The FRAM analysis is a method to map the difference between procedure and daily practice. This method corresponds well with a new movement that has taken off in recent years. This approach, called Safety II, is a hot item within the healthcare industry. Safety II focuses on learning from things that go well in the workplace, instead of learning from incidents. To further improve the quality and safety in your organisation, you are no longer dependent on (near) incidents. On the contrary, you look at the daily practice, analyse the various situations in the workplace and how people react to certain (deviating) circumstances. This adaptability of the employee is the reason that things usually go well. Essential to Safety II is the focus on improving this employee resilience.
Within the FRAM method, research on employees is conducted in an open and positive way and deals with how they perform their daily activities. Not every situation can be recorded in procedures and in practice, procedures are not always followed correctly. As we gain more knowledge about the daily work routine, we can start increasing adaptability in the workplace.
Content and images supplied by The Patient Safety Company.