Root Cause Analysis in Behavioral Health CBOs
Root cause analysis can benefit organizations wanting to remove obstacles and avoid making the same mistakes repeatedly.
Root cause analysis is frequently used in scientific and engineering fields. It refers to identifying the root cause of faults or problems. From a reactive perspective, the premise is that a Community-Based Organization (CBO) in behavioral health can examine the reason for a problem or incident by taking several steps. Through this process, the CBO can understand why something happened and then take steps toward preventing it from occurring. The CBO can use this process in their quality improvement efforts, clinical operations such as suicide prevention, or leadership functions.
The root cause analysis is explained through several processes. One is the “Six Ps” approach, explained in an article on quality improvement. The author, Dr. Anthony Weiss, used the following method to 2) discuss clinical incidents: 1) Patient-related factors; 2) Personnel or staff-related factors; 3) Policies written that impact the event; 4) Procedures on clinical operations that affect the needed outcome; 5) Place or environmental factors that impact the event; and 6) Political or outside/institutional factors that come into play. By using these elements, a clinical process may be improved.
Another approach uses a systematic method. There are five steps identified in this root cause analysis process: 1) Define the problem; 2) Collect data; 3) Identify possible causal factors; 4) Identify the root cause(s); and 5) Recommend solutions. An example may be used with a behavioral health CBO who notes many psychiatric hospitalizations among their clients. They would then define the problem as hospitalizations. The data collected would include the length of time to be studied, the clients hospitalized, and the variables around their situation (demographics, prior history, type of treatment or medications, precipitating event, and how managed). The causal factors would be looking at all the reasons the hospitalizations occurred (medication non-compliance, lack of crisis intervention, no family support, no behavioral health CBO systems to handle crises). The root causes would narrow down one or more causes that apply to the hospitalizations. And finally, recommendations would be made to rectify the problem.
A final root cause analysis approach is to ask “Why?” five times. The benefit of this method is that it pushes a CBO deeper into the problem and requires accountability. Suppose a behavioral health CBO needs to improve productivity because it is lower than expected and revenue is not meeting projections. The first “Why” maybe because staff are not billing sufficiently. The second “Why” could be because they do not know how to reduce cancellations or engage clients. The third “Why” perhaps relates to burnout. The fourth “Why” could be due to overstaffing or lack of time management. The fifth “Why” could then be a lack of training. This is one example, but the “Whys” can lead to multiple directions, depending on how they are answered.
Root cause analysis can benefit organizations wanting to remove obstacles and avoid making the same mistakes repeatedly.
Praxes Behavioral Health provides consultation to behavioral health CBOs. Please feel free to contact us.
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