Teaching Root Cause Analysis Using Simulation: Curriculum and Outcomes

Abstract

Background: Clinicians are key drivers for improving health care quality and safety. However, some may lack experience in quality improvement and patient safety (QI/PS) methodologies, including root cause analysis (RCA).

Objective: The Department of Veterans Affairs (VA) sought to develop a simulation approach to teach clinicians from the VA's Chief Resident in Quality and Safety program about RCA. We report the use of experiential learning to teach RCA, and clinicians' preparedness to conduct and teach RCA post-training. We provide curriculum details and materials to be adapted for widespread use.

Methods: The course was designed to meet the learning objectives through simulation. We developed course materials, including presentations, a role-playing case, and an elaborate RCA case. Learning objectives included (1) basic structure of RCA, (2) process flow diagramming, (3) collecting information for RCA, (4) cause and effect diagramming, and (5) identifying actions and outcomes. We administered a voluntary, web-based survey in November 2016 to participants (N = 114) post-training to assess their competency with RCA.

Results: A total of 93 individuals completed the survey of the 114 invited to participate, culminating an 82% response rate. Nearly all respondents (99%, N = 92) reported feeling at least moderately to extremely prepared to conduct and teach RCA post-training. Most respondents reported feeling very to extremely prepared to conduct and teach RCA (77%, N = 72).

Conclusions: Experiential learning involving simulations may be effective to improve clinicians' competency in QI/PS practices, including RCA. Further research is warranted to understand how the training affects clinicians' capacity to participate in real RCA teams post-training, as well as applicability to other disciplines and interdisciplinary teams.

Keywords: curriculum; medical education; patient safety; quality improvement; root cause analysis; simulation.

Figure 1.

Conceptual model of optimal learning through simulation, adapted from Kolb et al.^,

Figure 2.

Reported preparedness to conduct and teach root cause analysis among 93 alumni of the Chief Resident in Quality and Safety program. Chief Resident in Quality and Safety alumni are US-based clinicians from various medical specialties. The data presented are Likert-type scale (1 = not at all, 5 = extremely) and were collected through a voluntary, non-incentivized, web-based survey administered in November 2016.