ABSTRACT
The elements required for facilitating a thorough and credible RCA are identified in this chapter. The responsibilities of the RCA facilitator and those of the Executive Sponsor are discussed and practical tips on facilitation and ideas for skill development are shared, including the use of RCA software. Guiding teams to identify Latent Root causes and not stop at the Human Root level is necessary to address the vulnerabilities in our care delivery systems.
An RCA facilitator must understand the methodology of the Logic Tree, the use of deductive reasoning, and be able to accurately identify Physical, Human, and Latent roots. It is also important to have the Executive Sponsor and RCA facilitator co-lead the RCA team meetings. The Executive Sponsor helps set the tone of appreciative inquiry and Just Culture and holds the team accountable for achieving a thorough and credible result. It is crucial that the RCA facilitator guide the RCA team by using active facilitation and by focusing on the building of the Logic Tree. Executive Sponsors and RCA facilitators have a moral responsibility to assure the thorough and credible analysis and action planning to prevent unintended events from reoccurring.
