Exploring the “Black Box” of Recommendation Generation in Local Health Care Incident Investigations: A Scoping Review

W Lea, R Lawton, C Vincent, J O'Hara - Journal of Patient Safety, 2023 - journals.lww.com
Background Incident investigation remains a cornerstone of patient safety management and
improvement, with recommendations meant to drive action and improvement. There is little …

Team experiences of the root cause analysis process after a sentinel event: a qualitative case study

S Liepelt, H Sundal, R Kirchhoff - BMC Health Services Research, 2023 - Springer
Background Root cause analysis (RCA) is a systematic approach, typically involving several
stages, used in healthcare to identify the underlying causes of a medical error or sentinel …

Implementation of Root Cause Analysis on Patient Safety Iincidence in Hospital: Literature Review

RT Alifia, I Dhamanti - Journal of Public Health Research and …, 2022 - repository.unair.ac.id
Background: Root cause analysis (RCA) is a process used by hospitals to reduce the level
of patient safety incidents. The minimized application of root cause analysis has resulted in …

Root cause analysis for understanding patient safety incidents in nursing student placements: A qualitative content analysis

C Ropero-Padilla, VM González-Chordá… - Nurse Education in …, 2022 - Elsevier
Aim to explore nursing students' experiences with the use of RCA technique in patient safety-
related incidents during clinical placements. A secondary descriptive qualitative content …

[HTML][HTML] The pursuing excellence collaborative: engaging first-year residents and fellows in patient safety event investigations

DE Paull, RC Newton, AV Tess, JP Bagian… - Journal of patient …, 2023 - journals.lww.com
Objectives Resident and fellow engagement in patient safety event investigations (PSEIs)
can benefit both the clinical learning environment's ability to improve patient care and …

What are the experiences of team members involved in root cause analysis? A qualitative study

R Willis, T Jones, J Hoiles, PD Hibbert… - BMC Health Services …, 2023 - Springer
Background Conducting root cause analysis (RCA) is complex and challenging. The aim of
this study was to better understand the experiences of RCA team members and how they …

Validity of root cause analysis in investigating adverse events in psychiatry

M Deshpande, JMA Sinclair… - The British Journal of …, 2023 - cambridge.org
Root cause analysis (RCA), imported from high-reliability industries into health two decades
ago, is the mandated methodology to investigate adverse events in most health systems. In …

[图书][B] Safety leadership: a different, doable and directed approach to operational improvements

RJ De Boer - 2021 - taylorfrancis.com
Aimed at those who are responsible for the overall performance of organisations, divisions
or departments in diverse industries such as healthcare, aviation, construction, oil and gas …

Sentinel events and miscommunication what do we know in 2021: a language and social psychology framework

BM Watson, XI Wu - Health Communication, 2023 - Taylor & Francis
The paper explored the extent to which hospital appointed official root cause analysis (RCA)
panels consider antecedent and proximal events when they investigate communication …

[HTML][HTML] Contributing Factors to Adverse Events in Long-Term Care Facilities in Ireland, a Content Analysis

N McGrane, P Dunbar, LM Keyes - Journal of the American Medical …, 2024 - Elsevier
Objectives There is substantial research on contributing factors to adverse events (AEs) in
acute settings. Little is known about AEs in long-term care facilities (LTCFs). Our aim was to …