Identifying Root Causes of Avoidable ED Visits Leads to Improved Quality

Goal

A major healthcare organization has an innovative palliative care program that recently experienced significant expansion. The success of the program depends on clinicians adhering to its care model, so it is critical for the program to identify and address any causes of model drift promptly. The program decided to embark on a project to reduce avoidable ED visits by their patients. They asked Freed Associates to help them identify and address the root causes of these visits.

Strategy

Freed was engaged to design, plan, and execute a root cause analysis of avoidable ED visits. Influenced by Lean methodology, the organization wanted the project to engage staff from all areas of the program, so separate root cause sessions would be needed for each central department or remote service area.

Tactics

Freed developed an approach for root cause analysis that employed the “5 Whys” technique, trained facilitators on how to conduct root cause sessions, scheduled these sessions, and facilitated sessions. Most participants were nurses who had not been familiar with root cause analysis techniques prior to the sessions. However, with Freed’s guidance, they quickly embraced the technique, and participated with enthusiasm.

Results

When the 12+ root cause sessions were complete, Freed aggregated the contributors and root causes identified by program participants, and presented findings and recommendations to program management, including root causes which, if addressed, could have the biggest impact on program quality.

Freed’s recommendations included some root causes with “quick fixes,” simple solutions that could be rolled out immediately, program-wide. Freed also recommended other more complex root causes and facilitated a session with program management, during which they selected the root causes to focus on.

The client will develop possible solutions to address the selected root causes and design experiments that they will pilot in limited service areas to test these solutions. Based on the outcome of the pilots, they will decide which solutions they want to roll out program-wide.

Conclusion

All organizations have problem areas they want to address, and they must identify their root causes if they truly want to solve them. Drilling down on the symptoms and contributors of a problem to identify root causes is required before effective solutions can be developed. Where large numbers of personnel need to be engaged in this process, an objective outside resource can help plan and facilitate, as well as provide support for solution design and implementation phases of a project.