Background: To evaluate the effectiveness of root cause analysis (RCA) recommendations and propose possible ways to enhance its quality in Hong Kong public hospitals. Methods: A retrospective cross-sectional study was performed across 43 public hospitals and institutes in Hong Kong, reviewing RCA reports of all Sentinel Events and Serious Untoward Events within a two-year period. The incident nature, types of root causes and strengths of recommendations were analysed. The RCA recommendations were categorised as 'strong', 'medium' or 'weak' strengths utilizing the US's Veteran Affairs National Center for Patient Safety action hierarchy. Results: A total of 214 reports from October 2016 to September 2018 were reviewed. These reports generated 504 root causes, averaging 2.4 per RCA report, and comprising 249 (49%) system, 233 (46%) staff behavioural and 22 (4%) patient factors. There were 760 recommendations identified in the RCA reports with an average of 3.6 per RCA. Of these, 18 (2%) recommendations were rated strong, 116 (15%) medium and 626 (82%) weak. Most recommendations were related to 'training and education' (466, 61%), 'additional study/review' (104, 14%) and 'review/enhancement of policy/guideline' (39, 5%).Conclusions: This study provided insights about the effectiveness of RCA recommendations across all public hospitals in Hong Kong. The results showed a high proportion of root causes were attributed to staff behavioural factors and most of the recommendations were weak. The reasons include the lack of training, tools and expertise, appropriateness of panel composition, and complicated processes in carrying out large scale improvements. The Review Team suggested conducting regular RCA training, adopting easy-to-use tools, enhancing panel composition with human factors expertise, promoting an organization-wide safety culture to staff and aggregating analysis of incidents as possible improvement actions.

Background: Appropriate human resources interventions to address healthcare workers' concerns are key to maintaining confidence and morale of staff to combat a pandemic in any healthcare system. The objectives of this study are to analyze concerns of healthcare workers in public hospitals during the initial 3 months, throughout which the Hong Kong Hospital Authority implemented multiple measures to address staff needs.Methods: A retrospective study analyzing the immediate and longitudinal concerns of healthcare workers during the coronavirus disease 2019 (COVID-19) pandemic. All enquiries by unsolicited phone calls and WhatsApp messages raised over a 12-week period from 29/1/2020 to 22/4/2020 were reviewed and categorized. Thematic analysis of the enquiries was conducted, together with timing and frequency of enquiry categories.Results: A total of 1,868 enquiries were raised over the 12-week period. These enquiries comprised 740 (40%) in "recognition and staff wellbeing", 573 (31%) in "infection control", 357 (19%) in "duty arrangement" and the remaining 196 (10%) "others".Conclusions: Spikes spread over the 12 weeks of data capture demonstrated major concern areas for a healthcare system in maintaining the morale and confidence of staff. Financial incentives introduced during the pandemic may have drawbacks around equity, defining thresholds for payments and setting precedence.A Human Resources App and e-bulletins were effective in rapidly communicating information to staff and allaying their fears, especially during the initial phase of the crisis. Further study of financial incentives to help decision-makers understand the impact and consequences of such approaches should be undertaken.

BackgroundRoot cause analysis (RCA) is a structured investigation methodology aimed at identifying systems factors to prevent recurrence of incidents. To enhance staff’s knowledge and skills, a hybrid RCA training course was conducted in February 2021. Overseas instructors conducted training online and local participants attended the training together physically with onsite facilitator support. This study aimed at understanding the experiences of trainees who have undergone the training, evaluated its effectiveness and identified opportunities to enhance RCA training quality in the future.MethodsA qualitative study using virtual synchronous focus group interviews was conducted. Purposive sampling was adopted to invite all trainees from the RCA training course to join. A semistructured interview was used to guide the study participants to share their experiences. All groups were audio-recorded, transcribed verbatim and anonymised for data analysis.ResultsOverall, 6 focus groups with 19 participants were held between July and November 2021. Five key themes were identified including: (1) training contents, (2) perceptions of RCA, (3) challenges in RCA, (4) hybrid training and (5) future perspectives. Participants felt the RCA training was useful and broadened their understanding in incident investigation. More in-depth training in interviewing skills, report writing with practical sessions could further enhance their competencies in RCA. Participants accepted the use of hybrid online–offline training well. Most participants would welcome an independent organisation to conduct RCA as findings would be more objective and recommendations more effective.ConclusionsThis study provided an evaluation on the effectiveness of a hybrid RCA training course. Healthcare and training organisations can consider this training mode as it could reduce the cost of training and enhance flexibility in course arrangement while preserving quality and effectiveness. Virtual focus groups to interview participants were found to be convenient as it minimised travelling time and onsite arrangement while maintaining the quality of discussion.