Beyond root cause analysis: How variation analysis can provide a deeper understanding of causation in complex adaptive systems

Abstract

Root cause analysis (RCA) is a recognised approach to understanding causation of adverse events across high-risk industries including healthcare. These methodologies were developed during the early part of the twentieth century when the workplace could be understood as a series of linear processes. Within a complex system these approaches offer limited insight, which has since been recognised within healthcare literature. This paper proposes an approach to understanding of causation that addresses Hollnagel’s ‘hypothesis of different causes’ and integrates Safety I and Safety II approaches. This develops Stretton’s Lilypond Model to conceptualise the relationship between work-as-imagined and work-as-done within a complex system where individual adaptations and variations can be analysed. Understanding variation in such a way creates a shift in methodology from a deterministic to a probabilistic approach, which is more appropriate for understanding causation within complex systems.

Reducing delayed transfer of care in older people: A qualitative study of barriers and facilitators to shorter hospital stays

“…Poor communication within healthcare organizations and with service users is a common and consistent cause of failure in NHS inquiries dating back to the 1960s 44 . More needs to be done to uncover what drives poor communication, perhaps by analysing the behaviours and decisions that deter staff from providing respectful patient‐centred care and encourage poor care and communication 45 . The coronavirus pandemic prompted rapid service modifications, changed the hospital environment and increased staff shortages due to redeployment or absence.…”

“… 44 More needs to be done to uncover what drives poor communication, perhaps by analysing the behaviours and decisions that deter staff from providing respectful patient‐centred care and encourage poor care and communication. 45 The coronavirus pandemic prompted rapid service modifications, changed the hospital environment and increased staff shortages due to redeployment or absence. This provided the perfect backdrop for job demands to outweigh job resources, 46 , 47 leading to decreased motivation and increased job stress and dissatisfaction.…”