By Kim Smiley
A recent headline from the New York Times reads “Infections at Hospitals Are Falling, CDC Says”. That sounds like fantastic news right? Well, what about this one from the same day from the Washington Post: “One in 25 patients has an infection acquired during hospital stay, CDC says.” One in 25 doesn’t seem like great odds to me. The two headlines give very different impressions of the problem, so which one is right?
The truth is that both statements are accurate, but neither tells the complete story. To really understand the situation, you need to read a lot more than just the headlines. This is a good analogy for what happens in meetings every day. Something goes wrong and everybody thinks they know what THE problem is or what is THE root cause. Many times when people argue they aren’t really in disagreement, they are just focused on different parts of the same puzzle.
Building a Cause Map, a visual format for performing a root cause analysis, can help reduce miscommunication. The first step in the Cause Mapping process is to fill in an Outline. The top of the Outline lists the basic background information. At the bottom of the Outline, there is space for listing the specific impacts to the overall goals. People may argue about what THE problem is, but it’s hard to argue when specifically listing how the problem impacts goals. For example, most people would agree that increased cost of healthcare is an impact to the overall economic goal of a hospital. It may sound counterintuitive, but adding detail helps clarify the situation, when defining the problem and when actually determining what went wrong.
In the case of those headlines listed above, both refer to a recent study by the Center for Disease Control and Prevention that found that about 1 in 25 patients in US hospitals in 2011 acquired at least one infection based on data from 11,282 patients treated at 183 hospitals in 10 states. (The total number of patients who acquired at least one infection is over 700,000.) The study estimated that around 75,000 of these patients died, but didn’t provide information on whether the deaths directly resulted from the infections. The study also didn’t include nursing homes, emergency departments, rehabilitation hospitals and outpatient treatment centers. Previous estimates put the number of infections each year at 2.1 million in the 1970s and 1.7 million from 1990 through 2002. The rate of infections also varies widely from hospital to hospital. There is uncertainty in the data available, but the trend seems to be going in the right direction, even though the problem of hospital-acquired infections remains significant. Before working to reduce the risk of a problem, it’s important to lay out all the facts and understand what exactly the problem is. That generally requires more than a simple statement, which is why the Cause Mapping uses a formal Outline to define a problem.
After the Outline is completed, the next step is to analyze the issue by building a Cause Map by asking “why” questions starting with one of the impacted goals. Hospital acquired infections are an impact to the patient safety goal so we could begin by asking “Why are patients getting infections in hospitals?” This occurs because they are exposed to a pathogen. Why? There are pathogens at the hospital because many sick people are there for treatment. Inadequate cleanliness also plays a role. Additionally, the pathogen is able to infect the patient. You would continue asking questions to determine why patients are being infected until you reach the desired level of detail. Generally, the bigger the problem, the greater level of detail is needed.
To view a completed Outline and a Cause Map of this issue, click on “Download PDF” above.