HFMEA consists of 5 steps.
Step 1:
Define the topic. The topic should be a manageable process with a clear beginning and end. “The medication process” would not be suitable because this is far too large a process. Better would be “the transition of medication care from the neurology ward to the primary care doctor”.
Step 2:
Assemble the team. The team should consist of a member from each speciality that plays a role in the process which is investigated. If possible, a patient who has experienced the process should be included. Patients can play an invaluable role because they have seen or experienced risks during care that personnel are not aware of.
Step 3:
Graphically decribe the process. A flow diagram is made of the process and subprocesses. Each process step is numbered.
Step 4:
Conduct a hazard analysis. For each process step, the team considers all possible failure modes (ways in which parts of the process can go wrong). For each failure mode, the severity and the probability are determined. After this, a decision tree is used to determine the criticality and detectability of the failure mode. Only then does the team brainstorm about all possible causes for that failure mode. The causes are then evaluated in the same way as the failure modes. If a cause is judged to be significant, the team goes to the next step.
Step 5:
Action and outcome measures. The decision is made to “eliminate”, “control” or “accept” the failure mode cause. The team then decides what action should be taken, who should be responsible and what outcome measure can be used to check if the action is executed and if it serves its purpose.