The Dutch version of RCA consists of seven steps.
Step 1: collecting information
The goal is to collect as much information as possible relevant to the incident. Typically, the patient chart is read and personnel involved in the incident or personnel well known with the process in which the incident took place are interviewed. In some instances the location where the incident took place is visited or extra information is gathered from outside the hospital (e.g. from a supplier).
Step 2: sorting information
The goal is to get an overall picture of the incident and specifically the situation that the involved personnel were in just before and whilst the incident took place. The RCA investigator should be able to envision the incident as if it were a movie.
Step 3: define the subject of the investigation
The goal is to state the borders that the investigation is limited to, so as to keep the RCA manageable. Incidents often consist of a main incident and one or more sub-incidents, things that also go wrong around the same time. The deeper the search, the more elements are found to be suboptimal. An enthousiastic investigator will want to fix all these problems at once. But it is important to prevent the RCA process from taking too much time and diluting, because that will not only have a negative influence on the RCA itself, but also on the enthusiasm and acceptation of the method amongst personnel. It is impossible to change the whole hospital in one session, so the focus must remain on the incident at hand.
Step 4: identify the causes of the incident
The goal of this step is to identify the root causes of the incident and the other factors that have made the incident possible. In this step the investigator also pays attention to the things that did go according to plan, so as not to just focus on the negative elements. This not only reduces the intimidating effect RCA might have on personnel, but also jields productive information on the strong points of the organisation. This information can be a valuable asset for the next step.
Step 5: devise safety and quality improvements
The goal of this step is to devise useful and pragmatic suggestions on how to prevent similar incidents from occuring in the future. For this step, the RCA investigator preferably draws ideas from the professionals that work in the process in which the incident took place and the middle management. If an incident took place in a patientward, the head nurse and attending physician would be consulted before a suggestion is included in the report.
Step 6: write a report
The goal is to produce a concise report that lets management take considered decisions on how to act in respons to the incident. This means that the report should be understandable for a layman and stick to the facts. Suggestions should preferably be written SMART (Specific, Measurable, Achievable, Realistic, Timely).
Step 7: Follow-up
The goal is to make sure that everybody who was involved in the RCA knows what happened with the suggestions made in report. If for example hospital management changes a policy due to the report, this is communicated to them. In this way personnel get feedback on the effect that their collaboration with the RCA process has had.