Table 4

Comments by health care professional respondents on RCA practices
Positive benefits
· Working locally with teams and supporting staff during the process
· Reflecting on the outcomes of the implementation of the recommendations and action plans, and observing the consequent improvements in patient safety and service delivery
· Allowed you to step back and look objectively at the situation without being too close and avoid the wood for the trees scenario
· Staff feeling there was a real attempt to look for improvements rather than blame
· I believe it has brought reproductive medicine and obstetrics & gynaecology theatres together more as a team
· Everyone involved could see the benefit of getting to the roots of the issue so that it wouldn’t happen again, or at least the risks of it happening were reduced
· Reassuring staff that RCA is trying to identify ways of learning from mistakes…and not to punish.
· Staff started to understand the importance of problem-solving and the breaking down of a blame culture
· Team of people involved felt listened to and understood
· Outcome reflection raised awareness and attitude change to how we can do things differently and improve the patient experience
· Clarifying what was the actual cause of the problem. It is not always what seems obvious. And working out what can be done to prevent a recurrence.
· Confidence that the situation was being examined in a systematic & comprehensive way
· Getting the problem sorted in a positive manner and every one learning from it
RCAs should be conducted by clinical staff only
· Disagree, useful to have input from those removed from the situation.
· Clinical input essential in clinical cases - but objective input to provide different perspective can be valuable in any investigation
· I think assistance from a dedicated team might help, especially if you don’t have alot of experience in completing regularly.
· It is of benefit to have a understanding of the area however not necessarily should an RCA be carried out by staff within department.
· It depends very much on the incident reported who should be involved. There may be incidents such as case notes going missing which involved other groups of staff , not just those from a clinical background.
· Yes but with help from other clinical staff who have undertaken an RCA
· It should also involve staff out-with your own clinical area to allow a more balanced view i think.
· needs a mix and definite somebody removed from situation
· Should be conducted by colleagues within clinical background however fresh eyes can often help in some situations
· No, the most appropriate person should lead. It's good on occasions to have someone independent
Patients or relatives should be involved in RCA investigations
· Yes I believe they should if they are willing
· It would depend on the nature of the incident being investigated.
· Possibly - would depend on the situation and training available.
· No - will not necessarily be appropriate as emotions can develop and are not helpful.
· It might be useful to have “specialist” patient/carer representatives involved - i.e. ones with some real experience of the patient/carer perspective plus RCA training, but who were not personally involved in the particular incident.
· A patient liaison officer maybe more appropriate to avoid upset or distress to a patient or relatives
· No, I think it would be difficult for others to share their opinion in discussion if they were present, but it may be appropriate at times to meet with relatives or patients before and/or after an RCA has been conducted

Bowie et al.

Bowie et al. BMC Health Services Research 2013 13:50   doi:10.1186/1472-6963-13-50

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