Learn, Connect, Growth | Tingkatkan Mutu Pelayanan Kesehatan Indonesia

Langkah-Langkah Root Cause Analysis (RCA)

Oleh: dr. Hanevi Djasri, MARS

art-6meiKeselamatan pasien atau patient safety merupakan hal yang marak dibicarakan dalam dunia medis belakangan ini. Pertemuan tahunan Joint Comission International tahun 2005 telah menekankan mengenai pentingnya pelayanan kesehatan yang aman. Kesalahan yang terjadi pada upaya pelayanan kesehatan adalah kesalahan dalam mendiagnosis, kesalahan dalam menggunakan alat bantu penegakan diagnosis, kesalahan dalam melakukan follow up, pengobatan yang salah atau kejadian yang tidak diharapkan setelah pemberian pengobatan. Permasalahan-permasalahan diatas dapat terjadi karena penggunaan teknologi yang tidak diimbangi kompetensi penggunanya, bertambahnya pemberi pelayanan kesehatan tanpa mengindahkan komunikasi antar individu serta tingginya angka kesakitan serta kecelakaan, perlunya pengambilan keputusan yang cepat dan tepat yang menyebabkan stressor tersendiri serta kelelahan yang dialami oleh para staff medis karena keterbatasan jumlah staff yang tersedia. Salah satu budaya patient safety adalah mengkomunikasikan kesalahan, melaporkan kesalahan dengan tetap berpegang pada keselamatan pasien dan belajar dari kesalahan dan mendesain ulang sistem keselamatan pasien yang lebih baik. Untuk menyelesaikan permasalahan yang terjadi, dicetuskan suatu ide sistem analisis yang proaktif sebagai strategi pencegahan error.

Root cause merupakan alasan yang paling mendasar terjadinya kejadian yang tidak diharapkan. Apabila permasalahan utama tidak dapat diidentifikasi, maka kendala-kendala kecil akan makin bermunculan dan masalah tidak akan berakhir. Oleh karena itu, mengidentifikasi dan mengeliminasi akar suatu permasalahan merupakan hal yang sangat penting. Root cause analysis merupakan suatu proses mengidentifikasi penyebab-penyebab utama suatu permasalahan dengan menggunakan pendekatan yang terstruktur dengan teknik yang telah didesain untuk berfokus pada identifikasi dan penyelesaian masalah.

Di Amerika telah dilakukan 2840 root cause analysis pada berbagai bidang, seperti kasus bunuh diri pada pasien rawat jalan, komplikasi post operatif, kesalahan pemberian obat, kematian pasien karena keterlambatan penanganan, kematian perinatal, kasus infeksi, kasus anestesi dan lainnya. Penelitian tersebut dilakukan di RS umum, RS jiwa, unit gawat darurat, unit psikiatri, long term care facility, home care facility dan laboratorium klinis. Root cause analysis dipercaya mampu menurunkan terjadinya kejadian yang tidak diharapkan.

Root cause analysis memberikan jalan keluar yang lebih baik, tidak sekedar "faktor A menyebabkan kejadian B", namun "Dengan mengubah faktor A, maka kemungkinan rekurensi kejadian B dapat dikurangi atau bahkan dicegah." Mempelajari root cause analysis secara tepat merupakan kajian yang penting untuk diperkenalkan kepada para pemberi pelayanan kesehatan.

Berikut ini adalah langkah-langkah RCA dan tools yang dapat digunakan pada setiap langkah

Langkah Deskripsi Note and Tools
1 Bentuk Tim (Organize a team) Anggota tim kurang dari 10
2 Rumuskan masalah (Define the problem) Brainstorming, multivoting, FMEA
3 Pelajari Masalah (Study the problem) Braintorm, flowchart, pareto, scatter, affinity diagram, etc
4 Tentukan apa yang terjadi (Determine what happen) Flow chart, timeline
5 Identifikasi faktor penyebab (Identify contributing factors) Control chart, tree analysis, FMEA
6 Identifikasi faktor-faktor lain yang ikut mendorong terjadinya insiden (Identify other contributing factors) Brainstorm, affinity diag, cause-effect diagram
7 Ukur, kumpulkan dan nilai data berdasar penyebab utama dan terdekat. (Measure, collect and assess data on proximate and underlying causes) Kembangkan indikator
8 Desain dan implementasikan perubahan sementara (Design and implement interim changes) Gantt chart
9 Identifikasi sistem mana yang terlibat (akar penyebab)(Identify which systems are involved (the root causes)) Flow chart, cause effect diag, FMEA, tree analysis (analisis pohon), barrier analysis
10 Pendekkan/kurangi daftar akar penyebab (Prune the list of root causes)
11 Pastikan/konfirmasikan akar penyebab (Confirm root causes)
12 Cari dan identifikasi strategi pengurangan risiko (Explore & identify risk-reduction strategies) FMEA
13 Formulasikan tindakan perbaikan (Formulate improvement actions) Brainstorm, flow chart, cause effect diagram (diagram sebab akibat)
14 Evaluasi tindakan perbaikan yang diajukan (Evaluate Proposes Improvement Actions)
15 Desain perbaikan (Design improvements) Gantt chart
16 Pastikan rencana diterima (Ensure acceptability of the action plan)
17 Terapkan rencana perbaikan (Implement the Improvement Plan) PDCA, critical path
18 Kembangkan cara pengukuran efektiftifitas dan pastikan keberhasilannya (Develop measures of effectiveness and ensure their success)
19 Evaluasi penerapan rencana perbaikan (Evaluate implementation of improvement plan) Run chart, control chart, histogram
20 Lakukan tindakan tambahan (Take additional action)
21 Komunikasikan hasilnya (Communicate the results)

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