[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-243546-105":53,"doc-detail-243546-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","root-cause-analysis-report-updated-september-2021-reporting-template","ROOT CAUSE ANALYSIS REPORT - Updated September 2021 - Reporting Template","","Standardized Root Cause Analysis reporting template for documenting causes and corrective actions after an adverse event or system flaw. Provides guidance to define a clear problem statement, assemble an appropriate multidisciplinary team, and use structured tools such as Fishbone (Ishikawa) Diagram and Five Whys to identify root causes. Includes a blank report format for capturing identified causes and a proposed action plan with area of concern, interventions, target dates, responsible persons, and monitoring mechanisms.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":11,"@type":70,"position":76},"https://docshare.wps.com/template/presentations/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/root-cause-analysis-report-updated-september-2021-reporting-template/243546/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/root-cause-analysis-report-updated-september-2021-reporting-template/243546.png","ImageObject",442,249,{"name":88,"@type":89},"Skyler","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-19","2026-09-12",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",13,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What is the purpose of this Root Cause Analysis reporting template?","Question",{"text":109,"@type":110},"It provides a standardized reporting framework to review an identified problem, determine causes, and define actions that address causes and help prevent future incidents.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"Which steps guide completing the root cause identification section?",{"text":114,"@type":110},"The template instructs assembling a team and completing structured RCA exercises using tools such as the Fishbone Diagram and Five Whys.",{"name":116,"@type":107,"acceptedAnswer":117},"What information is captured in the proposed plan of action?",{"text":118,"@type":110},"It includes an area of concern (root cause), specific interventions, target dates, responsible persons, and monitoring mechanisms to ensure actions are addressed meaningfully.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},243546,1791719986,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":8,"category_name":11,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":136,"language":137,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":138,"faqs":139,"seo_title":140,"seo_description":61,"update_tm":141,"read_time":73},2336464648746,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","ROOT CAUSE ANALYSIS REPORT  \nIntroduction  \nA Root Cause Analysis (a standardized approach to understanding the causes of an adverse event or identifying system flaws for correction) has been requested in response to an identified problem that may include, but is not limited to, one or more of the following:  \n Events that led to a Significant or Sentinel Event  \n Failure to achieve performance goals  \n Variation in a process contributing to one of the above  \nIdentify prevention strategies for process improvement  \nThe following standardized form provides a reporting template for Root Cause Analysis and related activities. The form outlines a recommended procedure for a systematic review of:  \nthe identified problem,  \nthe causes, and  \nthe actions to address the causes and prevent future incidents.  \nThis document was developed to assist in completion of a root cause analysis request and consists of 3 parts:  \n Part I: Instructions for completion of the template  \n Part II: A blank Root Cause Analysis Report template  \n Part III: An example of a completed Root Cause Analysis Report template  \n1  Updated September 2021  \nROOT CAUSE ANALYSIS REPORT  \nPart I: Instructions  \n\n| Root Cause Analysis Report |  |\n| --- | --- |\n| Individual Completing Report: |  |\n| Date of Report: |  |\n| Problem Statement |  |\n| The problem statement should be clearly defined, concise, and specific. It should relate to the purpose of the Root Cause Analysis request (e.g., significant event, failure to achieve goals, etc.) . The problem statement will guide the root cause analysis activities and discussion for identified actions for improvement. |  |\n| Root Cause Identification |  |\n| Step 1. | Assemble a team for discussion and completion of root cause analysis exercises. The team should consist of |\n| Team Involved\u003Cbr>in RCA | individuals involved in the process where the problem occurred and may include, as appropriate: Physicians, Clinicians, Peer Specialists, Administrative Staff, Individuals in Treatment, Leadership (Decision-Makers), and Quality staff.\u003Cbr>Consideration should be given to including the “voice of the customer” whenever possible. |\n| Step 2.\u003Cbr>Tools used for RCA | Complete structured Root Cause Analysis tools such as the Fishbone Diagram and Five Whys for a systematic identification of causes.\u003Cbr>1. Fishbone Diagram (also known as an Ishikawa Diagram)\u003Cbr>1.1. Brainstorm potential causes leading to the problem\u003Cbr>1.2. Group potential causes together in an affinity diagram and label the categories\u003Cbr>1.3. Place the causes into the fishbone diagram with corresponding categories. Generally, it is best if teams identify their own categories to ensure no potential causes are overlooked. However, some teams find that causes end up in one of the following category groupings: (Methods, Equipment, People, Materials, Measurement, Environment) or (Policies, Procedures, People, and Plant)\u003Cbr>1.4. Identify the top “root causes” leading to the problem\u003Cbr>2. Five Whys\u003Cbr>The Five Whys activity can be utilized to dig deeper on a root cause identified during the Fishbone exercise. The exercise starts with this question: Why did this problem occur? The team will answer this question. Then, the team will ask why did that happen or occur? This will continue until the team reaches “I don’t know.” The Five Whys activity can be conducted on more than one cause identified by the team during the Fishbone exercise. |\n\nStep 3.  \nIdentified Root Cause(s)  \nThe team will identify the main cause(s) of the problem that need to be addressed. Please list the root causes tobe addressed.  \n 2  Updated September 2021  \nROOT CAUSE ANALYSIS REPORT  \n\n| Root Cause Analysis Report |  |  |  |\n| --- | --- | --- | --- |\n| Proposed Plan ofAction |  |  |  |\n| The most important aspect of a Root Cause Analysis is to develop a proposed plan ofaction to reduce the chance that this problem/event would happen again. When the root cause has been identified, the team should develo","cbCaitIokUzMDvwT","https://ap.wps.com/l/cbCaitIokUzMDvwT","pdf",162995,6,"English","# Introduction\n# Part I: Instructions\n## Root Cause Identification\n## Proposed Plan of Action\n# Part II: Root Cause Analysis (RCA) Reporting Template\n# Part III: Example of a Completed RCA Report","[{\"question\":\"What is the purpose of this Root Cause Analysis reporting template?\",\"answer\":\"It provides a standardized reporting framework to review an identified problem, determine causes, and define actions that address causes and help prevent future incidents.\"},{\"question\":\"Which steps guide completing the root cause identification section?\",\"answer\":\"The template instructs assembling a team and completing structured RCA exercises using tools such as the Fishbone Diagram and Five Whys.\"},{\"question\":\"What information is captured in the proposed plan of action?\",\"answer\":\"It includes an area of concern (root cause), specific interventions, target dates, responsible persons, and monitoring mechanisms to ensure actions are addressed meaningfully.\"}]","ROOT CAUSE ANALYSIS REPORT - Updated September 2021 - Reporting Template | PDF",1789205217]