Critical Incident

Quality Glossary Definition: Critical incident 

The critical incident technique is an advanced tool for root cause analysis that can aid in the search for causes. Unlike more basic cause analysis tools that help with finding causes, like the flowchart, brainstorming, or the fishbone diagram, the critical incident technique finds the cause through interviews of various people involved in the process in which an event occurred.

Critical Incident Technique Overview

The critical incident interviews are typically conducted on the unit or a unit like the one involved in the unanticipated event. They are conducted not only with persons involved in the recent event, but also with those who may provide help in understanding the general conditions that may have precipitated the event. The interviewees are also asked which steps or factors typically cause them the most trouble over a certain period, and not just the time when the event occurred.

Critical Incident Steps

1. Decide on the participants to be included, attempting to cover all departments or functional areas involved in the event.
2. Ask each participant to answer in writing questions like: Which patient care processes are most difficult to handle, and why? What factors create the biggest impediments to maintaining proper patient care? Have you identified gaps in your training? Are there improvements to the process that you have recognized? Do you ever employ "work-arounds" to a process?
3. Collect, sort, and analyze answers based on the frequency of different incidents.
4. Use the most critical incidents as a starting point for the further search for causes of the event.

Openness is a Technique Prerequisite

Most tools used in root cause analysis have two things in common:

1. They are best applied by a team of people working together to find the problem’s causes and solve them.
2. To work properly, they require an atmosphere of trust, openness, and honesty that encourages people to divulge important information without fearing consequences.

If a climate of trust is not provided, chances are the root cause analysis will fail to bring to the surface the true nature of the problem or its causes. Creating this climate is everyone’s responsibility, but management clearly possesses the most instruments for achieving it. This is pertinent especially with the critical incident technique, as it can bring to light embarrassing situations.

Critical Incident Example

A private company running an ambulance service was transporting a patient who was experiencing a drug overdose. The patient died en route to the hospital as a result of late arrival by the dispatched ambulance.

The investigation into the event revealed a number of cases where ambulances had arrived late, either at the scene or at the hospital. Since these cases appeared to be the result of a number of different problems, the critical incident technique was used to map which of these constituted the key problems.

Table 1 below shows the critical incident matrix, listing incidents in descending order of frequency of occurrence. This eliminated some possible causes from the inquiries, and others seemed difficult to do much about (outside of influence), but the root cause analysis team used the results to set the direction for the analysis ahead.

Table 1: Critical Incident Example

Excerpted from Root Cause Analysis and Improvement in the Healthcare Sector: A Step-by-Step Guide, ASQ Quality Press.