ROOT CAUSE ANALYSIS OF A SENTINEL EVENT Diane Swintek Western Governors University Root Cause Analysis of a Sentinel Event A root cause analysis (RCA) is a method by which we can examine a serious adverse event and identify the cause‚ or causes‚ that led up to the event. Although personnel are involved in these events‚ the primary purpose of the RCA is to identify the cause‚ not to assign blame (Agency for Healthcare Research and Quality‚ 2014). It is through identifying a cause‚ or
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ACA or the Obamacare has two main focuses‚ which also known as root causes. They were to increase insurance coverage and cut down cost. With mandatory insurance coverage and introduction of out of pocket limits (the maximum amount of costs for covered services paid out-of-pocket) for individuals and households‚ the government is trying to prevent the excess health care expense burden that people face due to varying health insurance policy (Bose‚ 2016). The major coverage provisions of the ACA went
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validate root causes in a lean sigma approach Silvia Pederzolli Milan‚ the 15th of april 2013 attivaRes Define Opportunities Measure Performance Analyze Opportunity Improve Performance Control Performance CCR’S Objective • • • • • Identify problem statement: what is wrong and why. Deviation from what is expected (targeted performance). How much/how often Effects on Customers. Find and validate the root causes that assure the elimination of “real” root causes. Actions
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properly investigate the situation in hopes to learn from the event and hinder another episode. The following will discuss procedures used to investigate sentinel events such as root cause analysis‚ change theory and failure mode and effects analysis using the scenario involving Mr. B in Task 2 instructions. A. Root Cause Analysis Nursing is a profession of helping others. Those who choose to work in healthcare never intended on harming. However‚ if harm does come to a patient proper policy and
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EDU 530: Adv. Techniques in Instruction and Assessment Root Causes of Student Achievement Problems Due: March 1‚ 2011 Descriptive Section: This is an average American fourth grade class. Most students complete their homework every night‚ are proficient in Reading and Math‚ and come from stable homes. There are a few advanced students‚ and a handful of low-performing students. I asked their teacher to identify the root causes to the lack of performance in her-lowering performing students
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Obesity: root cause of many disease Outline What is obesity Its measurement Global trends Reasons Energy rich foods Lack of exercise genetic predisposition Related Morbidity Cardiovascular diseases Diabetes Mellitus Other diseases e.g bone and joint diseases‚ asthma‚ skin diseases‚ certain cancers etc Social implications How to fight obesity Diet Exercise Drugs and surgical procedures Conclusion. Obesity is a medical condition
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something about it. Requiring black passengers to pay fares in the front of the bus and then entered through the rear (31)‚ reserving the front 10 double seats for whites (31) and addressing black patrons with obscene language (31)‚ were some of the root causes of the Civil Rights Movement.
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In my opinion‚ there are several motives to hate crime. It could be gender‚ religion or any personal issues. Also‚ and one more significant point that I should be talked about the root causes of hate crime is the ignorance. People should be aware or educate themselves before forming a negative perspective towards sensitive issues that can have destructive impact on the society. Being respectful towards one another in spite of having
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Economy‚ Thomas Jefferson (tr.)‚ New York‚ Augustus M. Kelley. Dunoyer‚ Charles (1880) “Notice Historique sur l’Industrialisme‚” in Oeuvres 3 Notices de l’Économie Sociale‚ Paris‚ Guillaumin. Euzent‚ Patricia J. and Martin‚ Thomas L. (1984) “Classical Roots of the Emerging Theory of Rent Seeking: the Contribution of Jean-Baptiste Say‚” History of Political Economy 16 (2) (Summer): 255-62. Grossman‚ Lionel (1976) Augustin Thierry and Liberal Historiography‚ Beiheft 15‚ Theory and History. Halévy‚ Élie
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Shoot Root The organs found in both systems are: roots‚ stems‚ and leaves Roots Functions of roots: Anchoring the plant absorbing minerals and water storing organic nutrients and other functions Absorption of water and minerals occurs near the root tips‚ where root hairs increase the surface area. Many plants have modified roots: Prop roots in mangrove Tubers in sweet potato and cassava Tubers are enlarge root or stem that acts as nutrient storage Aerial roots of the strangler
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