My workgroup had a training course on root cause analysis (RCA) earlier this week. (We’ve actually done several RCAs, but now we’re finally getting our training.) The idea behind RCAs is to find the actual cause behind a problem, and solve it instead of just fixing the most obvious problem. It’s actually quite a powerful technique for improving processes, although I suspect many people at our company look upon RCAs primarily as a quality improvement technique.
An RCA is essentially an act of self-reflection or team reflection, as is often the case. The primary activity of an RCA is asking “Why?” repeatedly. The answer to each question is a cause, and the last answer is the “root cause.” A rule of thumb is that you shouldn’t stop asking “why?” until you’ve done it five times. Knowing all of these causes isn’t any good unless you create countermeasures to prevent them from happening again. So, it’s just as important to ask “What now?”
It occurred to me that diabetes is a natural fit for RCA. Something is always going a little (or quite a bit) off — we have plenty of opportunities for “self-reflection” — and we can (and should) make lots of small changes to improve our ability to manage our blood sugar. And I’ve read enough from other people with diabetes on the Internet to believe that we can get pretty good — although not perfect — blood glucose readings.
So how does this work? Let’s take an example.
- My blood glucose was very high. Why?
- I didn’t bolus enough insulin for my food. Why not?
- I was worried that I would go low if I bolused the full amount. Why?
- I’ve gone low a lot recently. Why?
- I usually had too much insulin on-board. Why?
- Until recently my basal rates were too high.
My blood sugar was too high because I didn’t trust my carb:insulin ratio because I had the wrong basal rates for a long time. So that explains a lot. But if I don’t fix these causes I’m going to keep under-bolusing. So let’s figure out some countermeasures for each cause. For each problem, what should I do.
- Take a correction bolus.
- Take the recommended bolus amount from now on.
- Stop using food as medicine. Use insulin to cover food.
- Let go of the memory of all those previous lows. It’s not helping.
- No countermeasures here.
- Finish running tests to correct my basal rates.
It’s possible to do an RCA and create countermeasures for just about any problem, but they are very useful for large classes of related problems.
