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Why ‘SCA’ should be as common as ‘RCA’ in health and human services

Why ‘SCA’ should be as common as ‘RCA’ in health and human services

Over the past three decades, the predominant approach to improving safety in health care has involved studying adverse outcomes to identify system vulnerabilities and correct them. While this approach has been useful, it has limitations. A focus only on unfavourable outcomes can limit innovation and adaptability, not to mention undermine worker morale and engagement.

Then another approach — Safety-II — emerged. Safety II acknowledges that human adaptability and system attributes often make things go right in complex, unpredictable environments, despite the many challenges. However, it has not yet become a common learning practice. Few organisations have introduced structured processes to learn why and how favourable outcomes occur and to hardwire these strategies into systems to promote safe outcomes in the future.

Success Cause Analysis (SCA) aims to add the study of the things that go well to our current focus on failure and RCA. SCA deploys root cause analysis methodology but uses it to understand the factors that contribute to a favourable outcome and learn and apply the lessons.

It looks deeply at the factors that allowed the team to innovate, collaborate, and adapt, and how these factors relate to other routine aspects of work. Individuals trained in RCA methodology conduct SCAs to systematically review a positive outcome and aim to identify specific actions that other units can use to improve performance and outcomes. Even the seemingly heroic actions of an individual or team may be the product of a culture and structure that promoted that behaviour.

In part, because they are not error-focused, SCA discussions may allow the inclusion of more people than the typical RCA and empower more individuals to share their perspectives without fear. 

Applying SCA has many benefits, not least that learning from success is just as powerful, if not more, than unpacking negative events when seeking to improve processes and practices.

All accessed 10/1/24:

Deutsch, Ellen S, et al. A new pairing: root cause and success analysis. PA Patient Saf Advis 2018 Sep;15(3).