The future of the RCAs is problematic and RCAs shortfalls do not need to be re-examined. The role of governance and political agendas are central to this predicament and warrant attention.
Recent changes in the decentralisation of Queensland Health’s Patient Safety Quality Improvement Service and the election of a new government in 2011 saw the assent of the Queensland Health and Hospital Boards Act, 2011. This means that each Hospital and Health Service holds governance to support patient safety and drive a review of a clinical incident. No longer is there a commitment to a standardised process of analysis because decentralisation provides a level of autonomy to patient safety, reporting and analysis of events. Furthermore, the Health and Hospital Boards Act 2011 maintained legislative enabling conditions that allow healthcare authorities the option to conduct RCA. While a patient safety entity, individuals granted access to view an RCA report, have been expanded.
The Health and Hospital Boards Act, 2011
. . . replaces the quality assurance provisions of the Health Services Act 1991 (Part 4, Division 2), the provisions have been modified to reflect the
establishment of networks and to incorporate some of the protections that apply to root cause analysis teams (Health and Hospitals Network Bill, 2011, p.25).
This means legislative provisions provide protections for safety and quality committees to access RCA information more easily in the new Act (2011). The problem remains in the current legislation that bureaucracies shape not only the conduct of RCA but initiating processes while provisions of concealment are maintained and these conditions inherently contribute to accidents (Sagan, 2004) and fail to improve patient safety. Thus, policy-making needs to focus on issues of secrecy and concealment that limit the process of techniques to improve patient safety. Finally, the future of patient safety relies on new patient safety methodologies with a greater focus on safety. An example is reliable measures of incident reporting that provides data that is trustworthy and not bureaucratically tailored
for electoral purposes; where inter-organisational factors draw lessons that guide and prevent future patient harm rather than safety models that support subjective approaches.
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