Root Cause Analysis
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Root Cause Analysis


Root Cause Analysis

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Note About RCA Sentinel Event The RCA case study was modified from a sentinel event reported in the following article: Smetzer, J., Baker, C., Byrne, F. D., & Cohen, M. R. (2010). Shaping systems for better behavioral choices: Lessons learned from a fatal medication error. Joint Commission Journal on Quality and Patient Safety, 36(4), 152-163.Short videos are used in this non-linear module to introduce students to the case, and to give them the opportunity to view interactions between the... More
Material Type: Case Study
Technical Format: HTML/Text
Date Added to MERLOT: February 26, 2013
Date Modified in MERLOT: February 27, 2013
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Keywords: root cause analysis, sentinel event, patient, safety, case study, management, healthcare


  • Reviewed by members of Editorial board for inclusion in MERLOT.
    Editor Review
    Very good quality; in queue to be peer reviewed
    avg: 5 rating
  • User Rating (not rated)
  • Comments (none)
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Primary Audience: College Lower Division, College Upper Division, Graduate School, Professional
Mobile Compatibility: Not specified at this time
Technical Requirements: This module can be viewed in a browser using the free Flash player.  It is also HTML5 compatible and best viewed on an iPad by downloading the free Articulate Mobile Player from the app store.
Language: English
Cost Involved: no
Source Code Available: no
Accessiblity Information Available: unsure
Creative Commons: Creative Commons License
This work is licensed under a Attribution-NonCommercial-NoDerivs 3.0 United States


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