Failure mode and effects analysis (FMEA)

• Where are the quality problems and which problems should I tackle first?
• Ishikawa / Fishbone / Cause & Effect Diagrams
• Process Mapping
• Five Whys
• Pareto Charts
• Failure Modes & Effects Analysis
• Root Cause Analysis

Failure mode and effects analysis helps a QI team brainstorm about all the things that can possibly go wrong when delivering a health care service.  For each possible thing that can go wrong, teams identify what bad impact the failure might have for patients (S, for severity), the probability it will occur (O, for occurrence), and the chance that it might slip by unnoticed (D, for detection).  For each of these three items, teams assign a score of 1 (lowest risk) to 10 (highest risk).  They then calculate a Risk Priority Number (RPN = S x O x D).  QI teams can then use this information to reduce or eliminate failures, starting with those with the highest priority. 

FMEA is most frequently used in patient safety projects aimed at anticipating and preventing critical incidents.  However, FMEA can also be used in other QI projects for identifying and avoiding possible failures at different processes of care.  In such instances, FMEA can be applied to projects aimed at improving access, efficiency or patient experience. 

Other resources:

ISMP provides examples of how FMEAs are used in improving medication safety.
http://www.ismp.org/Tools/FMEA.asp

IHI has an interactive tool for creating FMEAs.
http://www.ihi.org/ihi/workspace/tools/fmea/

Example:  Failure Mode Effects Analysis

Failure Mode:  How did this process fail?
Effects:  what is the consequence to the patient from this failure?
Causes:  what caused the process to fail this way?
Controls:  what is in place to detect the failure before it causes its effect?
SEV:  severity of effect (1=least, 10=worst)
OCC:  occurrence of failure mode (1=least frequent, 10=most frequent)
DET:  probability of detection (1=likely detected, 10=likely not detected)
RPN:  risk priority number (SEV x OCC x DET)



Click on table above to see a larger view.

Click here for template