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BMJ Qual Saf 21:607-611 doi:10.1136/bmjqs-2011-000723
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Failure mode and effects analysis: too little for too much?

  1. Nick Barber1,2
  1. 1Centre for Medication Safety and Service Quality, UCL School of Pharmacy and Imperial College Healthcare NHS Trust, London, UK
  2. 2Department of Practice and Policy, UCL School of Pharmacy, London, UK
  1. Correspondence to Professor Bryony Dean Franklin, Director, Centre for Medication Safety and Service Quality, UCL School of Pharmacy and Imperial College Healthcare NHS Trust, Pharmacy Department, Charing Cross Hospital, London W6 8RF, UK; bryony.deanfranklin{at}imperial.nhs.uk
  1. Contributors All authors contributed to the conception and writing of this paper.

  • Accepted 9 February 2012
  • Published Online First 23 March 2012

Abstract

Failure mode and effects analysis (FMEA) is a structured prospective risk assessment method that is widely used within healthcare. FMEA involves a multidisciplinary team mapping out a high-risk process of care, identifying the failures that can occur, and then characterising each of these in terms of probability of occurrence, severity of effects and detectability, to give a risk priority number used to identify failures most in need of attention. One might assume that such a widely used tool would have an established evidence base. This paper considers whether or not this is the case, examining the evidence for the reliability and validity of its outputs, the mathematical principles behind the calculation of a risk prioirty number, and variation in how it is used in practice. We also consider the likely advantages of this approach, together with the disadvantages in terms of the healthcare professionals' time involved. We conclude that although FMEA is popular and many published studies have reported its use within healthcare, there is little evidence to support its use for the quantitative prioritisation of process failures. It lacks both reliability and validity, and is very time consuming. We would not recommend its use as a quantitative technique to prioritise, promote or study patient safety interventions. However, the stage of FMEA involving multidisciplinary mapping process seems valuable and work is now needed to identify the best way of converting this into plans for action.

Footnotes

  • Funding There was no specific funding for this work. The Centre for Medication Safety and Service Quality is affiliated with the Centre for Patient Safety and Service Quality at Imperial College Healthcare NHS Trust which is funded by the National Institute of Health Research. Nada Shebl was partly funded by the UK Overseas Research Award Scheme.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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