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Improving RCA performance: the Cornerstone Award and the power of positive reinforcement
  1. James P Bagian1,
  2. Beth J King2,
  3. Peter D Mills3,4,
  4. Scott D McKnight2
  1. 1University of Michigan Medical School and College of Engineering, Ann Arbor, Michigan, USA
  2. 2VA National Center for Patient Safety, Ann Arbor, Michigan, USA
  3. 3VA National Center for Patient Safety Field Office, White River Junction, Vermont, USA
  4. 4Dartmouth Medical School, Hanover, New Hampshire, USA
  1. Correspondence to Peter D Mills, VAMC, 10X, 215 N. Main Street, White River Junction, VT 05009, USA; peter.mills{at}


Background The Veterans Health Administration has had a comprehensive patient safety program since 1999 that includes conducting root cause analysis (RCA) of adverse medical events. Improving the quality and timeliness of the RCAs at the local level has been a continual challenge.

Methods We initiated a non-monetary program called the Cornerstone Award into our patient safety reporting system to recognise facilities conducting high-quality and timely RCAs containing deterministic corrective actions that are implemented and evaluated for effectiveness.

Results Since the Cornerstone Program began in 2008, the per cent of RCAs completed in a time-critical manner (≤45 days) has increased from an average of 52% pre-Cornerstone to an average of 94% post-Cornerstone. The per cent of action plans with stronger deterministic actions and outcomes has increased from an average of 34% pre-Cornerstone to an average of 70% post-Cornerstone.

Discussion Implementing a non-monetary recognition award that was tied to specific improvement goals greatly improved the timeliness and quality of the RCA reports in the Veterans Health Administration System.

  • Root cause analysis
  • patient safety
  • quality improvement
  • compliance

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  • Funding This material is the result of work supported with resources and the use of facilities at the Department of Veterans Affairs National Center for Patient Safety at Ann Arbor, Michigan, and the Veterans Affairs Medical Centers, White River Junction. While NCPS completes the data analysis and sponsors the award program, the effort and recognition to improve RCAs resides with the staff at VA facilities and Veterans Integrated Service Networks (VISNs). It is through the accomplishments at each individual facility that the nationwide RCA program is enhanced and the VA is able to claim overall improvements. The Research and Development Committee, White River Junction, VA Medical Center approved this project and the Committee for the Protection of Human Subjects, Dartmouth College considered this project exempt. The views expressed in this article do not necessarily represent the views of the Department of Veterans Affairs or of the United States government.

  • Competing interests None to declare.

  • Ethics approval This study was conducted with the approval of the VAMC White River Junction Vermont R and D committee.

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