Root Cause Analysis for Effective CME Needs Assessments

Needs assessments are essential to continuing medical education (CME), helping identify where health care professionals have gaps in knowledge or performance. But too often, they stop short of the deeper question: What is the cause of these gaps? 

Root cause analysis goes beyond standard needs assessments to reveal the true drivers of practice and performance issues. With this tool, medical communicators can design educational programs that truly address practice and performance gaps.

In this blog post, we’ll cover what root cause analysis is, why it matters in CME, and how to conduct one to develop more effective interventions.

What Is a Root Cause Analysis?

A root cause analysis is a structured process used to identify the underlying reasons behind performance or practice gaps. In CME, root cause analysis goes beyond needs assessments to uncover the systemic, environmental, or behavioral factors that drive those gaps.

To get to the true cause, medical communicators who develop CME can analyze a range of data sources, such as literature reviews, interviews with clinicians, and survey and practice data. With the right information, you can move beyond surface-level observations and uncover systemic or behavioral contributors that may otherwise go unseen.

Why Root Cause Analysis Matters in CME

In this podcast by Alexandra Howson, PhD, she explains how root cause analysis helps medical writers to design education that creates meaningful, measurable change. That means that interventions

• Address real problems. Identify core reasons behind skills and performance gaps.
• Increase impact. Help create education that leads to quantifiable behavior shifts.
• Foster continuous improvement. Support ongoing quality improvement across health care teams and systems.
• Use resources wisely. Direct funds and energy toward interventions that matter most.

Health care organizations use root cause analysis for quality improvement, analyzing underlying problems that contribute to adverse events. For CME developers, the same approach ensures your educational programs teach impactful changes that address areas of risk.

How to Conduct a Root Cause Analysis 

The process of leading a root cause analysis relies on continually asking “Why?” until the underlying issue appears. According to the accrediting body The Joint Commission, these are the key steps for root cause analysis: 

• Identify the issue. Define the knowledge or performance gap.
• Investigate causes. Explore systemic issues like communication barriers, work environment challenges, or process breakdowns.
• Gather and analyze data. Review interviews, surveys, and literature to identify and confirm patterns and causes.
• Develop targeted solutions. Develop education and interventions that address root causes. 
• Evaluate results. Monitor impact at 30, 60, and 90 days, and adjust as needed. 

Before designing interventions, verify the suspected causes with data (e.g., response-time reports, chart audits, and brief staff and patient interviews). Avoid assuming a cause—such as staffing—without corroboration.

Example: Fall Prevention in Older Patients

Let’s look at an example showing how root cause analysis works in practice.

• The issue: A health care facility reports a high number of patient falls among older adults, often causing injury.
• The root cause analysis process: Staff interviews, patient data analysis, and a literature review highlight recurring issues in the facility and best practices for improvement. 
• Diving deeper with the 5 Whys tool: To identify the true source of the problem, the team applied the 5 Whys tool—a simple method within the root cause analysis process that helps uncover the underlying cause of an issue.
  • Why were patients falling? Patients fell while going to the toilet unassisted.
  • Why? Call lights were not within reach.
  • Why? Bedside checklists were applied inconsistently.
  • Why? No one audited compliance.
  • Why? The fall prevention standard had no clear owner and wasn’t embedded in policy or the electronic health record (EHR) with required prompts.
• The intervention: The unit named a checklist champion, developed training and competency checkoffs for staff on a standard bedside setup, integrated a checklist into policy and the EHR, and ran daily audits with feedback.
• Outcome: Monitoring confirmed training uptake and improved compliance, accompanied by declines in unassisted toileting and falls per 1000 patient-days.

For CME developers, this example shows how using root cause analysis can transform a general observation into an actionable, evidence-based intervention.

What Tools Can Writers Use for Root Cause Analysis?

Several simple tools can guide your root cause analysis process:

• Fishbone Tool (Ishikawa) – The fishbone diagram visualizes possible causes across categories such as staff, policy, or environment.
• 5 Whys – The 5 Whys tool is a structured way to keep asking “Why?” until you uncover the true cause. 
• Pareto Charts – A Pareto chart helps identify which issues contribute most to a problem so you can focus your efforts effectively.

When medical writers apply tools like these during the needs assessment process, they can uncover not only what needs to change but why. That understanding creates stronger CME programs with more effective results.

Next Steps for Medical Communicators

Mastering root cause analysis is a valuable skill that elevates the work of medical writers who develop CME. By incorporating root cause analysis into your needs assessments, you can design programs that drive measurable improvement in clinical performance and patient outcomes.

Ready to expand your medical communication toolkit? Explore our guide to advancing your career as a medical writer.

AMWA acknowledges the contributions of Nicole Bowens, PhD, for peer review in the development of this AMWA resource.