A nurse manager notices an increasing fall rate. Which quality improvement approach would most directly address this problem?

• A. Six Sigma
• B. Root cause analysis (RCA) followed by a Plan-Do-Study-Act (PDCA) cycle
• C. Randomized controlled trial
• D. Benchmarking

Answer: (B)

Understanding why a problem is happening and testing changes in small, rapid cycles is the key idea here. When falls are increasing, you want to go beyond treating the symptom and uncover the underlying contributors—environment, staffing, patient risk factors, medication issues, or protocol gaps. Root cause analysis digs into data, incident reports, and staff input to identify those deeper factors that allow falls to occur rather than just noting that falls happened.

Once you’ve pinpointed the root causes, you don’t stop there. You plan targeted interventions, implement them on a small scale, and study the results before wider rollout. This Plan-Do-Study-Act cycle keeps the improvement effort iterative: Plan a change, Do the change, Study the outcomes (e.g., fall rate, near-malls, safety audits), and Act based on what the data show. If the results look promising, you standardize the successful changes; if not, you adjust and try again. This approach directly links problem analysis to practical, measurable improvement.

Other approaches aren’t as tightly focused on both uncovering causes and testing fixes in a rapid, systematic way. Six Sigma can reduce defects and variation, but it’s more about process-level optimization over longer timelines and may be less immediately targeted to safeguarding against falls. A randomized controlled trial is a research design suited for testing interventions in controlled settings, not for ongoing unit-level quality improvement. Benchmarking compares performance to others but doesn’t provide the mechanism to diagnose root causes or implement iterative changes.

So, combining root-cause analysis with a PDCA cycle best addresses persistent fall rates by revealing underlying factors and iteratively testing fixes to reduce risk.