Failure Mode and Effect Analysis (FMEA) may enhance implementation of clinical practice guidelines: An experience from the Middle East

Amir Babiker; Yasser S Amer; Mohamed E Osman; Ayman Al-Eyadhy; Solafa Fatani; Sarar Mohamed; Abdulrahman Alnemri; Maher A Titi; Farheen Shaikh; Khalid A Alswat; Hayfaa A Wahabi; Lubna A Al-Ansary

doi:10.1111/jep.12873

Failure Mode and Effect Analysis (FMEA) may enhance implementation of clinical practice guidelines: An experience from the Middle East

J Eval Clin Pract. 2018 Feb;24(1):206-211. doi: 10.1111/jep.12873. Epub 2017 Dec 29.

Authors

Amir Babiker^{1

2}, Yasser S Amer^{3

4}, Mohamed E Osman¹, Ayman Al-Eyadhy¹, Solafa Fatani⁵, Sarar Mohamed^{1

6}, Abdulrahman Alnemri¹, Maher A Titi³, Farheen Shaikh^{7

8}, Khalid A Alswat^{7

9}, Hayfaa A Wahabi¹⁰, Lubna A Al-Ansary¹⁰

Affiliations

¹ Pediatrics Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
² King Abdullah Specialized Children's Hospital, King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia.
³ Quality Management Department, Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia.
⁴ Alexandria Center for Evidence-based Clinical Practice Guidelines, Healthcare Quality Directorate, Alexandria University, Alexandria, Egypt.
⁵ Pharmacy Services Department, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
⁶ Prince Sultan Military Medical City, Pediatrics Department Riyadh, Saudi Arabia.
⁷ Quality Management Department, King Saud University, Riyadh, Saudi Arabia.
⁸ Administration of Clinical Projects, King Saud University Medical City, Riyadh, Saudi Arabia.
⁹ Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
¹⁰ Family and Community Medicine Department, Research Chair for Evidence-Based Health Care and Knowledge Translation, College of Medicine, King Saud University, Saudi Arabia.

PMID: 29285849
DOI: 10.1111/jep.12873

Abstract

Rationale, aims, and objectives: Implementation of clinical practice guidelines (CPGs) has been shown to reduce variation in practice and improve health care quality and patients' safety. There is a limited experience of CPG implementation (CPGI) in the Middle East. The CPG program in our institution was launched in 2009. The Quality Management department conducted a Failure Mode and Effect Analysis (FMEA) for further improvement of CPGI.

Methods: This is a prospective study of a qualitative/quantitative design. Our FMEA included (1) process review and recording of the steps and activities of CPGI; (2) hazard analysis by recording activity-related failure modes and their effects, identification of actions required, assigned severity, occurrence, and detection scores for each failure mode and calculated the risk priority number (RPN) by using an online interactive FMEA tool; (3) planning: RPNs were prioritized, recommendations, and further planning for new interventions were identified; and (4) monitoring: after reduction or elimination of the failure mode. The calculated RPN will be compared with subsequent analysis in post-implementation phase.

Results: The data were scrutinized from a feedback of quality team members using a FMEA framework to enhance the implementation of 29 adapted CPGs. The identified potential common failure modes with the highest RPN (≥ 80) included awareness/training activities, accessibility of CPGs, fewer advocates from clinical champions, and CPGs auditing. Actions included (1) organizing regular awareness activities, (2) making CPGs printed and electronic copies accessible, (3) encouraging senior practitioners to get involved in CPGI, and (4) enhancing CPGs auditing as part of the quality sustainability plan.

Conclusion: In our experience, FMEA could be a useful tool to enhance CPGI. It helped us to identify potential barriers and prepare relevant solutions.

Keywords: Failure Mode and Effect Analysis (FMEA); Middle East; Saudi Arabia; clinical practice guidelines; implementation; quality.

MeSH terms

Guideline Adherence / standards*
Healthcare Failure Mode and Effect Analysis / methods*
Humans
Practice Guidelines as Topic
Practice Patterns, Physicians' / standards*
Prospective Studies
Quality Improvement
Risk Management / organization & administration*
Saudi Arabia