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Diagnose Root Causes

What is this and why does it matter?

A Root Cause Analysis (RCA) helps organizations understand why undesirable outcomes occur so they can address root issues, not just symptoms. When applied with an equity and anti-racist lens, an RCA goes further — asking how structural factors like racism, classism, and ableism shape access to care and patient experiences, and what power dynamics within the healthcare system reinforce inequities. By centering historically marginalized populations in the analysis, teams can identify and address the true root causes of inequities rather than unintentionally reinforcing them.

How should you work through this component?

Begin with the Key Considerations primer, then review the Base Deck presentation. Use the Facilitator Guide alongside the deck — it provides instructions and context for leading the exercises. Apply an equity lens throughout to ensure structural inequities stay visible in your analysis.

When does it make sense to work through this component?

This component should be worked through early in any health equity initiative — and as soon as possible if your team has the ability to question and influence systemic factors. It is particularly useful when disparities persist despite prior improvement efforts, data shows inequitable outcomes but the reasons are unclear, new programs are being designed, or there is an opportunity to re-examine policies and practices that may be unintentionally contributing to inequities.

Curriculum to be completed for this component:

Conducting a Root Cause Analysis with an Equity Lens: Key Considerations

This primer supports equity-focused RCA brainstorming by providing guiding principles, key questions, and considerations organized across six levels of the health system — policy, community, organization, microsystem, care team, and patients/families. It emphasizes centering community voices, avoiding blame, and examining structural factors at each level to surface the true root causes of health inequities.

RIC – DRC – Key Considerations 6.2025Download

Diagnosing Root Causes with an Equity Lens (Base Deck – Presentation)

This presentation covers key concepts like social drivers of health, how structural racism underlies health inequities, and practical guidance on using fishbone diagrams and assembling diverse stakeholder teams to diagnose the systemic causes of disparate health outcomes.

RIC – DRC – Root Cause Analysis – (base deck) 6.2025Download

Diagnose Root Causes (Facilitator Guide)

This facilitator guide provides step-by-step instructions for leading teams through a root cause analysis session using an equity lens to uncover systemic causes of health inequities.

RIC – DRC – Facilitator Guide 6.2025Download

Self-Assessment Topics and Questions:

This self-assessment tool will help you identify, anticipate and address common challenges implementing the Roadmap.  Using it will increase your chances of successfully reducing and eliminating health and healthcare inequities. Each Roadmap component will have a set of questions and topics in their respective sections; AHE recommends utilizing the assessment questions in two ways:

  1. Questions to assess the strengths and weaknesses of a root cause analysis (RCA) plan.  Similar questions can also help you assess the strengths and weaknesses of a previously conducted RCA.
    • Who will participate in the root cause analysis (RCA) and provide input/responses?
      • Patients living with the health equity focus?
        • Describe their level and manner of participation.
      • Representatives from community based organizations who serve patients living with the health equity focus?
        • Describe their level and manner of participation.
      • Care team members serving patients living with the health equity focus?
        • Which care team members?  Were patient service representatives, pharmacists, community health workers (CHWs), social workers, behavioral health specialists, nurses, and quality improvement team members included?
          • Describe their level and manner of participation.
      • Key stakeholders at the health plan partners?  Who?
        • Describe their level and manner of participation.
      • Key stakeholders at the state Medicaid agency?  Who?
        • Describe their level and manner of participation.
    • What will be the top-line or “head of the fishbone” question of the RCA?
      • Describe how the question is framed?  For example, does the question identify patients, the healthcare system, or something else as the “problem” that needs to be addressed/fixed?  Remember that it is best practice to frame the healthcare system as the “problem” that needs to be fixed when identifying the root causes of health and health care inequities.
  2. Questions to assess the strengths and weaknesses of a completed RCA.
  3. What were the results of the RCA?
    • What major categories of analysis were included (e.g., the top-level “why?” questions)?
    • Did the RCA miss any potential categories of analysis?
    • What surprises were there?  Surprises are a sign that the RCA process has served its purpose (by bringing to light potential causes of inequities that were previously hidden or not considered relevant.
  4. Were the results and conclusions of the RCA shared back to the participants for their feedback?
    • If yes, what was their response?  What recommendations did they provide?
  5. Were any of the identified root causes tied back to any forms of oppression and/or discrimination?
    • Have these been flagged for intervention?  Where did they end-up in the priority matrix?

Goal and Objective Setting:

About the Roadmap Goal and Objective Setting Tool

This tool is designed to facilitate goal setting and completion for your team. The tool will allow your team to:

  1. Record goals which align with the various Roadmap components
  2. Record objectives, time frames, and target completion dates, among other important items for each goal
  3. Monitor progress of goals per Roadmap component

Your team is welcome to engage with this tool as much or as little as it would like, and is helpful, in the development, implementation, and evaluation of your health equity initiative. We encourage you to use this tool to ensure clear goal setting and promote consistent communication, accountability, and progress within your team. This tool is designed to be used over time as your team progresses through the Roadmap and your initiative. This is in no way intended to be used one way by all teams. This is meant to help you progress through the Roadmap component(s) on which you are working at a given time and you may reach your goals in any order. We welcome you to consult your AHE TA lead on getting started with this tool.

Each Roadmap component is listed as a separate tab. Navigate to the desired Roadmap component via the task bar at the bottom of the webpage to add, edit, or view goals. Hide certain tabs as needed to narrow your view to specific Roadmap components or the snapshot. Changing the status of a goal will automatically shift the Snapshot view for the specific Roadmap component.