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Prioritize Root Causes

By the end of the root cause analysis (RCA), multiple causes of the targeted health inequity should be evident. The next step is selecting which root causes to prioritize for intervention via transformation of the healthcare system. This isn’t always the easiest decision. Prioritizing the most specific root causes can help because they are often the key drivers of the inequities. In a fishbone diagram, these are the smallest branches (“bones”) of the fish diagram.  However, there are other factors to consider, such as feasibility.

One way to consider multiple factors when prioritizing root causes of a health inequity for intervention is to utilize a priority matrix. A priority matrix is a two-by-two square that helps you ask two major questions about each of the identified root causes:

If you recruited a well-informed and diverse team to conduct the root cause analysis, the same group of people will be ideally suited to answer these questions and arrive at a consensus. 

2×2: A priority matrix helps identify which root causes to prioritize

Assessing Importance and Feasibility

Quantitative data (e.g., community needs assessment) and qualitative data (e.g., patient and community focus groups) can help you assess the feasibility and importance of root causes. Common considerations that teams might take into account include:

Some teams may wish to utilize a more nuanced three-by-three priority matrix with three importance categories on one side (Most Important, Moderately Important, Least Important) and three feasibility categories on the other (Most Feasible, Moderately Feasible, Least Feasible).

3×3: A priority matrix helps identify which root causes to prioritize

Selecting Root Causes

A completed priority matrix will help the team create an equity-forward care transformation and a payment transformation to support it.  Consider the following when selecting root causes for intervention:

Solution matrix: A priority matrix will help us choose the most important and feasible root causes to address