Root Cause Analysis & Equity Review
Last summer, the National Association of County & City Health Officials (NACCHO) and a Colorado-based social enterprise and consulting firm called HEART (Health Equity and Action Research Tools & Training for Transformation) provided a health equity workshop consisting of an opening live session, several modules with videos and assorted tools, and a closing live session.
In the modules, several core components of a health equity workplan were presented (see Figure 1). In Michigan, we are endeavoring to use these core components to evaluate our quick response teams (QRTs). This is the first of a series of blog posts that will chronicle the implementation of these core components into our QRT evaluations.
We are planning to integrate these core components into our QRT evaluation profiles. In order to accommodate the first and last components, two elements were added to the QRT evaluation profiles: a development element and a sustainability element (see Figure 2). Over the course of FY22, we plan to implement two core components per quarter (see Figure 3).
Root Cause Analysis
Last month, we asked our QRT contractors the following question: What is the root cause of the problem being addressed by your QRT project? We provided them a 5-Whys Guide and Template to answer the question (see Figure 4).
The 5-Whys template is a simple brainstorming tool that can help teams identify the root cause(s) of a problem. Asking the 5-Whys allows teams to move beyond obvious answers and reflect on less obvious explanations or causes. We feel that this exercise provided a good starting point for the conversation about health equity that we want to have with our QRT contractors during FY22 and beyond.
To conduct an equity review means looking at an activity with an equity lens. It includes watching for language that is stigmatizing or that does not promote inclusivity, plus several other considerations that may not be obvious when planning and executing an activity. We selected several questions from one of the modules in the health equity workshop. (See Figure 5.)
During the quarterly evaluation calls with our contractors last month, we discussed their answers to these questions.
Co-production vs. Analysis
In last month’s blog post where I introduced this book: Evaluating and Valuing in Social Research, I mentioned a process called co-production which is explained in the book. Co-production is a thoughtful, practical doing called praxis that is used to facilitate social learning. It is an iterative and collaborative process involving multiple types of expertise, actors, and knowledge to answer how did we do and what should we do now.
Co-production emphasizes deliberation over analysis. Analysis uses rigorous methods to arrive at answers to factual questions. With deliberation, people ponder and confer on matters of mutual interest to negotiate and persuade each other and may include both consensual communication and adversarial communication. To encourage such deliberation, the answers provided by our QRT contractors have been collected as qualitative data and placed in a spreadsheet (see Figure 6).
In this spreadsheet, the answers provided by the different QRT contractors can be compared and contrasted and will hopefully lead to an understanding of how we are doing and what we should do going forward. In subsequent blog posts, I’ll update you on the co-production process as we move through the implementation of the core components of the health equity workplan into our QRT evaluation profiles and together we’ll see how well this works. 😊