title: Improving RCA performance: the Cornerstone Award and the power of positive reinforcement.
abstract: BACKGROUND
  The Veterans Health Administration has had a comprehensive patient safety program since 1999 that includes conducting root cause analysis (RCA) of adverse medical events. Improving the quality and timeliness of the RCAs at the local level has been a continual challenge.
  
  
  METHODS
  We initiated a non-monetary program called the Cornerstone Award into our patient safety reporting system to recognise facilities conducting high-quality and timely RCAs containing deterministic corrective actions that are implemented and evaluated for effectiveness.
  
  
  RESULTS
  Since the Cornerstone Program began in 2008, the per cent of RCAs completed in a time-critical manner (≤45 days) has increased from an average of 52% pre-Cornerstone to an average of 94% post-Cornerstone. The per cent of action plans with stronger deterministic actions and outcomes has increased from an average of 34% pre-Cornerstone to an average of 70% post-Cornerstone.
  
  
  CONCLUSIONS
  Implementing a non-monetary recognition award that was tied to specific improvement goals greatly improved the timeliness and quality of the RCA reports in the Veterans Health Administration System.
authors.affiliation: University of Michigan Medical School and College of Engineering, Ann Arbor, MI, USA.
authors.forename: James P
authors.initials: JP
authors.lastname: Bagian
authors.forename: Beth J
authors.initials: BJ
authors.lastname: King
authors.forename: Peter D
authors.initials: PD
authors.lastname: Mills
authors.forename: Scott D
authors.initials: SD
authors.lastname: McKnight
mesh_terms: D001363:Awards and Prizes; D019300:Medical Errors / Q000517:prevention & control; D060891:Root Cause Analysis / Q000592:standards*; D017751:Safety Management; D014481:United States; D014493:United States Department of Veterans Affairs