title: A Case Study on Improving Intensive Care Unit (ICU) Services Reliability: By Using Process Failure Mode and Effects Analysis (PFMEA).
abstract: BACKGROUND
  In any complex human system, human error is inevitable and shows that can't be eliminated by blaming wrong doers. So with the aim of improving Intensive Care Units (ICU) reliability in hospitals, this research tries to identify and analyze ICU's process failure modes at the point of systematic approach to errors.
  
  
  METHODS
  In this descriptive research, data was gathered qualitatively by observations, document reviews, and Focus Group Discussions (FGDs) with the process owners in two selected ICUs in Tehran in 2014. But, data analysis was quantitative, based on failures' Risk Priority Number (RPN) at the base of Failure Modes and Effects Analysis (FMEA) method used. Besides, some causes of failures were analyzed by qualitative Eindhoven Classification Model (ECM).
  
  
  RESULTS
  Through FMEA methodology, 378 potential failure modes from 180 ICU activities in hospital A and 184 potential failures from 99 ICU activities in hospital B were identified and evaluated. Then with 90% reliability (RPN≥100), totally 18 failures in hospital A and 42 ones in hospital B were identified as non-acceptable risks and then their causes were analyzed by ECM.
  
  
  CONCLUSIONS
  Applying of modified PFMEA for improving two selected ICUs' processes reliability in two different kinds of hospitals shows that this method empowers staff to identify, evaluate, prioritize and analyze all potential failure modes and also make them eager to identify their causes, recommend corrective actions and even participate in improving process without feeling blamed by top management. Moreover, by combining FMEA and ECM, team members can easily identify failure causes at the point of health care perspectives.
authors.affiliation: Ph.D. Student of Health Policy, Faculty of Health, Tehran University of Medical Sciences, Tehran, Iran. t.yousefinezhadi@gmail.com.
authors.forename: Taraneh
authors.initials: T
authors.lastname: Yousefinezhadi
authors.forename: Farnaz Attar
authors.initials: FA
authors.lastname: Jannesar Nobari
authors.forename: Faranak
authors.initials: F
authors.lastname: Behzadi Goodari
authors.forename: Mohammad
authors.initials: M
authors.lastname: Arab