Root Cause Analysis Isn't a Tool—It's a Core Competency for CME Professionals
If root cause analysis were a tree, surface-level knowledge gaps would be visible above the ground, with deeper factors like workflow constraints, beliefs, and system design below the surface.
If you’re a CME writer, you probably remember the first time a client asked you to do a root cause analysis (RCA), and how out of reach it may have felt. These days, clients are asking writers to take on RCA more often, even though it’s rarely taught as a core competency.
However, RCA doesn’t have to be the thing you quietly hope won’t land on your plate. When you know how to use it well, RCA becomes a powerful way to deepen your work and demonstrate your value—not just as a writer, but as a strategic partner.
Let’s take a closer look at how to put RCA to work for you.
Why Root Cause Analysis Matters Now in CME
The evidence base that CME professionals must navigate has become increasingly fragile. And compounding the challenge, few CME professionals are trained to synthesize across evidence types—to hold clinical literature, survey data, qualitative interviews, and outcomes metrics in productive tension rather than treating each as a separate input.
Consider what each evidence type actually offers:
Literature shows associations, not lived realities.
Surveys capture perceptions, not decision-making processes.
Interviews surface emotions and rationalizations, not the pressures clinicians navigate in real time.
Outcomes data tells us what happened, not why.
This isn't a failure of data. It's the nature of the evidence we work with.
At the same time, the CME field has been asked to do something difficult: shift from knowledge-focused education to skill-building education. New interventions are recommended at a pace learners cannot realistically absorb and implement in practice. As a result, the gap between best practice and what's actually happening in clinical settings has become wider and more complex.
In this environment, the ability to work with ambiguous, incomplete, or contradictory evidence isn't optional; it's what makes CME education defensible. And it's what distinguishes professionals who can think diagnostically from those who can only execute procedurally.
RCA, when used strategically, is the skill that bridges this gap. It’s a diagnostic approach that helps CME teams understand why practice gaps exist and persist. It transforms how we interpret evidence, how we design interventions, and ultimately, how much impact our education actually has.
Understanding Root Cause Analysis
RCA is a systematic process for identifying the underlying causes of a problem or a performance or practice gap, rather than simply addressing the symptoms. A common misconception is that RCA ends once a cause has been identified. In practice, that’s often where the work begins.
Consider a familiar example: women presenting with symptoms of a cardiac event receive delayed or inadequate treatment compared to men. A literature review might suggest that clinicians lack knowledge about how cardiac events present differently in women.
While true, this is an incomplete picture. Strategic use of RCA goes deeper and wider. It asks why that knowledge gap exists, what reinforces it, and why it persists despite existing education. RCA methodology triangulates its sources. To do so, it examines:
Published literature
Survey results
Qualitative insights
Each data source offers a different lens. Sometimes these lenses align, sometimes they don’t. RCA treats those tensions as signals rather than problems to smooth over.
Asking “why” repeatedly, especially when the answers are uncomfortable or ambiguous, is what moves RCA from surface-level explanation to meaningful insight.
From Procedural Step to Diagnostic Tool
Too often, RCA is treated as a procedural step: identify a problem, name a cause, move on. But that approach rarely produces insight.
Strategic RCA asks a different set of questions. It examines barriers and facilitators to both learning and practice. It requires CME writers and education strategists to collect, interpret, and synthesize multiple types of evidence into a coherent explanation of behavior.
What Happens When RCA Is Treated as a Tool?
When RCA is applied mechanically, it tends to produce conclusions like:
“There’s a knowledge gap.”
“Clinicians need more education.”
“Guidelines aren’t being followed.”
These statements may be true. They’re also rarely sufficient.
In real-world CME work, root causes don’t announce themselves neatly. They show up as contradictions, half-articulated frustrations, and tensions between data sources.
If those signals are ignored, education may be misaligned.
Few CME professionals are formally trained to do this kind of analysis. But when RCA is used diagnostically rather than mechanically, it changes how we interpret evidence, design interventions, and evaluate impact.
That shift matters now more than ever. Clinicians are overwhelmed, short on time, and often unable to see their lived realities reflected in educational offerings. RCA helps bridge that gap.
“We’re all looking for barriers and facilitators [to learning] and trying to figure out — okay, we see this gap. Why does it happen? Root cause analysis is really valuable for digging into attitudes and and belief systems and values in a way that a conventional needs assessment doesn’t necessarily tap into. ”
The Benefits of Root Cause Analysis in CME
There are several benefits of RCA when it is used as a diagnostic and strategic tool:
More targeted interventions: Addressing underlying drivers of practice gaps rather than symptoms.
Better use of resources: Aligning gaps, interventions, and outcomes improves efficiency.
Stronger educational rationale: Clear diagnostic reasoning supports funding and stakeholder confidence.
Professional credibility: Demonstrates that the writer or strategist is not just executing tasks, but shaping impact.
Including RCA as part of a needs assessment in an outcomes report or presented as a standalone analysis, also helps stakeholders understand why education is necessary, not just what it intends to do.
When Education Isn’t the Right Intervention
Education is not always the appropriate outcome of an RCA.
Some practice gaps stem from policy constraints, workflow design, access issues, or systemic barriers that education alone cannot resolve. Defaulting to education in these cases risks placing responsibility on individual clinicians for structural problems. That doesn't mean RCA has failed. It means the analysis has done its job.
Knowing when education isn't the answer is itself a valuable outcome. It protects you from designing interventions that can't succeed—and positions you as a trusted advisor rather than someone who defaults to "more training" regardless of the problem. In these situations, education may need to shift its role. It can contextualize constraints, support communication across teams, or address beliefs and norms rather than skills alone. Every root cause demands a tailored response. That flexibility is what makes RCA strategic rather than prescriptive.
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5 Core Competencies That Make Root Cause Analysis a Strategic Tool
The Alliance for Continuing Education in the Health Professions identifies nine fundamental competency areas for CME professionals, including: healthcare and CPD landscape, adult learning, program planning and design, and accreditation. RCA proficiency cuts across all four—and increasingly distinguishes strategic partners from task-level executors.
For CME medical writers and education strategists seeking to move beyond task execution, five core capabilities define strategic RCA practice. I see these as habits of thinking that develop with deliberate practice, rather than as steps to follow.
1.Diagnostic judgment
Knowing when RCA is warranted, and when it isn’t. Persistent gaps, resistance to prior education, or mismatches between knowledge and behavior often signal the need for deeper analysis.
2. Tool selection
Choosing methods based on uncertainty, not habit. Simple problems may call for simple tools. Complex, human-centered challenges often require qualitative and systems-based approaches. The RCA tool you use should match the problem, not the other way around.
3. Interpretive reasoning
Drawing on concepts like cognitive bias, professional identity, social norms, and organizational culture to explain behavior that knowledge gaps alone can’t.
4. Ambiguity tolerance
Treating contradictory evidence as insight-rich rather than problematic. Tension is often where the most meaningful explanations live.
5. Strategic translation
Turning complex findings into educational decisions that fit the context, and setting realistic expectations for what education can achieve.
These capabilities don't develop from reading about RCA. They develop through practice with guidance, feedback, and increasingly complex challenges.
For a deeper dive into how these capabilities fit within broader CME professional development, see Core Competencies for CME Writers.
A Real-Life Example: When Root Cause Analysis Changed What We Paid Attention To
Example 1: Attitude and Belief Barriers in Primary Care
Years ago, I partnered with Opus Science on an Astellas-supported RCA project focused on overactive bladder syndrome. We interviewed 30 primary care providers to understand how they managed OAB and to identify gaps in their practice.
What surface analysis suggested: Clinicians needed more education about OAB diagnosis and treatment options. The literature showed underdiagnosis and undertreatment. A knowledge-focused intervention seemed like the obvious response.
What RCA uncovered: The barriers weren't primarily about awareness. Through in-depth interviews, a different picture emerged.
Clinicians described discomfort initiating conversations about urinary symptoms.
They held assumptions about what patients would or wouldn't bring up.
They expressed uncertainty about when symptoms warranted intervention versus watchful waiting.
And they faced workflow constraints during short visits that made a comprehensive assessment feel impractical.
These weren't knowledge gaps. They were attitude barriers, belief patterns, and system frictions—the kind of drivers that surface-level analysis typically misses.
Why this distinction mattered: Because the education that followed was aligned with those deeper drivers, it worked. When I conducted education outcomes interviews five years later with another client that designed and delivered education based on this RCA, we saw measurable improvements in OAB management: clinicians were more proactive about screening, more confident in recognizing urgency as a key symptom, and more consistent in their approach.
The education succeeded not because it was more comprehensive, but because it was more precise. RCA made that precision possible.
Example 2: System-Level Barriers in Cardiac Care
Let’s return to the cardiac care example introduced earlier: women presenting with symptoms of a cardiac event receive delayed or inadequate treatment compared to men.
What surface analysis suggests: Clinicians need more education about how cardiac events present differently in women—atypical symptoms, varied presentation patterns, the limitations of diagnostic tools developed primarily on male populations.
What deeper RCA might reveal: The root causes often extend beyond individual clinician knowledge.
Triage protocols might be designed around "classic" presentations that systematically disadvantage patients with atypical symptoms.
Time pressures in emergency departments create decision-making shortcuts that default to pattern recognition.
EHR prompts and clinical decision support tools may not account for presentation variability.
Workflow design makes it difficult to pause and reconsider when initial assessments don't fit the data.
Why this distinction matters: Education targeting individual clinician bias, while valuable, cannot solve problems embedded in workflow design, protocol structure, or technology limitations. RCA that surfaces system-level drivers changes the educational response entirely. Instead of (or in addition to) clinical content, education might focus on team communication strategies, protocol advocacy, or helping clinicians recognize and work within system constraints.
This is what strategic RCA offers: clarity about where the leverage points actually are, so education can be designed to address them, and so stakeholders understand why education alone won't be sufficient.
What RCA Guides Leave Out
You can find step-by-step RCA guides in many places. Most follow a familiar pattern: define the problem, collect data, identify contributing factors, analyze, develop solutions.
Those steps are accurate. They're also where most guides stop.
What's harder to find is guidance on the judgment calls that determine whether RCA produces genuine insight or just procedural documentation:
When do you stop asking "why"? There's no universal formula. It requires sensing when you've reached a driver that's actionable versus one that's too abstract or too far upstream to address.
How do you choose between competing explanations? Real data rarely points to a single root cause. Skilled practitioners weigh plausibility, consider multiple contributing factors, and resist the urge to oversimplify.
What do you do when data sources contradict each other? This is where many analyses stall. Strategic RCA treats contradiction as signal—an invitation to probe deeper rather than a problem to resolve by picking a winner.
How do you know if you've gone deep enough? Surface causes feel satisfying but rarely drive change. Root causes often feel uncomfortable, systemic, or harder to address. That discomfort is often a sign you're in the right territory.
How do you shift from blaming individuals to seeing systems? The language we use shapes what we see. Reframing "clinician error" as "system friction" opens different—and usually more productive—intervention pathways.
These are the judgment calls that WriteCME Pro’s upcoming RCA practice lab addresses—with specific decision frameworks, not just encouragement to "trust your instincts." You'll leave with tools like the RCA Stopping Rule Reference and the Minimum Viable Evidence Table that make these decisions systematic rather than guesswork.
Are You Ready to Build Root Cause Analysis as a Professional Skill?
If RCA has ever felt underwhelming—or overly mechanical—it's likely because no one taught you how to use it strategically.
RCA proficiency is becoming a marker of advanced practice—the skill that distinguishes strategic partners from order-takers. For CME medical writers building their careers or education leaders shaping strategy, this is a capability worth developing deliberately.
On April 9 (9am-12pm PT), I'm teaching a live, online practice lab focused on building RCA as a methodological skill: knowing when to use it, how to choose the right tools, and how to work with evidence that doesn't neatly announce a root cause.
This isn't a workshop about memorizing the 5 Whys or filling out a Fishbone template (although we'll practice with these tools). It's about developing the diagnostic judgment that makes your needs assessments and your educational strategies more defensible.
We'll focus on:
Knowing when RCA is the right approach (and when it isn't)
Selecting tools based on the type of uncertainty you're facing
Working with evidence that doesn't neatly announce a root cause
Translating complex, human data into stronger educational decisions
If you've ever felt that RCA should be more powerful than it has been in your practice, this workshop is designed for you.
Register for the RCA Practice Lab →
Continue Learning
Listen to the Write Medicine podcast episode on RCA for a foundational overview of tools and steps
Hear Greg Salinas discuss his approach to RCA in needs assessment work