Why It Matters
Teams can use the FMEA tool to evaluate telehealth processes for possible failures and to identify ways to prevent them.
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How Planning for Failure Can Make Telehealth Safer

By IHI Multimedia Team | Thursday, May 28, 2020

Planning for Failure

We’ve all heard about the sudden increase in the usage of telehealth. Some of us have enjoyed the convenience and appreciated getting an appointment more quickly than in the past. We may have experienced what felt like a lack of connection between patient and provider. Some may be seeing this sudden plunge into the future of health care from the provider’s perspective, but many of us have also seen these clinical encounters when we have been the patient.

With the use of telehealth significantly increasing across the globe because of coronavirus physical distancing restrictions, IHI has been talking with many people who have been working tirelessly to implement a telehealth process. We’ve learned that many organizations are employing televisits for the first time. Some have shared that they are identifying problems within the system as they go.

As telehealth continues to rapidly expand, what steps can health systems and providers take to ensure a safe and positive health care experience for patients? Instead of crossing our fingers and hoping for the best, we can proactively understand the risks of delivering care virtually.

One way is to conduct a Failure Modes and Effects Analysis (FMEA). An FMEA reviews:

  • Steps in the process
  • Failure modes (What could go wrong?)
  • Failure causes (Why would the failure happen?)
  • Failure effects (What would be the consequences of each failure?)

Teams can use FMEA like a table-top simulation of providing a televisit. Using the FMEA tool, walk through each step in the process. What happens from the first point of patient interaction through follow-up care?


Figure 1 – Example FMEA

Figure 1 includes a few examples of failure modes identified as potential unintended consequences associated with telemedicine. Your organization or team will find others. After conducting your own FMEA, your team can then rank each failure mode to identify improvement opportunities and determine where to start. FMEAs can then be coupled with the Plan Do Study Act (PDSA) tool to test change ideas and identify more failure modes.

While there is still some uncertainty about whether the changes that allowed rapid adoption of telehealth will become permanent, it’s likely that at least some kinds of telehealth visits will continue long after the COVID-19 pandemic has subsided. This means the time is now to identify the actions you will take to reduce the likelihood of potential errors and harm to patients.

Allison F. Perry is an IHI Director. Frank Federico, RPh, is an IHI Vice President.

You may also be interested in:

Video – An Overview of the Failure Modes and Effects Analysis (FMEA) Tool

Recommendations for Designing High-Quality Telehealth

More COVID-19 Guidance and Resource

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