Author Archives: Marcus Miller

TapRooT® launches a new edition of the Friends & Experts eNewsletter focused for Healthcare

Posted: September 10th, 2018 in Media Room, Medical/Healthcare

Great news for our healthcare readers!  TapRooT® is making a commitment to the healthcare industry by creating healthcare’s own TapRooT® E-Newsletter and here is why:

A recent Johns Hopkins study claims more than 250,000 people in the U.S. die every year from medical errors. Other reports claim the numbers to be as high as 440,000. Medical errors are the third-leading cause of death after heart disease and cancer (Makary & Daniel, 2016).  The cost of sentinel events in time, money and reputation is significant especially when good margins measure only in the single digits.  The Society of Actuaries estimated that medical errors cost the U.S. $19.5 billion in 2008, with non-reimbursable medical costs per error ranging from $810 to $47,099 (Milliman, 2010). Total costs, which include in-hospital mortality and short-term disability costs, reached over $93,000 per error.

This begs the question; how do health care organizations reduce the risk and financial burden of mistakes and errors that cause poor clinical and financial outcomes?

I whole-heartily believe that the healthcare industry can learn from the likes of oil and gas, mining, nuclear and utilities industries. TapRooT’s® clients typically operate their business’s in dangerous industries. Quite literally lives depend on TapRooT’s® world class investigation, root cause analysis and corrective action implementation processes.  Our clients are the top tier companies in these industry sectors: household names such as Chevron, Exxon, DuPont, Delta, Siemens, and Nuclear Fuel Services.  These enterprises fully understand just how critical safety and quality are and how they impact their organization’s reputation and bottom line.  Our clients clearly see the value of a very well thought out and pragmatic approach to developing a formal root cause analysis platform within their organization.

My goal is simple, to introduce TapRooT® to health care organizations so they can also realize and benefit from the value of such a program and platform.  The healthcare newsletter will be one strategy to meet that goal.  Our content will focus on bringing information to our readers about programs such as CMS’ Value Based payment models which attempt to tie reimbursement to financial and performance accountability.  It will also bring insightful resources to our readers’ attention like the must-read book for all health care supervisors and executives:  Beyond the Checklist: What Else Health Care Can Learn from Aviation Teamwork and Safety (The Culture and Politics of Health Care Work).  Here is an excerpt from the book and a link to a video that highlights the value of this book:

“In medicine it seems now to be universally acknowledged that failures of teamwork and communication-not simply failures in technical proficiency-cause the majority of medical errors and injuries in hospitals and other health care facilities. Studies too numerous to cite have documented that it is not the incompetent surgeon or a small group of bad apples in other disciplines that cause harm to patients. It is human factors – the failure of human beings to relate effectively and productively with one another highly technological settings, to recognize human limitations in performance ability owning to “Life factors” such as extreme fatigue and emotional distress, and to actively resist the culture of blame- that are the major cause of patient harm.” p. 8.

TapRooT® has 30 years of research and experience which we will bring to our readers.  TapRooT® exists to solve problems like worker comp issues, quality issues, environmental releases, or god forbid, fatalities and injuries through training on investigations techniques, using the evidence to find causal factors for effective root cause analysis and the implementation of corrective actions that can be both validated and verified so those problems are solved for good.

When you find yourself frustrated that your organization’s corrective action are mostly re-training, re-writing policy and procedures, disciplinary actions like write ups and termination and decide you’d like to spend just a little time having a conversation about the problems you are experiencing and possible solutions, my email is  We can set up a time to talk about your problems and see if it makes sense to take the next step with an introduction to TapRooT®.

It is our privilege to provide this monthly newsletter to our healthcare subscribers so please enjoy the first edition on September 11. If you’re not subscribed, contact to sign up.

Bias and Blame in Healthcare’s Culture Has To Change

Posted: July 10th, 2018 in Uncategorized


Taking the blame out of root cause analysis is critical.  See this article for more information on a physician in the UK who was charged with manslaughter when the system failed her and her patient. Click here.  The physician wasn’t at fault.  She didn’t intentionally make an error.  The system and processes need analyzed and improved so mistakes aren’t made again.  It actually does harm to put a physician in jail because of  process or system errors.  It takes the focus off of the real problems.  It diverts time and resources from where they are truly needed.  It incentives physicians to cover up errors which could be analyzed for lessons learned resulting in better outcomes.  Physician burn out and suicide rates are at an all time high because of the pressure physicians are under. Click here for more info.  They are held accountable and blamed for bad outcomes when something goes wrong.  The responsibility and burden on physicians must be tremendous.  Until Healthcare catches up to other industries that do train their teams on how to conduct unbiased root cause analysis as part of their continuous quality improvement process, the culture will be hard pressed to change.


To find more information on TapRooT’s® comprehensive quality improvement process, please contact me at

Winners and Losers in Healthcare’s Shift to Value-Based Payments

Posted: July 9th, 2018 in Investigations, Medical/Healthcare, Performance Improvement, Quality, Root Causes, TapRooT, Uncategorized


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The 2010 Affordable Care Act (ACA) was established to shift payment away from the volume of services provided toward the quality of those services. The ACA directed the Department of Health and Human Services to create a budget neutral payment model. CMS (Centers for Medicare & Medicaid Services) published an ACA fact sheet in 2015 that can be found here.

What does budget neutral mean in this case? A very smart healthcare executive explained it to me.  She said that budget neutral means you will have losers and you will have winners. The Department of Heath and Human Services had to put a payment model in place that takes money away from the losers and gives it to the winners so Medicare doesn’t see an increase in costs but still incentivizes providers to focus on quality. If you don’t have positive outcomes, money will be taken away and given to the providers that do show positive outcomes (the winners). So the difference between winners and losers is the quality of their outcomes. TapRooT® should be the quality improvement process healthcare organizations use to ensure they are on the winning side by improving quality and safety which also protects their revenue and margins. To find out more how your organization can improve your outcomes and protect your reimbursement, please contact me at

Joint Commission Focuses Surveys to Assess Safety Culture

Posted: June 26th, 2018 in Career Development, Medical/Healthcare, Performance Improvement, Quality



Healthcare is catching up to other industries that have strong continuous improvement programs like mining, gas and oil. Joint Commission is leading that charge by implementing survey process improvements this month for how it assesses the safety culture in hospitals and critical access hospitals.  These improvements will be implemented for all other programs by October of this year. See this article for more details: (Read article.) Continuous Quality Improvement has become a major focus for payers.

In addition, the value-based payment model is replacing the fee for service payment model faster than anticipated. Healthcare organizations must find a comprehensive continuous quality improvement process for patient safety and to strengthen clinical and financial outcomes. Healthcare organizations must protect their revenue by limiting the financial impacts of poor clinical outcomes through a strong continuous quality improvement program. Survival is at stake. Medicare sequestration and payment penalties can easily erase already slim margins.

TapRooT® is that comprehensive continuous quality improvement process that Joint Commission or State Survey teams love to see as part of your QAPI program. TapRoot® trains safety, compliance and quality teams on complete investigation/auditing techniques, finding why incidents occur and identifying the root cause of those mistakes, errors or failures, identifying and implementing corrective actions and ensuring they are effective. TapRooT® has remarkable software that guides teams through the process and helps create impressive reports for management or survey teams.

If you would like to learn more to decide if TapRooT® is the right continuous quality improvement process for your organization, you can contact me at



QAPI and TapRooT®: The Bridge to Operational Excellence and Quality Care in our Nursing Homes

Posted: June 1st, 2018 in Medical/Healthcare, Performance Improvement, Quality


TapRooT® and QAPI


The Center for Medicare and Medicaid Services (CMS) defines QAPI as the coordinated application of two mutually reinforcing aspects of quality management systems:  Quality Assurance (QA) and Performance Improvement (PI) = QAPI.  Every nursing home in the U.S. is required to have a well documented QAPI program to be compliant with the Affordable Care Act.  Nursing homes are required to continuously identify and correct quality deficiencies as well as sustain performance improvements.

TapRooT® is used to identify root causes of potential and actual risk to quality performance and prescribes corrective actions that will eliminate the risk or significantly reduce risk and consequences of incidents.  TapRooT® training, tools and software are perfect solutions to implementing and maintaining a strong, compliant QAPI program.   

Let’s first look at the QA portion of QAPI.  QA is defined by CMS as the specification of standards for quality of service and outcomes, and a process throughout the nursing home for assuring that care is maintained at acceptable levels in relation to those standards.  QA is ongoing, both anticipatory and retrospective in it’s efforts to identify how the organization is performing, including where and why facility performance is at risk or has failed to meet standards.  TapRooT® processes ensure specification of standards by prescribing proven best practices for the root cause of any problem affecting quality of service, outcomes or breakdown of processes that assure  quality of care.  TapRooT® training, tools and software ensure the real root cause is identified by honing the teams’ skill in auditing and investigations practices that meet the criteria for both anticipatory and retrospective efforts in quality assurance. The TapRooT® Corrective Action Helper Guide will lead the team to proven best practices once root causes are identified and ensures the actions are effective. TapRooT®  will also help teams measure and compare current performance against performance standards and goals.

CMS defines PI as the continuous study and improvement of processes with the intent to better services or outcomes, and prevent or decrease the likelihood of problems or barriers to improvement.  TapRooT® Root Cause Analysis for Audits and Proactive Performance Improvement training, tools and software will lead QAPI teams through implementation of a continuous improvement program.  There are countless good QAPI teams out there that are great at identifying problems but struggle with prescribing, implementing and measuring the effectiveness of corrective actions.  They typically prescribe the weakest of corrective actions which generally include the “re” actions:

  • Re-train
  • Re-write the procedure or process
  • Re-mind
  • Re-emphasize
  • Re-evaluate
  • Re-view
  • Re-peat warnings, discipline training, etc.

The strongest corrective actions include putting new or additional safeguards in place, or even better, removing the risk or removing the patient from harms way.

Using TapRooT® to identify the real root causes of quality and performance issues through strong audit and investigation techniques and implementing effective corrective actions that lead to continuous improvement will help the QAPI team achieve Operational Excellence.  The big winners are our loved ones who took care of us and now need our commitment to providing them the quality care they deserve.

Want to learn more? You can contact us through the website, call into our office at 865.539.2139 or attend one of our public TapRooT® Courses or contact us to schedule an onsite course.



Using TapRooT® to Prevent Medicare Payment Reductions

Posted: May 30th, 2018 in Medical/Healthcare, Root Cause Analysis Tips, Root Causes


Medicare has introduced several programs that attempt to link quality of care to payment. That is a tremendous challenge for healthcare providers that are used to the fee-for-service payment model Medicare traditionally used to reimburse providers. For example, in the fee-for-service payment model, healthcare providers bill Medicare for the number of visits and/or tests they order for the patient. If providers did the work and it’s well documented, they could depend on Medicare payment. Medicare is now shifting that fee-for-service payment model to value-based payment models. Healthcare providers will now be reimbursed for providing high quality services, and incur payment reductions for poor patient outcomes.

A couple of examples of Medicare’s value-based purchasing programs are:

  1. Hospital Readmissions Reduction Program. The Affordable Care Act authorizes Medicare to reduce payments to acute care hospitals with excess readmissions for patients who were treated for conditions such as heart attacks, hip and knee replacements, pneumonia, COPD and/or Coronary Artery Bypass Graft Surgery.
  2. Hospital Value-Based Purchasing. Medicare adjusts a portion of payments to hospitals at the beginning of each fiscal year based on how well they perform on each outcome measure compared to all hospitals or how much they improve their own performance during a prior baseline period.
  3. Hospital-Acquired Condition Reduction Program. The Affordable Care Act also authorized Medicare to reduce payments to hospitals that are in the bottom 25% for certain quality outcomes and hospital acquired conditions.

The healthcare industry now more than ever needs to develop its skill in proactively identifying the root causes of preventable hospital readmissions and the root causes for poor quality measures that affect payment. TapRooT® is a solution. TapRooT® software and training teaches us to identify the real root causes of problems (not just the problems) and build and execute corrective actions that can ensure patients have better experiences and performance outcomes while protecting against payment reductions that hurt the bottom line.

I’ll never forget the mantra of a friend of mine who was an executive at a non-for-profit organization: You can’t help the poor if you are the poor. If healthcare providers don’t transition from the fee-for-service payments to valued-based payment models, it won’t take a root cause analysis to see why they failed.

Learn how to use proactively in our 5-Day TapRooT® Advanced Root Cause Analysis Team Leader Training. (View schedule of upcoming courses here.)

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