Revised sunflower-SHELL model--an analysis tool to ensure adverse-events' factor analysis and followed by patient safety strategy.

Background: The original SHELL model is specified for analyzing human errors. In addressing medical errors, medical systems should be targeted for improvement instead of blaming human errors. The Sunflower-SHELL model was made for patient-centered incident analysis. A further change was added to enhance more practical and convenient analysis in the healthcare environment based on users' feedback.

Methods: The revised-Sunflower-SHELL model was proposed. Pre-documented factors were newly added in sub-factor rows for easier analysis. Twenty-two nurses learned this analysis in three five-hour day workshops conducted by one of the authors, and reported the effectiveness of the model six months later.

Results: The importance of the systemic change was recognized by the twenty two nurses. They noticed changes in awareness of nurses themselves, their peers, and the hospital managers even six months after the workshop. They understood that patient safety is the key to be a hospital chosen by customers. They also noticed that the hospital itself had changed due to the social pressures caused my media exposure and patients' increasing awareness of patient human rights.

Conclusions: The revised Sunflower-SHELL can be applied to conduct root-cause change and to prevent recurrence of the incidents. Once one case is analyzed, the action plan can be applied to other similar incidents' prevention. The model is practical and convenient, so healthcare providers can complete it easily, which raises cost effectiveness because it reduces their efforts on advance events' management.