Abstract
Aim: Root cause analysis is widely used in healthcare services to analyze the causes of near misses and adverse events with a systematic approach. This study, it is aimed to determine the root causes of rejected samples, define corrective/preventive actions, and create an action plan that will help the implementation of the suggested remedial actions and evaluate their effectiveness.
 Material and Methods: For the 21-step methodology, observation, interview, document and record review techniques were applied. The steps of the process were visualized with the flowchart technique and the reasons for rejected samples were analyzed with team members. The identified causes were visualized with the Fishbone Diagram technique, and the risk reduction strategies and improvement actions for rejected samples were determined by the Failure Mode Effect Analysis (FMEA) method. The Action Hierarchy tool was used to evaluate the power of improvement actions.
 Results: The root causes of rejected samples were identified as inadequate orientation and training practices, lack of applicability of policies and procedures, lack of monitoring and evaluation, inefficient process flow and lack of equipment. A total of 11 improvement actions were determined and planned for these root causes. It was predicted that there will be an approximately 64.5% decrease in risk scores in general with the basic measures presented in the performed FMEA.
 Conclusion: Overall, it was found that the 21-step methodology is suitable for determining root causes by offering detailed guidance.
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