In both engineering and science arenas, root cause analysis (RCA) is an increasingly popular method of problem-solving used for identifying the root causes of problems.
Over the past 15 years, RCA has been used more and more in IT operations, telecommunications, accident analysis, medicine and rail transport. Normally, RCA is used to serve as input to a remediation process whereby corrective actions are taken to prevent the problem from reoccurring. This usually occurs after a four-step process:
- Identify and describe the problem
- Establish a timeline from the normal situation up to the time the problem occurred
- Distinguish between the root cause and other possible causes for the problem
- Produce a casual graph between the root cause and the problem
At the heart of the root cause analysis system is the focus on finding the true reason for a problem and not focusing on culprits. Generally, organizations that spend more time looking for culprits than causes seldom really gain the benefit they could gain from understanding the foundation of the unwanted situation.
Tools of the Trade
Cause mapping is one commonly used tool for organizations practicing root cause analysis. Cause Mapping is a root cause analysis method that improves the way people analyze, document, communicate and solve problems.
A real life example of cause mapping in action involves how over the course of two days, a U.S. airline placed an unaccompanied minor on the wrong flight on two different occasions. The initial solution that the airline came up with for preventing this problem was to reinforce procedures with its employees. However, by using cause mapping to break this problem down, it became clear that the generic “reinforcing procedures” would not be enough to get to the root cause of the issue.
Further analysis showed that at least four different breakdowns occurred in order for the unaccompanied minors to be placed on the wrong flight:
- The gate agent didn’t recognize the error, so the initial error was made during the escort to the plane.
- The flight attendant also failed to catch the error illustrating ineffective paperwork
- Even though there were too many people on the plane, the preflight attendant count was ineffective
- The count was also off (too few passengers) on the plane the minors were supposed to be on – but no one noticed
Bottom line, the more thorough root cause analysis turned up several specific issues that needed to be addressed directly, thus paving the way for a much better chance of preventing the problem in the future rather than just going with the basic “reinforcing procedures.”
Want to learn more about root cause analysis? Tonex offers more than 30 Root Cause Analysis courses ranging from 2-days to 4-days.
Additionally, Tonex offers nearly 400 classes, seminars and workshops in close to four dozen categories of systems engineering training.
For more information, questions, comments, contact us.