Tuesday, July 31, 2012

Want Success with Root Cause Analysis? Prove Yourself Wrong

As practitioners of Root Cause Analysis (and generally hard headed engineering types) one of our worst enemies is well... us.  Over time we see failures and reoccurring problems and we start to draw general conclusions. Then a few months later we see something similar and we apply past experience maybe a bit two freely and we end up using the tools of root cause to focus on proving our theory correct. This can lead to missing causal chains and pursuing solutions that will not solve the real problem ergo return on investment is not achieved.
To combat this issue I recommend that if you feel the itch to make a "know it all" proclamation to the RCA team first, take a few minutes to at least try to prove your self wrong. Use the tools to look for evidence and data that does not support your theory. It is not about proving yourself right, it is about proving yourself wrong. If you can not prove yourself wrong then by all means proceed.

This advice applies specifically to RCA facilitators but is good advise for others as well. This is not about stifling brain storming it is more about preventing railroading by the more out spoken types.

What advice would you give to new RCA champions?


  1. Shon,
    Really very interesting your comments. Something I can add as part of my experience in Análisis de Causa Raíz is that beyond know how to use the current methodologies, the most important is the approach to identify potential solutions. In this sense , once we find potential solutions we have to make the macht with the need of the core -business; avoiding the "paralysis by analysis" determining two possible solutions: "Interim Corrective Actions" or "Permanent Corrective Actions". This is part of Apollo Root Cause.

  2. This is similar to the Kepner-Tregoe concept of "What it is." and "What it isn't.". Being able to point and say 'it isn't that." is very useful.

  3. My Number 1 and what I think is the most important rule of facilitation; as a facilitator it is your job to lead the process and let the TEAM discover and resolve the cause of the failure.

    The first time you walk out of a RCA and exclaim "I" solved the problem might be the last time you ever get an honest answer.

    1. Agreed, You are correct based on the definition of facilitator.

      If the team finds the solution implementation will be much more successful.

      Compare yourself to the banks of a river. You cannot effectively control the river but you can guide it and keep the water in. We do this by asking questions.

  4. Arthur Conan Doyle (Sherlock Holmes) ... "Change your theory to match the facts, not the facts to match your theory."

    Both the Reliability Center and Bob Nelms taught me 20 years ago about the essential nature of verification in the RCFA process. Cause - Effect logic is based upon hypothesis (aka scientific method), but your conclusions are only as accurate as your verification of those hypotheses.

    Tim Holmes, DuPont