RC-Yay! Finding Success with Root Cause Analysis

Shon Isenhour, Eruditio


Many industry practitioners inherently know that Root Cause Analysis (RCA) is the right thing to do, but very few are having true success in finding the real return on investment. Root Cause Analysis can be a very powerful tool for eliminating defects and increasing efficiency and profits.

Well, if that statement is true then why are we not celebrating it more? I have noticed eight common pitfalls that prevent practitioners from getting maximum value from their RCA efforts.

If you can manage them effectively, you can increase your likelihood for "RC-Yay"!

Pitfall No. 1: Not Digging Deep Enough into the Problem

This pitfall manifests itself typically in two ways: the first is getting stuck on the physical causes, which leads to replacing a lot of parts and solving the symptoms but not the true problem. The second, and arguably worse, is the practitioner drills down only to the human causes where it becomes a blame game.

A gentleman by the name of W. E. Deming addressed this when he said, “blame the system not the people." You must go deeper. The system or systemic causes allow for many if not all the human mistakes to exist. By first understanding the systemic problems, you can then can address the human ones.

Under these issues is yet another layer of what we call latent roots, which are either organizational or cultural in nature. If you don’t understand these lower-level causes, your solution may be thwarted despite you technically addressing the problem.

Pitfall No. 2: Conducting Too Many Root Cause Investigations Per Month

The RCA triggers can be set up to work off a certain amount of downtime, cost, lost production, safety, or a combination of multiple elements. But they should be set up to change as you mature into RCA. If you have the triggers set too low or if you are relying on management to ask for the investigation, then you could have too many RCA investigations and reports to complete each month.

It is also important not to forget that for every RCA there are multiple action items that must be assigned, completed, and verified. Can your systems and resources support that if you are busy generating RCA reports every time the wind blows? My belief is that beginner RCA facilitators can handle two good RCAs per month, and triggers should be set accordingly.

Pitfall No. 3: Too Much Time Spent on the Report (Not Enough on Solutions and Follow-Up)

I am sure very few of you work for a company that makes RCA reports as a product. My guess is your company probably makes widgets and a three-pound, five-inch-thick final RCA report does not add anything to the bottom line or any more margin on your widgets. Please remember the company is not paid by the pound of report, we are paid by the solutions implemented and the return on investment they generate.

I have a one-page report that I will share with you as a model for your RCA reports if you send me an email.

Pitfall No. 4: Lack of Applicable RCA Tools and Processes

Many sites have good processes and bad tools, or just the opposite, and because of that missing side they miss the mark on results. One particular site I visited in Brazil had great processes for problem identification and prioritization, but the reliability engineers were using only the Five Whys as their RCA tool. The Five Whys tool alone does not provide the correct level of analysis needed for many reliability problems. You need both a process and a set of RCA tools to match the problem you are solving.

Pitfall No. 5: Facilitators Don't Ask the Right Question and Miss Major Causal Chains

One of the exercises we do in our RCA training workshops forces the participants to interview the parties involved in a failure. You would be amazed at how hard this is for some learners. They just can’t come up with the right questions to ask.

To help to mitigate this one, use something like design and application review and follow up with change analysis to perfect your questions before you start in-depth investigation and interviews. If you do this correctly, you’ll reduce the amount of time you spend stopping and gathering additional data during the analysis phase.

Pitfall No. 6: RCA Findings and Solutions Not Verified for Effective Elimination of the Original Problem

When this step is done correctly, the site uses quantifiable metrics to measure the solutions that were identified, and they are repeated at intervals to verify a sustainable long-term solution.

Pitfall No. 7: Organization Neglects to Focus on Ensuring Best Return on Investment

If you use the correct tools and you dig into the problem, you should be left with potentially multiple solutions. Once you have this identified, you can evaluate the cost and the effectiveness of the solution to see which action or combination of actions gives you the best overall return on the problem.

In the end, RCA becomes less about finding the "root cause" and more about the most effective and lowest cost-mitigation or elimination strategy.

Pitfall No. 8: Not Following the Process from Start to Finish

While Pitfall No. 4 talks about not having proper processes in place, the eighth and final one is not following your processes through to the end and making sure you execute every step, every time. This one has been born out of companies coming to us and saying, “Hey, we are doing RCA and not getting results.”

My immediate response was “Balderdash!” There is no way you are doing RCA and not getting results.

Our students demonstrate the power of RCA day in and day out as they progress through their IBL training and certification program. There must be another root cause for your failure. And lo and behold, there is: the process broke because someone did not complete one of the required steps.

For example, they investigate the problem and generate an awesome RCA report and then never have the tenacity to implement the corrective actions. And their process stops there! You did some very visible activities, but then you stopped before you got to the point of value creation.

Follow the process.

After reading through these eight common causes of root cause failure, I hope you were able to recognize a few and can eliminate them from taking the profits out of your process. Develop a strategy and spend a little time mapping out the plan to avoid the most common pitfalls with RCAs.

Then, maybe you, too, can experience a moment of RC-Yay!

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