How to Do Root Cause Analysis: Nailing the Process for Long-Term Success
Knowing When to Conduct an RCA
Root Cause Analysis (RCA) is a systematic approach to problem solving, used to identify the underlying causes of problems or incidents. The goal is to identify corrective actions that prevent the problem from happening again.
Common uses of RCA include investigation and resolution of recurring problems or safety-related incidents. RCA may also be conducted following both minor and major asset failures or as part of quality assurance or continuous improvement efforts.
Root cause analysis in continuous improvement
Root cause analysis plays a key role in continuous improvement as it provides a structured approach to understanding problems and ensuring that corrective actions are targeted and effective.
Through effective root cause analysis, organizations can:
- Prevent problem recurrence by resolving the underlying reasons it occurred
- Improve efficiency by addressing reasons for inefficiency or waste
- Enhance safety by reducing or eliminating risk
- Improve quality by resolving defects in product and design
- Improve ROI by focusing on solutions that deliver long-term value
Who should conduct RCA?
Bringing together the right people is essential to effective root cause analysis and the development of workable solutions. An RCA investigation should include people who bring experience across different—yet relevant—job roles and people who have direct knowledge of the incident. It is also important to have a skilled and unbiased facilitator who has undergone RCA training and understands how to do root cause analysis. The facilitator should also be adept at controlling a group and keeping the investigation on track.
RCA participants may include:
- Subject matter experts on the asset, product, or process involved
- Frontline staff directly involved in the incident or process
- Management/leadership who can ensure follow-through on solutions
- Quality Assurance team members
- Engineers or technical specialists
- Individuals from related department (to understand cross-functional impacts)
When should you conduct RCA?
Understanding how to do root cause analysis goes hand in hand with knowing when to apply it. Root cause analysis may be considered in response to significant failures, recurring problems, and unexplained performance issues such as a decrease in quality or efficiency. In order to apply the right process to different problems, you need to define clear parameters or triggers. Your parameters may be cost-based—for example, if an event causes over $500,000 in lost production, then you conduct an RCA. Or they may be human-centered—for example, if an event causes the hospitalization of an employee, then you conduct an RCA.
Triggers are unique to each company and should be clear, specific, and communicated to all relevant employees.
Steps of Root Cause Analysis
A structured approach is key to effective RCA. The International Electrotechnical Commission (ICE) standard for root cause analysis, outlines the following steps to be performed:
- Initiation: Based on the knowledge available on the focus event, determine the need to carry out RCA and define the purpose and scope.
- Establishing Facts: Collect data and establish the facts of what happened, where, when and by whom.
- Analysis: Use RCA tools and techniques to ascertain how and why the focus event occurred.
- Validation: Distinguish and resolve the different possibilities as to how and why the focus event was caused.
- Presentation of Results: Present the results of the focus event analysis.
Source: British Standards Institution (2015). BS EN 62740
The 5 Whys and Other RCA Tools
There are various tools and methods that can aid in how to do root cause analysis. These include:
5 Whys: The 5 Whys process is a quick and simple problem-solving methodology suited to minor events. The process involves repeatedly asking "Why?" to drill down from a symptom to its root cause.
Example:
- Why? Because the loading conveyor belt has stopped.
- Why? Because the drive motor on the conveyor pulley has tripped out.
- Why? Because there was an overload on the drive motor.
- Why? Because the main bearing had seized.
- Why? Because there was no lubrication in the bearing.
Causes Tree Method: A systematic approach for analyzing and visualizing events and conditions that contributed to a focus event or incident. The Causes Tree Method considers technical, organizational, human, and environmental causes.
Fault tree analysis: Fault tree analysis uses Boolean logic to map the relationship between events and system failures and identify contributing factors.
Fishbone or Ishikawa diagram: Illustrates the relationship between a focus event and all the factors that may influence it. The development of the diagram encourages brainstorming to identify all possible causal factors of the focus event.
Implementing Preventive Solutions
Understanding how to do root cause analysis is important for quality control and preventing problem recurrence. However, investments in root cause analysis will fail if the identified solutions are not implemented. This can be a common problem due to issues such as lack of accountability, budget, and competing organizational priorities.
To combat these issues and ensure timely, cost-effective and successful implementation of RCA solutions, organizations need rigorous processes to allocate actions to the right people and track them through to completion.
Tips for implementing corrective actions:
- Appoint an owner to oversee all incomplete tasks, to keep track of what’s outstanding, and to assign team members to work orders
- If an employee is given a work order, put it in writing and make the expectations clear
- Provide clear time frames for completion of tasks
- Have an escalation system in place for when solutions become overdue
- Invest in a proven solution-tracking software to monitor progress
Understanding Root Cause Analysis
Stepping back, root cause analysis is more than just a set of tools; it's an effective strategy for solving some of the bigger problems that can derail an organization’s success. Root cause analysis takes into account that problems often result from a chain of events and helps to piece together the causal chain and separate symptoms from actual root causes. Through thorough investigation and brainstorming, root cause analysis also identifies corrective actions that prevent issues from recurring.
Root cause analysis is not only for major events or catastrophic failures. It can be used in tandem with methodologies like Six Sigma to support continuous improvement and quality assurance initiatives.
Principles of RCA
RCA can refer to any systematic process that identifies the cause or causes that contribute to an incident event, whether that event is a success or failure. Effective RCA adheres to several core principles:
- Aims to reveal root causes to change their impact or the likelihood of their occurrence
- Analyzes the past for knowledge that can generate improvements in the future
- Acknowledges that the immediate or obvious cause of an incident is often a symptom of underlying causes
The Cordant™ Root Cause Analysis Method
The Cordant™ Root Cause Analysis method provides a systematic and comprehensive approach for problem solving that concludes with measuring the success of solutions, communicating wins across the organization, and institutionalizing the entire process. This makes Cordant™ Root Cause Analysis a leading choice for those establishing an RCA program.
Advantages of Cordant™ Root Cause Analysis
- Scalable for any size problem, including individual incidents or systemic issues
- Applicable for all problem types
- Integrated within the broader Asset Management process
- Domain experts who can partner with you to deliver sustained and continuous value
Training Your Team in One RCA Process
A consistent approach and understanding of how to do root cause analysis are vital for large organizations. With a single, standardized approach to RCA, organizations can ensure everyone speaks the same language and follows a rigorous methodology.
Dedicated RCA training and shared best practices are key. These best practices should include a willingness to keep an open mind, avoiding blame, and a focus on true root causes rather than symptoms.
Communication Between Teams
Many common challenges with problem solving relate to communication. It is helpful to recognize these challenges and prevent them by establishing clear and effective communication.
RCA training or a skilled facilitator can help provide guidance on best practices and processes for team communication.
Communication challenges include:
- Problem solving process is not well understood by everyone involved
- A common goal is not defined or well communicated
- A shared reality of the incident is not established
- A desire to place blame which can lead to unhelpful lines of discussion
- The information needed for RCA is not preserved
- RCA facilitation led by stakeholders or subject matter experts on the issue which can lead to biased discussion
- Focus on storytelling vs facts
Avoiding Blame in Root Cause Analysis
The goal of root cause analysis is to understand why an event happened, so it can be resolved or prevented from recurring.
Blame is not helpful and can discourage individuals from sharing important information. It also focuses on who is at fault, rather than digging deep to understand what happened and all the contributing factors.
To avoid falling into this trap, a crucial aspect of learning how to do root cause analysis is learning how to create a blameless environment. Avoid language that focuses on individual actions and instead, focus on what happened and the underlying reasons why.
Finding the Cause Besides the Symptoms
Remember that effective root cause analysis focuses on finding true root causes rather than symptoms. The symptoms of a problem or event tend to be obvious and may include asset failure, issues in product quality, or decreased production. Root cause analysis aims to identify what’s causing those symptoms, so that corrective actions can be applied.
