It is said that somewhere between Point A and Point B lies the truth. Finding that elusive point of fact is one of the most challenging opportunities in quality management. Everyone has their view of how things are and their opinion is what they perceive to be the truth. If you ask ten different employees why they all complete the same task, you will get ten differing opinions. Each opinion will be fully supported by what they perceive to be the facts. Unfortunately, in most cases, you get ten different opinions that are just slightly different than the fact you are seeking. Nobody will be intentionally deceiving you, and they are confident that their facts are the truth. It is simply human nature. However, for businesses to be successful, they must operate on facts and not perception of fact. Getting to the facts is the goal of using the RCA.
Root Cause Analysis (RCA) is a valuable tool in quality improvement for identifying the underlying causes or facts of a issue or incident so proper solutions can be identified and implemented. It is a tool designed to identify not only what happened and how it happened, but also why. When you truly able to determine the facts of why an event happened, then you be be able to apply workable corrective actions to prevent future events. Some organizations mistakenly interpret the term ‘root cause’ to mean there is one root cause of an issue. Nothing could be further from the elusive truth. Focusing on one cause can easily allow you to implement a solution that misses the problem all together. The ‘root’ of a plant is not singular, so the root cause of a problem typically is not singular.
RCA Cause Mapping Method
Define – What is the problem? Define the issue or event by the impact on the goals.
Analyze – Why did it happen? Use a cause map to visually represent the issues.
Solve – What will be done? Make effective solutions that change how the work is executed.
The most effective cause map is a simple one, which illustrates the how and why an incident or event occurred. Begin the exploration of the 5 Why’s and expand that into as much detail as necessary. The more complex and challenging an issue, the more times you ask why. The RCA cause map will allow you to understand the issue and create a visual dialog. It will show where there needs to be a bit more exploration of the roots to find the truth.
An effective RCA process moves past the typically excuses of ‘human error’ and ‘procedure not followed’ that many organizations tend to use as excuses. It is a deep dive that can result in true quality improvement for the organization.