Taproot

Following are downloadable presentations for the 2012 Global TapRooT® Summit Investigation, Troubleshooting & Root Cause Analysis Track.  The Summit will be held February 29 to March 2, 2012 in Las Vegas, Nevada.

Wednesday, February 29, 10:30 a.m. – TapRooT® Investigations & TapRooT® Process Improvements

Success Implementing TapRooT® Across an Engineeing Firm (Mark Devlin)
[Presentation has not be received from presenter. Contact editor@taproot.com for more info.]

Oil E&P Explosion Investigation & Lessons Learned (Marty Fulkerth)
[Presentation has not be received from presenter. Contact editor@taproot.com for more info.]

GAP Analysis of TapRooT® Implementation and Improvements Implemented (Eric Olson)
[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Wednesday, February 29, 1:00 p.m. – What is “Culture” & How Do You Identify & Solve Culture Problems Using TapRooT®? (Brian Tink, Brian Tink, Richard Mesker, & Clare Solomon)
[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Wednesday, February 29, 2:40 p.m. – Troubleshooting Equipment Problems as Part of a TapRooT® Investigation (Ken Reed)
[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Thursday, March 1, 9:10 a.m. – Corrective Action Best Practices

How Strong Are Your Corrective Actions? (?)
[Presentation has not be received from presenter. Contact editor@taproot.com for more info.]

Corrective and Preventive Actions (CAPA) Best Practices (Karen Adam)
[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Thursday, March 1, 10:50 a.m. – TapRooT® Users Share Root Cause Best Practices (Linda Unger & Michele Lindsay)
[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Thursday, March 1, 1:00 p.m. – Investigation & Root Cause Analysis Insights

The 7 Secrets of Incident Investigation & Root Cause Analysis – (Mark Paradies)
[Presentation has not be received from presenter. Contact editor@taproot.com for more info.]

A Regulator’s View of What Makes a Good Incident Investigation & Root Cause Analysis – (Tony Warchut)
[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Thursday, March 1, 2:40 p.m. – Investigation Process Best Practices

Optimize Your Investigation Process – (Ken Reed)
[Presentation has not be received from presenter. Contact editor@taproot.com for more info.]

Overview of the IEEE Nuclear Plant Root Cause Analysis Standard – (Kay Gallogly)
[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Friday, March 2, 8:00 a.m. – The Day 29 Miners Died: The UBB Mine Explosion (Ken Scott)
[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Friday, March 2, 9:00 a.m. – Planning Your Improvements
[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Following are downloadable presentations for the 2012 Global TapRooT® Summit Quality & Corrective Action Programs Track.  The Summit will be held February 29 to March 2, 2012 in Las Vegas, Nevada.

Wednesday, February 29, 10:30 a.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Wednesday, February 29, 1:00 p.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Wednesday, February 29, 2:40 p.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Thursday, March 1, 9:10 a.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Thursday, March 1, 10:50 a.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Thursday, March 1, 1:00 p.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Thursday, March 1, 2:40 p.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Friday, March 2, 8:00 a.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Friday, March 2, 9:00 a.m. – Planning Your Improvements

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Following are downloadable presentations for the 2012 Global TapRooT® Summit TapRooT® Software Super-Users/Administrators track.  The Summit will be held February 29 to March 2, 2012 in Las Vegas, Nevada.

Wednesday, February 29, 10:30 a.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Wednesday, February 29, 1:00 p.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Wednesday, February 29, 2:40 p.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Thursday, March 1, 9:10 a.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Thursday, March 1, 10:50 a.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Thursday, March 1, 1:00 p.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Thursday, March 1, 2:40 p.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Friday, March 2, 8:00 a.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Friday, March 2, 9:00 a.m. – Planning Your Improvements

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Following are downloadable presentations for the 2012 Global TapRooT® Summit Certified TapRooT® Instructor Track. The Summit will be held February 29 to March 2, 2012 in Las Vegas, Nevada.

Session 1:  Wednesday, February 29, 10:30 a.m. – Developing Great Investigators (Ken Reed, facilitator)

What Makes a Fully Qualified Investigator? (Jim Thatcher)
[Presentation has not be received from presenter. Contact editor@taproot.com for more info.]

Keeping Investigators Motivated (Pat Fortune)
[Presentation has not be received from presenter. Contact editor@taproot.com for more info.]

Part Time Investigator … Full Time Job (Dave Munro)
[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Session 2:  Wednesday, February 29, 1:00 p.m. - What is “Culture” & How Do You Identify & Solve Culture Problems Using TapRooT®? (Brian Tink, Brian Tink, Richard Mesker, & Clare Solomon)
[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Session 3:  Wednesday, February 29, 2:40 p.m. - What’s New in the TapRooT® Software (Dan Verlinde)
[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Sesson 4:  Thursday, March 1, 9:10 a.m. - Deepwater Horizon: A Dramatic Portrayal (Esther Walker and Forum Interactive)
[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Session 5:  Thursday, March 1, 10:50 a.m. - TapRooT® Users Share Root Cause Best Practices (Linda Unger & Michele Lindsay)
[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Session 6:  Thursday, March 1, 1:00 p.m. - Certified TapRooT® Instructor Best Practices (Ken Reed, Linda Unger, Michelle Wishoun)
[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Session 7:  Thursday, March 1, 2:40 p.m. - Positive Contributions in Facilitation & Management Interactions (Michele Lindsay & Ralph Blessing)
[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Session 8:  Friday, March 2, 8:00 a.m. - Using FACT to Measure & Analyze Fatigue (Both Reactive & Proactive) (Bill Sirois)
[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Session 9:  Friday, March 2, 9:00 a.m. – Planning Your Improvements
[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Following are downloadable “Special Topics” presentations for the 2012 Global TapRooT® Summit.  The Summit will be held February 29 to March 2, 2012 in Las Vegas, Nevada.

Wednesday, February 29, 10:30 a.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Wednesday, February 29, 1:00 p.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Wednesday, February 29, 2:40 p.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Thursday, March 1, 9:10 a.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Thursday, March 1, 10:50 a.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Thursday, March 1, 1:00 p.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Thursday, March 1, 2:40 p.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Friday, March 2, 8:00 a.m. -

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Friday, March 2, 9:00 a.m. – Planning Your Improvements

[Presentation has not be received from presenter.  Contact editor@taproot.com for more info.]

Finding ALL causal factors is extremely important.  In our courses, we teach a number of best practices for finding those causal factors.  One of them is the 5 Safeguard questions:

What word is common to all of these questions?  Error.  And an error that fits these questions is most likely a causal factor.

Beyond using these questions to find causal factors as we teach in our 2 and 5 day courses, there is also a best practice we share in our Advanced TapRooT® Techniques course, which is to use these questions to collect evidence, here is an example:

A customer gets burned by coffee from a drive through (note:  any resemblance to a real incident is purely coincidental)

You do a safeguards table, just like we teach in the 2 and 5 day courses:

The hazard is hot coffee

The target is the customer

Safeguards include temperature, the cup, the lid, the cup holders in the car, and awareness

Now use the 5 safeguard questions, for example:

What error allowed a hazard or allowed it to grow too large?  This safeguard question might prompt you to wonder how hot the coffee was, how hot it was supposed to be, and what a safe temperature really is.  After you gathered all of your data and are ready to find causal factors, you might ask the question again:

What error allowed a hazard or allowed it to grow too large?

Coffee machine was set to brew at 190 degrees

Look there – I now have a causal factor, because that temperature actually causes 3rd degree burns within 7 seconds.  Ouch.  And the typical home coffee maker brews at 140 degrees.

So I hope this tip might help you to use safeguards more, ask better questions, save you time, and help you find all of your causal factors.  By the way, if you want to attend the Advanced TapRooT® Techniques course for more helpful best practices, there is still time.  The course will be held in Las Vegas on February 27-28.  Click HERE for more info.

By the way, here is some “coffee trivia” for you – why do restaurants brew their coffee so hot?

The most common answer?  “It tastes better.”  WRONG!!!

The real answer?  It smells better, which gets more people to buy coffee.

Thanks for visiting the blog and happy investigating.

Often people participating in the TapRooT® Summit THINK they know what will be their favorite session, but are surprised when one of the sessions they attend BLOWS THEIR SOCKS OFF.

For example, all of the Keynote Speakers (CLICK HERE to review them) have the potential to be the best talk at the Summit.

But there are some Best Practice Session presenters who also have the potential to be your favorite session. Here are just a few of the ones that I’m looking forward to …

Lori Reineke-Avant and Eric Cropp   

They will discuss their personal experience being prosecuted for an accident.

Linda Unger and Michele Lindsay           

One of the most highly praised sessions at past Summits has been the “TapRooT® Users Share Root Cause Best Practices” session facilitated by Linda and Michele.

Richard Mesker                                                         

Richard gives interesting, interactive talks. What I’ve heard about his “Risk Management and Safety: Safety Third” session leads me to believe it will surprise you.

Dave Munro, Jade Washmon, Jim Thatcher and Pat Fortune (not pictured) will discuss what it takes to develop and maintain great investigators.

William Sirois from Circadian Technologies                 

I always like Bill’s talks about fatigue and he has two at the Summit that you should consider attending. The first is about a new federal requirement for airlines – developing a fatigue risk management plan. These plans really should be implemented everywhere that fatigue could be an issue.

Second, is “Using FACT to Measure & Analyze Fatigue (Both Reactive and Proactive)”. If you’ve ever wondered how you can prove that fatigue was an issue in an accident, Bill has the answer and will share it at the Summit.

- – -

Well, I said I’d share a few … so I better stop now. And I haven’t even mentioned the talks I’ll be presenting!

Make sure you attend the Summit so that you can learn all the valuable information that will help you take performance at your facility to the next level.

See all the Summit sessions at:

http://www.taproot.com/summit.php?t=schedule

I am really excited to announce that we have made a few changes to beef up our Risk Management topics for the Safety, Process Safety, and Risk Management track for the summit.

On Thursday, March 1 from 10:50-noon, we have the following presentation:

Risk Management

Assessing Organisational Risk Maturity – Malcolm Gresham

How do you assess the your organisation’s risk management maturity?  It is no longer sufficient to implement a Risk Management Framework and hope for the best.  Organisations need to assess whether their current level of risk management is appropriate. The Risk Maturity Model provides organisations with a valuable measure of the ongoing development of their ability to manage Risk.

Using the new Risk Management Standard ANSI Z690.2 : 2011 to Assess the Maturity of your Risk Management System – Jim Whiting

How mature is your organisation’s RMS ? This session discusses how to obtain assurance of the maturity, quality,  adequacy of your RMS measured against conformity with the new ANSI Z690.2 Standard for RM Systems. This Standard provides specific audit criteria and guidelines for the  principles, framework, and process required of a ‘Best Practice’ organisation. An audit process using ANSI Z690.2 criteria can be performed on both an Internal / First Party and even a External / Third Party basis. Either way the resulting benefits center on being able to demonstrate internally and/or externally that your organisation is managing risks in an adequate way. Hence the audit results can provide confidence and assurance to your own people as well as external stakeholders. The workshop will discuss how the evidence-seeking questions/ activities in such an audit can be constructed, delivered and their results analysed and reported.

Jim Whiting

This change also allows for us to create a session, also on March 1, from 9:10-10:30 entitled Risk Management and Safety: Safety Third?

In this session, we have Richard Mesker speaking.  Rich was one of the most highly rated speakers at our last summit, so you will not want to miss this.  Here is what he will be talking about:

When anticipating risk, performing risk analysis, and allocating resources is safety first or is it actually third/fourth/fifth in the priority list? If so, why? We have all heard the mantra of “Safety First.” Let’s find out if in fact safety is first.

We look forward to seeing everyone in Las Vegas!

Karen Migliaccio has done a tremendous job setting up this first TapRooT® Summit Quality Track. From cross industry representatives to demonstrating field successes all the way up to company process changes, you will find this Summit Week Track interesting and applicable.

Wednesday

TapRooT®; Implementation Success Stories:

Successful Implementation of TapRooT® at Steris (Kevin McManus)

High Quality TapRooT® Implementation (Dennis Osmer)

Using the Baldrige Criteria to Achieve Performance Improvement (Kevin McManus)

Root Cause Analysis of Quality Problems:

Challenges in Biotech Quality Root Cause Analysis (Michael Gorman)

Root Cause Analysis of Incidents Occurring in the Pharmaceutical

Industry (Debbie Riley)

Thursday

CAPA in Quality: The Strong and the Weak (Karen Migliaccio)

Quality Issues:

Quality Initiatives That Lead To Continuous Improvement Efforts (Bryan

Ward)

Using a Quality Plan to Drive Improvement (Zena Kaufman)

The 7 Secrets of Incident Investigation & Root Cause Analysis (Mark Paradies)

Designing Your Continuous Improvement Program (Kevin McManus)

Friday

How Pfizer Achieves Operational Excellence (Gerry Migliaccio)

Planning Your Improvements

To read more about each session see:

http://www.taproot.com/summit.php?t=schedule.

Then select the Quality and Corrective Action Programs Track.

But there’s more!

Before the Summit we have a special nTapRooT® Root Cause Analysis Course focused on finding the root causes of quality issues.

When you attend both the pre-Summit course and the Summit, you save $200 off the course fee.

Just click on the link below for more information…

TapRooT® Quality/Six Sigma/Lean
Advanced Root Cause Analysis Training

What is it that produces a safe environment with safe workers? Is it people with the right attitude… is it a reduced risk environment… or is it both? Do we need reward or punishment… or both? How do different cultures interact successfully to work safely? What is the best environment for a person to work in physically? How does one know?

Listening to a radio show recently about people trying to get out of debt, the host said this, “it is not the math that got them in the situation it is the behavior; that is why changing the behavior is the first step.” It was in reference to people who wanted to know why the had to pay off small debts first and not the large credit cards with high interest.

Point being, that the more one practices a behavior, the higher the probability that the behavior becomes habit. Providing a better environment with the right tools increases the ability to perform the behavior. It is with this in mind that the sessions below were put together:

Wednesday

• Proactive Prevention of Injuries and Accidents Due to Human Error
  Ergonomic and Human Performance Improvement
  Working Across Languages and Cultures

Thursday

• Changing Behavior By Praising the 49 Character Traits
  Criminal Prosecution of Accidents
  Using Training Simulation to Improve Human Performance
  Design for Reliable Performance

Friday

• Using FACT to Measure & Analyze Fatigue (Both Reactive & Proactive)
  Planning Your Improvements

To read more about each session go here: 

http://www.taproot.com/summit.php?t=schedule

One more thing …

Before the Summit there is a pre-Summit course that you should be considering …

Stopping Human Error

Just click on the link above for more info.

The course and the Human Performance and Behavior Change Best Practice Track make a great one-two punch for improving human performance. Plus, you will save $200 off the course fee when you attend both.

Don’t miss the remarkable knowledge available in the course and the Summit. Register today!

Pre-Summit

The TapRooT® Pre-Summit is the one time a year we hold our 2-Day Software course for public registration.  Be sure not to miss out on this opportunity!

Whether you are responsible for administering the TapRooT® Enterprise Software, or are the ‘Go-To’ TapRooT® guru at your company, you will get all the information you need to know on the latest version of the software, and find out about upcoming releases.

Day 1 of the course is spent running through the entire 7-Step Process flow in the latest version of the software, giving you all the best practices for recording your investigation data.

Day 2 we delve into the configurability and administrative set up of the software, teaching you to how to maximize your potential for trending, reporting and maintaining data integrity for you and your company.

Dan Verlinde

Matthew Irving

The Pre-Summit course will be taught by Dan Verlinde, Director of Information Technology and Software Development for System Improvements, and Matt Irving, Software Development Project Manager for Improvement Interactive.  Sign up for the 2-day Pre-Summit course today!  (Learn more!)

.

Summit

The TapRooT® Software Track for the summit will run Wednesday through Friday and address a variety of topics including:

Using the TapRooT® Software to Perform an Investigation (Instructor:  Dan Verlinde):  We’ll highlight the most common use of the software, performing an investigation, using the brand new 5.1.5 release with new interface functions.

A User Experience – Web Implementation of the TapRooT® Software (Instructor: Susan Lewis, Wilbros):  This session will cover one Super-Users experience implementing the TapRooT® V5 Software and how they met their business’s needs, including:

• System Configuration

o   User Groups

o   System Lists

o   Custom Fields

• Reporting
• Problems and Obstacles encountered

What’s New In The TapRooT® Software? (Instructor: Dan Verlinde, System Improvements): This session will cover new developments in the TapRooT® V5 Software since the last TapRooT® Summit.  Dan Verlinde will perform a demonstration of all the new features, and make important announcements about future releases of the software.

Bridging the Software Knowledge Gap (Instructor: Dan Verlinde, System Improvements):  This session will cover a range of topics Enterprise clients will need to address for successful TapRooT® V5 Software implementation, including:

• Software Installation
• Implementation Strategy
• System Configuration & Administrative Tools
• Data Migration

Learn how successful analysis of your business need can make implementation of the TapRooT® painless for your users.

How You Can Help Shape Future TapRooT® Software (Instructor: Matt Irving, Project Manager, Improvement Interactive):  Matt Irving tells us, “We are constantly at work behind the scenes to improve the software that so many depend on every day. The feedback that we receive from our users and instructors plays an important role into what goes into future releases.

Additionally, we are constantly staying apprised of the changes in technology that can enhance the user experience. This session will be a unique look into how all these factors come into play when deciding how and what goes into the TapRooT® Software.

Chris Vallee

Trending Using The TapRooT® Software (Instructor: Chris Vallee, System Improvements):  This session will cover how to use your data for trending purposes in the TapRooT® V5 Software, including:

• Corrective Action Status Reports
• Root Cause Reports
• Search Function
• Defining Trending going forward

Should be another great Summit this year in Las Vegas.  Look forward to seeing you there!  (Register for the Summit.)

A new 30-minute talk has been added to the Safety, Process Safety and Risk Management Track session, “Risk Management & Safety,” (Thursday, March 1 at 10:50 a.m.). Australian risk management expert and TapRooT® Instructor, Jim Whiting, will present “Using the New Risk Management Standard ANSI Z690.2 : 2011 to Assess the Maturity of your Risk Management System.”

How mature is your organization’s RMS? This 30-minute workshop session focuses on one part of the 2-day pre-Summit course, Risk Management Best Practices, i.e. how to obtain assurance of the maturity, quality, adequacy of your RMS measured against conformity with the new ANSI Z690.2 Standard for RM Systems. This Standard provides specific audit criteria and guidelines for the principles, framework, and process required of a ‘Best Practice’ organization. An audit process using ANSI Z690.2 criteria can be performed on both an Internal / First Party and even a External / Third Party basis. Either way the resulting benefits center on being able to demonstrate internally and/or externally that your organization is managing risks in an adequate way. Hence, the audit results can provide confidence and assurance to your own people as well as external stakeholders. The workshop will discuss how the evidence-seeking questions/ activities in such an audit can be constructed, delivered and their results analyzed and reported.

Learn more in our 2-Day Pre-Summit Course (February 27 and 28)

If you would like to dig deeper into this topic, register for the 2-day pre-Summit course, Risk Management Best Practices.  Jim Whiting (member of the committee that wrote AS / NZS 4360:1999, that significantly contributed to the ultimate development of the international risk management standard ISO 31000 and now the USA Standard ANSI Z690:2011to) has enhanced the course for 2012.

Dennis Osmer, former Worldwide Head of HSE, will be presenting some thoughts about quality implementation of TapRooT®, a system he has used for over 20 years at the 2012 TapRooT® Summit. Key elements covered will be: use of pilots; internal teaching; site review teams; investigator training; focused approach to broad approach; and continuous improvement.

Dennis is a TapRooT® Instructor with over 40 years of industrial experience – the last seven years of his career as the World Wide Head of Health, Safety, Environment (HSE) and Emergency Management at CIBA Vision (a business unit of Novartis). There, he was responsible for the HSE activities for all of CVs operations (14 supply chain sites, 37 sales and marketing group companies, 11,000 employees on 3 continents). He has a pragmatic approach to developing and implementing HSE strategy which balances employee safety, environmental protection and business needs. He is a recognized expert with a track record of delivering performance.

His most recent activities were with Pandemic Preparedness, energy efficiency improvements, auditing, due diligence, new site start-up and HSE strategies for world class performance. While with a different business unit, he was the deputy chief of an industrial brigade and part of a community outreach program.

Dennis has an MBA in general management and finance from Fairleigh Dickinson University, and a BA in mathematics from the same university.

This session will be part of the Quality and Corrective Action Programs track and the Leading Performance Improvement track.  If you are planning to sign up for a different track and want to attend this session, you may customize your schedule and add it!

One of the highest rated sessions at the TapRooT® Summit is the “TapRooT® Users Share Root Cause Best Practices” session. Here’s a video of one TapRooT® User sharing an idea …

This idea may or may not apply to your investigations. But just one or two good ideas can “pay for” you Summit attendance by the benefits they create back at work. I had an attendee at the 2010 Summit tell me that one idea he learned was going to save his company over $100,000 in the first year he implemented it.

Does your company need to learn good ideas (best practices) from industry leaders from around the world? Then register for the TapRooT® Summit at:

https://taproot.com/summit.php?t=register