Root Cause Analysis Blog


Public TapRooT® Course in Sao Paulo

Posted: April 24th, 2015 in Courses, Pictures

TapRooT® recently held a 5-Day Advanced Root Cause Analysis and Team Leader Training Public Course in Sao Paulo, Brazil.







Check out our schedule for many more Public Courses around the world.

Interested in an Onsite Course for your company? Click here to inquire.

SAVE THE DATE for the Global TapRooT® Summit that is quickly approaching. Click here for more information or registration.

Friday Jokes: Tattoo Bad Ideas

Posted: April 24th, 2015 in Jokes, Pictures

Screen Shot 2014 07 23 at 5 54 59 PM

Screen Shot 2014 07 23 at 6 10 47 PM

Screen Shot 2014 07 23 at 6 12 42 PM

Screen Shot 2014 07 23 at 6 14 54 PM

Makes you think that tattoo shops need a spell/grammar checker! I know I need one! (Did you see all the mistakes?)

Upcoming TapRooT® Course in London, England

Posted: April 23rd, 2015 in Courses, Local Attractions


Join the TapRooT® team on May 27, 2015 for a 5-Day Advance Root Cause Analysis Team Leader Training public course in London, England!

London has grown to the top of the list in leading global cities with strengths in education, entertainment, finance, healthcare, professional services, research & development, and, of course, tourism. After reviewing their international arrivals last year, London is also the world’s most visited city. There is no doubt that their historical heritage is what so many tourists long to see and experience.


The Five Fields: Interested in trying fresh gourmet flavors? The Five Fields has a multitude of options.

The Andover Arms: A local pub with a fun atmosphere and delicious London favorites.

The Art of Pizza:  If you love pizza, this is a must try! The Art of Pizza home-makes all dough and sauce to create the best pizza around.


Houses of Parliament Tour:  Visit, in person, the UK Parliament buildings you’ve only seen in movies and textbooks.

The National Gallery:  Appreciate the Arts with exhibits containing pieces by Rembrandt and Monet.

Hippodrome Casino: Enjoy a night out on the town at London’s Casino of the year.


To register for this course: click here

For more information regarding other public courses: click here.

SAVE THE DATE for the Global TapRooT® Summit, June 1-5 in Las Vegas!

TapRooT® Public Courses in Central & South America

Posted: April 23rd, 2015 in Courses


Bogota, Colombia

Upcoming TapRooT® Public Courses:

Sao Paulo, Brazil 2-Day May 14, 2015 (Language: Portuguese)

Bogota, Colombia 2-Day May 20, 2015 (Language: Spanish)

Bogota, Colombia 3-Day May 20, 2015 (Language: Spanish)

Bogota, Colombia 5-Day May 25, 2015 (Language: Spanish)

Monterrey, Mexico 5-Day June 8, 2015 (Language: Spanish)

Sao Paulo, Brazil 5-Day June 22, 2015 (Language: Portuguese)


For more information and registration, click here.

Grading Your Investigations – Summit Best Practice Session 2 at the 2015 Global TapRooT® Summit in Las Vegas

Posted: April 23rd, 2015 in Investigations, Performance Improvement, Summit, TapRooT

Mark Paradies is organizing the “Grading Your Investigations” session at the 2015 Global TapRooT® Summit

At this session participants will use an Excel spreadsheet (download your copy below) to grade a typical incident investigation from your facility.

All participants attending this session are asked to bring an investigation report from your facility and the Excel spreadsheet available below preloaded onto a device so that you can participate in the exercise that will teach attendees to grade their company’s investigations using the spreadsheet.


TapRooT® Public Courses in Europe, Africa & Middle East

Posted: April 22nd, 2015 in Courses


Dubai, UAE

Upcoming TapRooT® Public Courses:


London, England 2-Day May 27, 2015

Hamburg, Germany 5-Day June 15, 2015

Aberdeen, Scotland 2-Day June 22, 2015


Cape Town, South Africa 5-Day May 18,2015

Middle East: 

There are no upcoming public courses scheduled for this region. Check back frequently for updates or inquire about an onsite course.


For more information regarding our public courses around the world, click here.

Weekly Wisdom: Don’t play the blame game…

Posted: April 21st, 2015 in Wisdom Quote

five whos


“What we want are the 5 why’s, not the 5 who’s (to blame).” -Unknown

TapRooT® Public Courses in Canada

Posted: April 20th, 2015 in Courses


St. John’s, Canada

Upcoming TapRooT® Public Courses:

Edmonton 5-Day May 11, 2015

St. John’s 2-Day May 12, 2015

Calgary 2-Day May 27, 2015 (Risk Management Best Practices Course- FULL)

Calgary 2-Day June 22, 2015

For more information regarding our public courses around the world, click here.

Monda Accident & Lessons Leaned: Learning from a Lack of Accidents

Posted: April 20th, 2015 in Accidents, Current Events, Performance Improvement, Success Stories, TapRooT

Screen Shot 2015 04 16 at 6 07 12 PM

As a stockholder, I was reading The CB&I 2014 Annual Report. The section on “Safety” caught my eye. Here is a quote from that section:

Everything at CB&I begins with safety; it is our most important core value and the foundation for our success. In 2014, our employees maintained a lost-time incident rate of 0.03 for more than 160 million work-hours. This equals one lost-time incident for every 6.2 million hours on the job. These numbers are a testament to our safety record and a reason why we are in the top tier of safest companies in the industry.

CB&I’s lost time injury rate is 50 times better than the industry average (.03 compared to 1.5). That might make you wonder, how do they do that?

Answering that question is learning from a lack of accidents!

Here are a couple of thoughts that I have…

First, when you see this kind of success, you know it is because of management, supervisory, and employee involvement in accomplishing a safe workplace. Everybody has to be involved. There can’t be finger pointing and blame. Everybody has to work together.

Second, I know CB&I is a TapRoot® User. CB&I has trained TapRoot® Investigators to find and fix the root causes of incidents and, thereby, keep major accidents (LTI’s and fatalities) from occurring. 

So, congratulations CB&I on your excellent performance! Congratulations on the lives you have saved and the injuries you have avoided!

If you are interested in having industry leading safety performance, perhaps you should get your folks trained to find and fix the root causes of problems by using advanced TapRooT® root cause analysis. Find out about our courses at THIS LINK.

And consider attending the 2015 Global TapRooT® Summit on June 1-5 in Las Vegas. You can:

  • meet industry leaders who are achieving world-class performance
  • benchmark your programs with their programs
  • learn industry leading best practices
  • get motivated to take your safety performance to the next level.

See the 2015 Global TapRooT® Summit schedule at: 

2015 Global TapRooT® Summit Prizes Announced!

Posted: April 17th, 2015 in Summit

When you attend the Summit, you NOT ONLY

but ALSO have a chance to win amazing prizes just for showing up. Check out these awesome prizes we have waiting for our attendees:

ipad mini

Mini iPad





apple watch

Apple Watch


amazon card

Amazon Gift Cards

REGISTER TODAY for the 2015 Global TapRooT® Summit.

LEARN MORE about the Summit!

Hamburg TapRooT® Course June 15 – 19 … And See the Miniature Wonderland!

Posted: April 17th, 2015 in Courses, TapRooT, Video

Attending the 5-Day Advanced Root Cause Analysis Course in Hamburg, Germany will be a great experience because the training is exceptional. But you may also be interested in attending the Miniature Wonderland. Watch the following video for more info …

Upcoming TapRooT® Public Course in Cape Town, South Africa

Posted: April 16th, 2015 in Courses, Local Attractions


Among the many reasons to visit Cape Town, South Africa, a TapRooT® Course is one of the best. Join us on May 18, 2015 for a 5-Day Advanced Root Cause Analysis Team Leader Training course and gain the knowledge and ability to help improve your business. According to the New York Times in 2014, Cape Town was ranked the best place in the world to visit. The world famous harbour and natural setting in the Cape floral kingdom brings tourists from all over the world to admire its beauty. You will fall in love with this city.


The Test Kitchen: Looking for something a little different? The Test Kitchen offers a warm atmosphere with genuine flavours prepared by their world-famous chef.

Miller’s Thumb:  This fun, colorful restaurant is sure to show you a good time and feed you delicious, fresh fish.

Myoga: Relaxation can be a key factor when choosing where to eat dinner. Myoga strives to entertain you with their open kitchen and earthy ambience to bring complete relaxation with your meal.


Table Mountain National Park: Cape Town being on the beautiful harbour, opens up their incredible natural attraction to the public for a fun, unique experience.

The Old Biscuit Mill: Located in the heart of Woodstock, The Old Biscuit Mill brings in local artists to show their passions to the public in an intriguing environment.

Two Oceans Aquarium: Bringing the family with you the Cape Town? Spend the day at Two Oceans Aquarium for an exciting, interactive, educational day.

Click here to register for this course today!

SAVE THE DATE for the Global TapRooT® Summit on June 1-5 in Las Vegas. Click for more information and registration.

How Good is the TapRooT® Summit?

Posted: April 15th, 2015 in Summit

I was e-mailing with a TapRooT® User today and this is part of what they had to say about the Summit …

“… they are the best conferences that I have been to in the over 40 years of my career!!!”

See what he was talking about at:

2015 Global TapRooT® Summit After Hours: Thrills, Eat & Drink, Shows, Relax

Posted: April 15th, 2015 in Local Attractions, Summit

We’ve been featuring some fun things we like to do in Las Vegas, and so far have a dozen suggestions:


Exotics Racing

Zarkana by Cirque Du Soleil


Million Dollar Quartet

The Jersey Boys

Bellagio Fountains

Eat, Drink & Relax

The LINQ Promenade

Guy Fieri’s Kitchen & Bar on the LINQ

Container Park in Downtown Las Vegas

O’Sheas on the LINQ

Capo’s Speakeasy – Steakhouse


Mob Museum


Fashion Show Mall

What are your favorite things to do in Vegas? Leave your comments below and share with other attendees, and don’t forget to join us for the 2015 Global TapRooT® Summit, June 1 – 5, 2015 in Las Vegas, Nevada.



Click here to learn about the Reception we have planned at Margaritaville!


Click here for info about the host hotel

Root Cause Analysis Tip: Fixing Generic Causes

Posted: April 15th, 2015 in Performance Improvement, Root Cause Analysis Tips

One of the final steps in performing a TapRooT® Root Caquse Analysis is finding Generic Causes. 

What is a Generic Cause? It is the reason that a root cause is widespread.

For example, a root cause for an error made while using a procedure might be that the procedure have more than one action per step. 


4. Remove the drum lid and the polyethylene liner lid, place liner in prepared drum and place in loading position at the final packaging hut. Insert plastic bag in drum liner. Seal the plastic bag with tape to the inside of the drum loading insert. 

The fix for this specific root cause might look something like this:


4.  Remove the drum lid and the polyethylene liner lid.     .     .     .     .     . ___

5.  Place liner in prepared drum.    .     .     .     .     .    .    .    .    .    .    .    . ___

6.  Place prepared drum in loading position at the final packaging hut.    . ___

7.  Insert plastic bag in drum liner.    .     .     .     .     .    .    .    .    .    .    .   ___

8.  Seal the plastic bag with tape to the inside of the drum loading insert.  ___


If the team then went to check other procedures and found that this problem was widespread, they would then have a generic problem. The question then becomes: “Why is the problem of ‘more than one action per step’ so widespread? What is the generic Cause that allows us to produce poor procedures?

The root cause analysis team may find that the people writing procedures have no guidance for writing procedures and no training on how to write procedures.

This should cause the team to look for other generic procedure problems.They might also find that procedure formats are confusing, the level of detail is inconsistent, there are excessive references,and the graphics need improvement.

The Corrective Action Helper® Guide provides guidance to fix these kinds of Generic Causes. But the widespread generic procedure problems probably indicate that the company or site doesn’t really know how to produce good procedures. Therefore, the Corrective Action Helper® Book recommendation to fix specific Generic Causes might not be enough guidance.

For example, the Corrective Action Helper® Guide says that for generic “greater than one action per step” problems, the investigators should consider:

“…a general procedure improvement program to remove multiple actions per step from the rest of the facilities procedures.”

However, if the procedures are in really bad shape, more must be done.

Of course, the Corrective Action Helper® Guide provides even more information – references. And if the investigators read the suggested reference, they may look for the additional problems and develop a plan to improve their procedures that is more comprehensive.

That would be great. But how many team read the references? My guess is … not that many. After all, in today’s downsized, super-efficient workplace, people just don’t have time.

That why System Improvements is here to provide assistance.

If you run into generic problems that you think may be important to fix, we can help.

At a minimum, we can coach your team on the development of generic corrective actions.

Beyond that, we can put an evaluation team together to evaluate the scope of the Generic Cause and develop a plan to improve performance by eliminating the Generic Cause and upgrading current systems.

Finally, if you really need help, we can put together a team to help implement the fix. In this cause, a team of experienced procedure writers to help your company fix their current procedures and coach your procedure writers how to write better procedures in the future.

We can even make rerun visits to audit the status of the corrective actions and the work of your procedure writers.

So when you find a Generic Cause that you know your company isn’t good at fixing (or doesn’t have the time to explore and fix), remember that System Improvements can help. 

Don’t let problems repeat because Generic Causes are left un-fixed. Get help. Call us at 865-539-2139 or CLICK HERE to end us a message. We can help you improve!

Onsite TapRooT® Course in Reynosa

Posted: April 15th, 2015 in Courses, Pictures

Here are some photos of the recent Onsite TapRooT® course at Fresenius in Reynosa, Mexico.












Click here to inquire about an Onsite Course at your workplace.

Click here to see the many locations of our Public Courses.

SAVE THE DATE for our Global TapRooT® Summit this June 1-5 in Las Vegas. Click here for more information.

Find and Fix the Root Causes of Equipment Related Failures

Posted: April 15th, 2015 in Courses, Equipment/Equifactor®

Don’t end up “fixing” the same equipment problems over and over again. Don’t let equipment issues cause quality, operations, and safety issues. Find the real root causes of your equipment reliability issues and develop effective fixes that will keep them from happening again by using this systematic process.

Did you know that we have 3-day and 1-day courses? What’s the difference? 3-Day Courses include the 1-Day Equifactor® Course along with the 2-Day Incident Investigation and Root Cause Analysis Course so you have it all in one. The 1-Day courses are just the separate Equifactor® course that requires a previously taken 2-Day course along with it, not necessarily all in one trip.

Why take an Equifactor® course? You will not only receive invaluable knowledge for your business, but also a Free single-user copy of TapRooT® Software. (A $2890 Value!) You can’t get a better deal than that.

Still deciding? Watch the video below to hear our Equifactor® instructor, Ken Reed, talk about why this course is right for you.


Steps to register for the course and Free Software.


2) Select a 1-Day Equifactor® Course of your choice (Having already taken a 2-Day course or accompanying it with a 2-Day course)

3) Register for the course and add it to your cart

4) Done!


Upcoming Equifactor® Public Courses:

Sale, Australia | May 15, 2015


Forbes, Australia | June 26, 2015

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