Root Cause Analysis Blog


TapRooT® Onsite Course in Chile

Posted: July 7th, 2015 in Courses, Pictures

Here is a photo of the group that attended the TapRooT® Onsite Course in Chile last week.



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

Interested in a Public Course? Click here.

Learn How to Make Safe Behavior ‘Go Viral’ for a Great Safety Culture

Posted: July 7th, 2015 in Career Development

Clare Solomon and Mark Ormond invite you to learn how to make safe behavior ‘go viral’ for a great safety culture.

tipping point

International Culture Change Seminar – Creating a ‘Tipping Point’
September 17, 2015
Phoenix, Arizona


Clare Solomon

Mark Ormond

Mark Ormond

It was great to meet so many TapRooT® users at the Las Vegas Summit last month and to all those who got involved in our social experiment to create a Tipping Point – thank-you!

If you weren’t there, you missed a treat! We succeeded in getting almost 200 people up on their feet dancing, or tapping along to Simon and Garfunkel’s ‘Cecilia’… this was at 8.30 in the morning after a big night out in Vegas!

The tipping point… that magic moment when ideas, trends and social behavior cross a threshold, tip and spread like wildfire.
Malcolm Gladwell

So, what’s all this got to do with creating a great safety culture? It’s all about having 3 things:

1. the right people
2. the right message
3. … at the right time

Get this right and culture change can happen more quickly than you think. Just look at how fast behaviour can go viral, from a stadium wave to the ice bucket challenge!

Why do some messages stick?

As culture change specialists we have helped our clients see tipping points of change happen again and again through a powerful combination of coaching and communication tools designed to change attitudes, values and beliefs at every level of the organization.

In this seminar you will find out:

- The key elements required to influence a tipping point in your business
– How to create and sustain behavioural change that will lead to better safety performance.

On average our clients see a 30-50% improvement in incidents and accidents within 12 months.

Sign up to our Culture Change Seminar
September 17, 2105
Phoenix, Arizona
Call: 00 44 1494 782444

Or click below to find out more and book your place…

A highly professional, engaging and thought-provoking workshop. The presentation was smooth and demonstrated a deep understanding of the subject that has clearly delivered results. The event was expertly organised and facilitated.
James Pomeroy, Group HSE Manager
Senior plc

Weekly Wisdom: All safety precautions matter.

Posted: July 7th, 2015 in Wisdom Quote

sum of contributions

“It is the sum of our contributions to safety management that determines whether the people we work with live or die.”  -Sir Brian Appleton

Monday Accident & Lessons Learned: Lessons Learned from 5 Chemical Accidents

Posted: July 6th, 2015 in Accidents, Documents, Investigations

Lessons learned from five accidents reported by EU and OECD Countries. See:

Read insights on lessons learned from accidents reported in the European Major Accident Reporting System (eMARS) and other accident sources.

47 accidents in eMARS involving contractor safety issues in the chemical or petrochemical industries were examined. Five accidents were chosen on the basis that a contract worker was killed or injured or was involved in the accident.

What do you think? Leave your comments below.

Happy Independance Day!

Posted: July 4th, 2015 in Current Events


For those outside the USA, on the 4th of July we are off celebrating our God given freedoms that are guaranteed in the US Constitution that resulted from declaring our independence from the British crown. On July 4, 1776, the Continental Congress approved the final wording of the Declaration of Independence. That act continued the progress of the revolt that had started back in April of 1775 and resulted in the founding of the United States and the US Constitution. 

For more information about the US Constitution, see:

See you next week!

BP to Pay $18.7 Billion for Environmental Damage Caused by the Deepwater Horizon Oil Spill

Posted: July 3rd, 2015 in Accidents, Current Events

It is the largest environmental settlement ever.

BP will pay the US Government,Alabama, Florida, Louisiana,Mississippi, and Texas $18.7 billion to compensate for environmental damage done by the Deepwater Horizon spill.

For more info, see:

Upcoming Public TapRooT® Course in Boston, MA

Posted: July 2nd, 2015 in Courses, Local Attractions


Do you enjoy American history and visiting historical sites that helped make the United States what we are today? Do you also enjoy root cause analysis and investigations? Take a trip to Boston, Massachusetts with TapRooT® for a 2-Day Incident Investigation and Root Cause Analysis course and get it all in one trip. Touring the famous sites of some of the key points of the American Revolution, learning the depths of the American culture and being introduced to TapRooT® makes for one great trip.


James Hook & Co.: As if family owned restaurants weren’t already the best, try one with fresh lobster dishes straight from the sea. Enjoy!

Rino’s Place: Guy Fieri featured this delicious genuine Italian restaurant, that must mean it’s a winner!

Flour Bakery & Cafe: With four locations in the Boston area, there is no excuse not to stop. Fresh pastries, breads and gourmet coffee, what’s not to love?


Fenway Park: Sports lover or not, this baseball stadium is known as “America’s most beloved ball park”, don’t pass up this opportunity.

Freedom Trail: This special foundation created a route just for history buffs like you. See it all in one tour with an educated tour guide ready to share American history with you.

Samuel Adams Brewery Tour: One of America’s favorite beers brewed right here in Boston. Take a tour of the brewery and explore why it’s one of the best.

Ready to register? Click here.

TapRooT® Public Courses in Central & South America

Posted: July 2nd, 2015 in Courses


Sao Paulo, Brazil

Upcoming TapRooT® Public Courses:

Central America: 

Monterrey, Mexico | 5-Day | August 24, 2015 (Language: Spanish)

South America: 

Sao Paulo, Brazil | 5-Day | August 17, 2015 (Language: Portuguese)

Sao Paulo, Brazil | 2-Day | September 17, 2015 (Language: Portuguese)

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

Public TapRooT® Course in Chile

Posted: July 1st, 2015 in Pictures

Check out the latest Onsite course in Chile! Follow these links for more information on our Public and Onsite courses.


la foto





Root Cause Tip: What is the Root Cause of Memory Failure While Learning?

Posted: July 1st, 2015 in Root Cause Analysis Tips


Ever take your laptop to training to take notes? According to psychological research, (The Pen is Mightier than the Keyboard), if you want to retain what you learn during training, using a laptop to take notes is not a good idea.

The research indicates that the act of taking notes on a laptop seems to interfere with our ability to remember the information. Mueller & Oppenheimer, psychologists for the research, believe that’s because learners on laptops are mindlessly typing everything the instructor is saying.  When tested, laptop users performed similar to pen notetakers on factual questions about the notes, but significantly worse on conceptual questions.

Since we can’t take notes as fast nor capture as much information with a pen, we are required to think and actively listen for what’s most important to write down.  Thus, we store information into memory as we think about it.

One of the root causes of memory failure during learning appears to be the way we take notes.  Will this research change the way you take notes in training?  Leave your comments below.

Happy Canada Day!

Posted: July 1st, 2015 in Pictures, TapRooT® Instructor

canada day

We are grateful for all of our Canadian TapRooT® Instructors and friends! Happy Canada Day!

TapRooT® Public Courses in Europe, Africa & Middle East

Posted: July 1st, 2015 in Courses


Stavanger, Norway

Upcoming TapRooT® Public Courses:


Stavanger, Norway | 2-Day | September 9, 2015

Stavanger, Norway | 3-Day | September 9, 2015

Hamburg, Germany | 2-Day | September 14, 2015

Aberdeen, Scotland | 5-Day | September 21, 2015


Johannesburg, South Africa | 5-Day | August 24, 2015

Middle East: 

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


Career Development: On Information Overload? Take Action!

Posted: July 1st, 2015 in Uncategorized
breaking news

Interesting headlines can lead us to good information, but they also lead us away from taking action.

I admit to being an information junkie, and list article headlines steal my attention every single day because they are tasty morsels of knowledge I can’t resist knowing.

10 Things You Didn’t Know About …

15 Things You Need to Know About …

20 Things You Should Consider About …

You get the idea!

Not to say that information is a bad thing ….
but with the Internet we are all on information overload.  What happened to simply taking action?

I love this author’s idea about implementing a “deprivation week,” disconnecting from information sources and just doing the work you know you should be doing. If you feel like you are operating less successfully because of an overwhelm of information, check out his advice to quit learning and start doing: 10 Overlooked Truths about Taking Action


Weekly Wisdom: Be Proactive!

Posted: June 30th, 2015 in Wisdom Quote

first aid“Safety means first aid to the uninjured.” -Unknown


Would you know if your corrective action resulted in an accident?

Posted: June 30th, 2015 in Accidents, Courses, Great Human Factors, Human Performance, Investigations, Performance Improvement, Root Cause Analysis Tips, Root Causes, TapRooT, Training

“Doctor… how do you know that the medicine you prescribed him fixed the problem,” the peer asked. “The patient did not come back,” said the doctor.

No matter what the industry and even if the root causes found for an issue were accurate, the medicine can be worse than the bite. Some companies have a formal Management of Change Process or a Design of Experiment Method that they use when adding new actions while on the other extreme, some use the Trial and Error Method… with a little bit of.. this is good enough and they will tell us if it doesn’t work.

You can use the formal methods listed above or it can be as simple for some risks, to just review with the right people present before implementation of an action occurs. We teach to review for unintended consequences during the creation of and after the implementation of corrective or preventative actions in our 7 Step TapRooT® Root Cause Analysis Process. This task comes with a couple of basic rules first:

1. Remove the risk/hazard or persons from the risk/hazard first if possible. After all, one does not need to train somebody to work safer or provide better tools for the task, if the task and hazard is removed completely. (We teach Safeguard Analysis to help with this step)

2. Have the right people involved throughout the creation of, implementation of and during the review of the corrective or preventative action. Identify any person who has impact on the action, owns the action or will be impacted by the change, to include process experts. Hint, it is okay to use outside sources too.

3. Never forget or lose site of why you are implementing a corrective or preventative action. In our analysis process you must identify the action or inaction (behavior of a person, equipment or process) and each behaviors’ root causes. It is these root causes that must be fixed or mitigated for, in order for the behaviors to go away or me changed. Focus is key here!

4. Plan an immediate observation to the change once it is implemented and a long term audit to ensure the change sustained.

Simple… yes? maybe? Feel free to post your examples and thoughts.

TapRooT® Public Courses in Canada

Posted: June 29th, 2015 in Courses


Calgary, Canada

Upcoming TapRooT® Public Courses:

Calgary | 2-Day | August 18, 2015

St. John’s | 2-Day | August 25, 2015

Edmonton | 2-Day | September 21, 2015

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

Monday Accident & Lessons Learned: Broken Leg caused by Fall From Ladder Cost Company $2.4 Million

Posted: June 29th, 2015 in Accidents, Current Events

The Chicago Tribune reported “Fall from ladder nets Merrillville man $2.4 million jury verdict.”

Part of the reason that the company was found liable is that the ladder was “out of code.” It had been produced before standards for ladders were developed. 

Have any old ladders out there that need to be replaced?

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