2-Day Pre-Summit Courses, March 11-12, 2019

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TapRooT® Root Cause Analysis Training

The 2-Day TapRooT® Root Cause Analysis Course focuses on the essential TapRooT® techniques needed to investigate a precursor incident. The 5-Step investigation process simplifies TapRooT® to make the investigation efficient yet effective. The training focuses on understanding what happened, identifying Causal Factors, analyzing the Causal Factors using the Root Cause Tree®, and developing effective fixes using the Corrective Action Helper® Module.

Attendees should bring a safety incidents or quality issues from their facility for a team exercise. These may be either written reports or they may have knowledge of an incident with no written report. We divide into teams of 2-4 people and have each team analyze a different problem during course.

Day 1 (8:00am to 5:00pm) Day 2 (8:00am to 5:00pm)
  • Class Introductions and TapRooT® Introduction
  • TapRooT® System Overview – What you will be learning
  • SnapCharT® Basics – Gathering Information
  • SnapCharT® Exercise – Practice
  • Causal Factors – Identifying the Error
  • Root Cause Tree® – Eliminating Blame
  • Root Cause Tree® Exercise – On Your Own
  • Corrective Actions – Developing Fixes
  • Software Overview – Practicing the Techniques
  • Generic Causes – Optional Technique
  • Causal Factors – Additional Practice
  • Reporting – Management Presentation
  • Frequently Asked Questions
  • Final Exercise – Putting What You’ve Learned to Work

Course materials we provide:

  • TapRooT® Essentials Book
  • Laminated TapRooT® Root Cause Tree®
  • TapRooT® Root Cause Tree® Dictionary
  • Course Workbook
  • Corrective Action Helper® Guide

Upon completion of the course, attendees will receive a certificate of completion and a 90-Day Subscription to TapRooT® VI, our dynamic online software that guides you through the TapRooT® process with ease and efficiency.

Register for the TapRooT® Root Cause Analysis Training *and* the 2019 Global TapRooT® Summit (March 11 – 15, 2019).

Register for for this 2-day course only (March 11 – 12, 2019).

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Equifactor® Equipment Troubleshooting and Root Cause Analysis

Do you have repeat equipment failures? The Equifactor® and TapRooT® Techniques are designed to help you troubleshoot equipment problems and get the information you need to find and fix the root causes of equipment related failures. The Equifactor® Techniques are based on the work of noted equipment reliability expert Heinz Bloch. The tools can be used by maintenance personnel, equipment reliability specialists, maintenance managers, or investigators who don’t have an extensive understanding of equipment engineering.

In two days, you will learn how to use Equifactor® to troubleshoot equipment issues and find out what is leading to failures. Then you will learn to use the TapRooT® System to organize the information you collect, identify the Causal Factors of the failure, and find the fixable root causes of the failure. Finally you will learn to develop effective fixes to stop future equipment failures.

The tools you will learn include:

  • Equifactor® Troubleshooting Tables – a systematic guide to troubleshoot common equipment problems.
  • SnapCharT® Diagram – visualize and organize the information you collecting to make what happened understandable.
  • Root Cause Tree® Diagram and Dictionary – find the real, fixable root causes of human performance and equipment issues.
  • Corrective Action Helper® Module – provides suggested corrective actions to help you develop effective fixes.
  • Safeguard Analysis – helps define Causal Factors and develop effective corrective actions.
  • Change Analysis – collect and understand information about problems caused by changes or differences in system, equipment, or people.

In addition, the Equifactor® Techniques can be used to develop proactive equipment performance improvement initiatives and Equipment troubleshooting procedures.

Course Outline

Day One

  • Class Introductions and Background of TapRooT®
  • SnapCharT® Basics
  • SnapCharT® Exercise
  • Define Causal Factors
  • Intro to Root Cause Tree®
  • Root Cause Analysis Exercise 1 – Class Walkthrough
  • Root Cause Analysis Exercise 2 – Team Use of the Root Cause Tree®
  • Understanding Generic Causes
  • Developing Corrective Actions (Corrective Action Helper® and SMARTER)
  • Exercise: Generic Causes and Corrective Actions

Day Two

  • Troubleshooting Methodology
  • Equifactor® Overview
  • Equifactor® Troubleshooting Exercise
  • Custom Tables & Exercise
  • Process Troubleshooting
  • Failure Modes and Agents & Exercise
  • Evidence Gathering Plans & Exercise
  • Equipment Change Analysis & Exercise
  • Proactive Use of Equifactor®
  • Problem within a Problem Exercise
  • Final Team Exercise

Upon completion of the course, attendees will receive a certificate of completion and a 90-day subscription to TapRooT® VI Software, our dynamic cloud-based software that computerizes the Equifactor® and TapRooT® Techniques.

Register for the Equifactor® Equipment Troubleshooting and Root Cause Analysis *and* the 2019 Global TapRooT® Summit (March 11 – 15, 2019).

Register for this 2-day course only (March 11 – 12, 2019).

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TapRooT® Analyzing and Fixing Safety Culture Issues

This course includes:

  • A clear definition of safety culture.
  • An overview of various safety culture models.
  • An organizational culture survey from Human Synergistics International designed to identify your current culture.
  • Why it is good business to improve safety culture.
  • The relationship between incidents and safety culture.
  • The importance of strong safety leadership. What some organizations are doing to strengthen their safety culture.
  • What “puzzle pieces” you need to put in place to improve your safety culture.

Register for TapRooT® Analyzing and Fixing Safety Culture Issues *and* the 2019 Global TapRooT® Summit (March 11 – 15, 2019).

Register for this 2-day course only (March 11 – 12, 2019).

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Risk Management – Best Practices & Risk-Based Thinking

In all your HSEQ risk domains and management Systems – are you frustrated that the outcomes of your current risk assessments being performed in your organization lack consistency, confidence, reliability and accuracy?

Do facilitators and participants of the risk assessments know the most effective methods and tools?

Risk Based Thinking RBT & Risk Assessments RA are now recognised by new versions of ISO 31000 / ISO 45001 / ANSI Z10 / ISO 14001 / ISO 9001 / as definitely needed in each and every risk informed decision-making process.

RBT and RA need to be applied in all aspects of business without being confused and undermined by subjective beliefs, biases and risk perceptions.

The course has been continually improved. It still covers the core Best Practices that have made facilitation and participation in risk assessments as accurate and reliable as possible. As well, a number of other recent improvements include:

  • an interactive WORD template that takes the user through the risk assessment process and when completed serves as a diligent entry to your Risk Register or Risk Dashboard;
  • new neuroscience-based explanations of variability of individual’s risk perceptions and risk-taking; and
  • participants receive a USB stick of approx. 2 Gb of course handouts, copies of slides, useful reference materials and sample PPT files accumulated and developed by the Presenter over the last 30+ years of RM consultancy & training.

The presenter is Jim Whiting, international risk management expert and long-time TapRooT® Instructor. Jim was a contributory member of the committee that wrote the international risk management standard ISO 31000, which has now become the USA Standard ANSI Z690.2 and CAN/CSA/ISO 31000 The course is facilitated in a participative workshop format. Jim brings his risk management and root cause analysis experience and best practices from around the world (Australia/New Zealand, North America, Asia, Africa, and Europe) to this course. If you are interested in advancing the quality of your risk assessments in ALL risk domains, but particularly HSEQ, then attend this course.

Course Outline

Day 1 (8:00am to 5:00pm) Day 2 (8:00am to 5:00pm)
  • Introductions
  • Overview of Risk Management RM
  • Risk & Opportunity Management – Purposes, Approaches and Methods Strengths and Limitations – the basis for a new safety culture to move beyond traditional BBS principles and practices
  • Risk-Based Thinking in ISO 9001, ISO 14001 & new ISO 45001 & ANSI Z10
  • How to establish/compare your RM System to conform/comply with Standards ANSI Z690.2 and CAN/CSA/ISO 31000
  • Better Risk Communication & Consultation
  • Common Misuses of HSEQ Risk Language
  • Neuroscience-based explanations of variability of risk perceptions & risk-taking
  • Risk Identification incl. construction and use of Risk Maps (compare SnapCharts®)
  • Exercise in Risk Mapping
  • LUNCH BREAK
  • Risk Analysis – 3 levels of Risk Analysis -Qualitative / Semi-Quantitative / Full QRA
  • How to make sure that the Matrix Method really works for you
  • Full Quantitative Risk Analysis (QRA)
  • Quantitative Logic Trees and Bow-Ties
  • Discuss uses of methods of ANSI Z690.3 and IEC 31010 – which are identical
  • Exercises in Risk Analysis
  • Summary of Day 1 Topics
  • Revision of Previous Day 1 Topics
  • Matching the RM methods and tools to specific risk questions and situations
  • Risk Evaluation & Risk Owners
  • Risk tolerability criteria and frameworks at all levels personal / social / corporate / industry /national / international
  • How to demonstrate ALARP – As Low As Reasonably Practicable & SOFAIRP
  • Risk Treatment Plans – contrast to Corrective Actions to Risk Controls – Measures of Effectiveness of Risk Controls
  • A new version Hierarchy of Risk Controls – principles and applications – Optioneering
  • Hierarchy of Risk Controls – principles and applications – Optioneering –
  • Risk Tolerability Treatment Options RTTO – principles and methods of choice
  • Exercises in Risk Evaluation and Risk Treatment / Control / Mitigation
  • Record / Monitor / Review
  • Risk Registers & Dashboards
  • LUNCH BREAK
  • Exercises with Attendees’ own examples
  • Tips for Facilitating a Risk Assessment
  • Successes and Traps in Setting up RM systems and RA processes to conform / comply with ANSI Z690 & CAN/CSA/ISO 31000, ISO9001, ISO14001, ISO45001
  • Summary of the Whole Course
  • Optional Post Workshop Exercise emailed to facilitator/mentor/coach for individual assessment.

Register for Risk Management – Best Practices & Risk-Based Thinking *and* the 2019 Global TapRooT® Summit (March 11 – 15, 2019).

Register for this 2-day course only (March 11 – 12, 2019).

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TapRooT® Software Implementation and Application

To get the most from your TapRooT® VI Software you need to learn how to:

  • Create your own Custom Tabs, fields and pick lists.
  • Design and build your own reports.
  • Select Global preferences for your company, including Language options.
  • Select SnapCharT® preferences for yourself.
  • Use Optional investigation techniques.

Dan Verlinde, Director of Information Technology and Software Development and Angie Comer, Software Project Manager, will teach an intensive review of the TapRooT® VI Software. Whether you are a System Administrators or a TapRooT® user, you will learn all the capabilities built into this amazing software. Don’t get just 10-20% from your software investment. Learn the full power of your TapRooT® Software!

Course Guarantee: Attend this course then use the knowledge that you’ve gained when you return to your facility. If you aren’t satisfied that the course helps you perform your job better and that the course will save you much more than the cost of the course fee, just return the books, course materials, and/or software and we will refund your entire course fee. It’s that simple. How can we offer such an iron clad, risk free guarantee? We know this course is so good that you won’t want to send your materials back! Please bring your laptop to this course (with wireless capabilities, if possible).

Upon completion of the course, attendees will receive a certificate of completion and a 90-Day Subscription to TapRooT® VI, our dynamic online software that guides you through the TapRooT® process with ease and efficiency.

Register for TapRooT® Software Implementation and Application *and* the 2019 Global TapRooT® Summit (March 11 – 15, 2019).

Register for this 2-day course only (March 11 – 12, 2019).

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Using “What if” and TapRooT® for Hazard Assessment

The 2-Day What-If & TapRooT® Hazard course is a process hazard analysis course incorporating many of the methodologies used during an incident investigation. The SnapCharT® will be used to map out actions and all the conditions necessary for successful management of change. Using process and instrument drawings, the class will practice using Safeguard analysis to generate the type of thought-provoking questions essential to facilitate a What-If team analysis.

The same process used to develop action items following an incident investigation will be proactively applied. Using the Root Cause Tree® and Root Cause Tree® Dictionary to analyze significant issues, the Corrective Action Helper® Guide will aid in creating an action plan to address potential problems associated with a change in process design.

During the 2-Day What-If course, you will practice the communication skills needed to facilitate a team meeting effectively. The What-If methodology is well-suited for identifying potential hazards when managing change. Incorporating many of the TapRooT® skills proactively in the What-If analysis will keep your incident investigators ready when they need to lead an investigation.

Register for Using “What if” and TapRooT® for Hazard Assessment *and* the 2019 Global TapRooT® Summit (March 11 – 15, 2019).

Register for this 2-day course only (March 11 – 12, 2019).

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TapRooT® Evidence Collection and Interviewing Techniques to Sharpen Investigation Skills

There is so much to remember when collecting evidence … and so much to lose if you are not prepared.

  • Ever have trouble completing a SnapCharT® because you lacked pieces of information?
  • How can you be certain what to collect?
  • How do you help witnesses to an incident remember important facts with better accuracy?
  • What is an effective sequential structure for conducting an interview?

Solid evidence collection skills are critical to finding the real root causes of incidents. Evidence collection supports the investigation with facts (not opinions), and creates a clear sequence of events.  Sharpen your skills by attending training and practicing skills through hands-on exercises.

Day 1 of this 2-day course is focused on pre-planning, emergency response and collecting evidence (physical evidence, recordings and paper evidence).  Overviews of the TapRooT® investigation processes are presented to demonstrate how evidence collection fits into the TapRooT® System.   It is essential to build an accurate timeline in an investigation, so SnapCharT® basics are also reviewed on Day 1 for those who have not taken TapRooT® Root Cause Analysis Training or those who need a refresher.

Day 2 is all about collecting people evidence.  Most investigators have not had formal training on how to conduct investigative interviews, yet people evidence is crucial to solving problems; therefore, the TapRooT® 12-Step Interviewing Process is presented in depth and practiced.  This day includes how to use TapRooT® techniques like Change Analysis, and how to use the Root Cause Tree and Dictionary, essential tools for evidence collection. Finally, attendees learn how to “hear” what’s not said during an interview by de-coding non-verbal cues.

DAY ONE

  • Evidence Collection Quiz
  • What is Evidence Collection?
  • TapRooT® Investigation Processes
  • Pre-Planning for Evidence Collection
  • Emergency Response & Scene Management
  • SnapCharT® Basics
  • Evidence to Collect – 3Ps & an R
    • Recordings
    • Physical
    • Paper

DAY TWO

  • What to Collect – 3Ps & an R (Continued)
    • People
  • Change Analysis
  • Human Factors: The Root Cause Tree & Dictionary
  • Observation Quiz
  • TapRooT® 12-Step Interview Process
  • DeCoding Non-Verbal Behavior

Upon completion of the course, attendees will receive a certificate of completion and a 90-Day Subscription to TapRooT® VI, our dynamic online software that guides you through the TapRooT® process with ease and efficiency.

Register for TapRooT® Evidence Collection and Interviewing Techniques to Sharpen Investigation Skills *and* the 2019 Global TapRooT® Summit (March 11 – 15, 2019).

Register for this 2-day course only (March 11 – 12, 2019).

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Stopping Human Error

Joel Haight, human factors expert, will teach basic and advanced knowledge of human error prevention in this 2-day course.

Blame is common after an accident. After all, a human made a mistake. It is their fault! Or is it? Sometimes errors are designed into the system. And you can find and fix these system causes of human error before the accident happens.

The goal of this course is to teach you to understand human error, how humans operate….what are our capacities, constraints and needs are so that we can maximize human performance and minimize human errors.

Would you like to understand human errors and how to analysis, prediction and categorization them? Learn to minimize errors and resulting impact in their own facilities with tools that can be used in conjunction with the TapRooT® System and can be incorporated into your corrective actions.

There will be hands-on exercises including an analysis of an unsolved example (error case) that you bring from your facility.  your operations and we’ll try to dissect and solve it during the course.

Course Outline

Day One

  • Understanding Human Cognitive Performance
    • Visual and Sensory Systems
    • Auditory, Tactile, and Vestibular Systems
    • Cognition Exercise
    • Decision Making and Decision Making Exercise
  • Understanding Human Physical Performance
    • Anthropometrics
    • Biomechanics
    • Work Physiology
    • Ergonomics
  • The Human in the System
    • Stress and Workload
    • Fatigue
    • Human-Computer Interaction
    • Automation
    • Picking the Right Person and Training
    • Social Factors
    • Displays and Controls
    • Exercise

Day Two

  • Methods for Analyzing Human Performance
    • Observational Data
    • Poisson Distributions
    • Binomial Distributions
    • THERP
    • MAPPS
    • OAT
    • FTA
  • Human Performance Tools for Error Prevention/Reduction
    • Procedure Use/Adherence
    • Place Keeping
    • Independent Verification
    • Three-Way Communications
    • Pre-Job Brief
    • Concurrent Verification
    • Questioning Attitude
    • STAR
    • Time Out (Stop When Unsure)
    • Attention to Detail
    • Rule of Three/Conservative Decision Making
    • Error Traps and Precursors
    • Validate Assumptions
    • Do Not Disturb Sign

Upon completion of the course, attendees will receive a certificate of completion and a 90-day subscription to TapRooT® VI Software, our dynamic cloud-based software that computerizes the Equifactor® and TapRooT® Techniques.

This course includes reference material.

Register for Stopping Human Error *and* the 2019 Global TapRooT® Summit (March 11 – 15, 2019).

Register for this 2-day course only (March 11 – 12, 2019).

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Best Practices in Mistake Proofing & Effective Corrective Actions

Zero error and six sigma levels of quality cannot be achieved by simply reminding people to be careful, watching training videos, or reviewing procedures once a year. How do restaurant, energy, and aviation employees achieve very low error rates on a consistent basis, while others who do less mistake prone work make significantly more errors each day? What approaches are used to obtain higher levels of policy and procedure compliance? How do the best organizations use work process and tool design to drive personal accountability on the job?

When incidents, recalls, sentinel events, production outages, customer complaints, and daily errors do happen, most problem-solving efforts typically produce a weak mix of corrective actions. In other words, the fixes often fail to prevent the errors that contributed to the problem from happening again. In turn, the same problems pop up again, often across multiple locations and work groups. Risk levels fail to be reduced, and process failures and costs remain high. Additionally, the bulk of the investigative effort was wasted.

This workshop explores the common types of work process and tool design flaws that contribute to human error, including fixes that fail. It also gives you a coach and a practice field for learning to write more effective and sustainable corrective and preventive actions. Finally, this workshop gives you many best practices you can use to more effectively, and proactively, ‘mistake proof’ your workplace by fixing key work process and tool design flaws.

All two-day course participants will receive a course workbook and a copy of the facilitator’s latest book, “Error Proof – How to Stop Daily Goofs for Good.”

In this workshop, you will learn how to:

  • Use best practice approaches for error proofing job tasks of any type
  • Proactively identify and analyze opportunities for error in a systematic manner
  • Better utilize the 32 NI root causes through benchmarking and best practice exploration
  • Assess the relative strength of different corrective action options
  • Write effective corrective and preventive actions that add value and can be sustained over time
  • Capture and use process-level error rates as leading indicators of corrective action effectiveness

Kevin McManus developed and teaches this course. He serves as Chief Excellence Officer for Great Systems! and has taught more than 400 courses as an international contract trainer for the TapRooT® root cause analysis process. During his thirty-eight plus years in the business world, he has served as an Industrial Engineer, Training Manager, Production Manager, Plant Manager, and Director of Quality. He holds an undergraduate degree in Industrial Engineering and an MBA. He has served as a national Malcolm Baldrige Quality Award Examiner for eighteen years, and he is currently serving a three-year term on the national Judge’s Panel. He also writes the monthly performance improvement column for “Industrial and Systems Engineer” magazine, is an Institute of Industrial and Systems Engineering Fellow, and has been a member of IISE for thirty-eight years, His newest book, “The Ultimate Org Ergo Book – How to Build a Better Organization,” will be published in early 2019.

Register for Best Practices in Mistake Proofing & Effective Corrective Actions *and* the 2019 Global TapRooT® Summit (March 11 – 15, 2019).

Register for this 2-day course only (March 11 – 12, 2019).

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Advanced Causal Factor Development

Do you feel indecisive about determining causal factors? This course will help you feel more confident. Learn:

  • alternate definitions of causal factors
  • how to relate risk to causal factors
  • how to cover common problems encountered when defining causal factors
  • how to use the “could have, should have, would have” test to relate causal factors to the hierarchy of the TapRooT® process.

“When you are doing a root cause analysis (RCA) it means that your customer did not manage risk to their satisfaction,” says Ken Turnbull, instructor of this course.  “Causal factor determination is actually a qualitative risk analysis that should be done early in the RCA to make evidence gathering more efficient. This session will show how qualitative risk analysis should be used to determine causal factors.”

Register for Advanced Causal Factor Development *and* the 2019 Global TapRooT® Summit (March 11 – 15, 2019).

Register for this 2-day course only (March 11 – 12, 2019).

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Trending to Manage Performance

Are you really learning from your incident and root cause analysis data? How do you know if a trend is really significant? What is the best way to display a trend on a graph? Is your data really reliable? Those are all topics of the Trending to Manage Performance Course.

Learn how to:

  • Display trends (without misleading people)
  • Use Pareto Charts to spot where you need to improve
  • Use XmR Charts (Process Behavior Charts) to show significant trends
  • Use special XmR Charts to trend infrequently occurring data
  • Collect reliable data
  • Present data to management to help them manage performance

This course is only offered top the public once a year. Click below to register.

Register for Trending to Manage Performance *and* the 2019 Global TapRooT® Summit (March 11 – 15, 2019).

Register for this 2-day course only (March 11 – 12, 2019).

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