«
»

Another Example of Why 5-Why’s / Fishbone Diagrams are Bad Root Cause Analysis Systems

See this link for an example of 5-Why’s applied to a problem:

http://www.reproline.jhu.edu/English/6read/6pi/ppt/maqpi/gifs/slide17.gif

I’m not posting this as a particularly bad example of 5-Whys. Rather it is a rather typical example of 5-Whys.

If that isn’t bad enough, look at this Fishbone Diagram:

http://www.reproline.jhu.edu/English/6read/6pi/ppt/maqpi/gifs/slide16.gif

Any TapRooT® User who views this example will know how much is missing from either root cause analysis.

But others may think that the answers presented are OK – maybe even way better than their current analysis.

That’s why I shake my head when someone mentions 5-Whys or Fishbone Diagrams as a root cause analysis tools. It appears to be better but it just leads people down the road to the same old ineffectice answers that they always seem to get. It doesn’t get people beyond their current thinking.

4 people like this post.
Unlike

This entry was posted on Wednesday, November 15th, 2006 at 10:00 pm and is filed under Root Causes. You can follow any responses to this entry through the RSS 2.0 feed. You can skip to the end and leave a response. Pinging is currently not allowed.

5 Responses to “Another Example of Why 5-Why’s / Fishbone Diagrams are Bad Root Cause Analysis Systems”

  1. Sean - Ireland says:
    December 8, 2009 at 5:17 am

    It seems to me you are knocking the opposition such as 5 why’s etc without giving concrete examples of how Taproot is a better system. You show a fishbone diagram but don’t explain what the problem with the diagram is and how Taproot would have come up with a different answer or solution.

  2. Mark Paradies says:
    December 8, 2009 at 2:49 pm

    Thanks for your comment.

    I’ve always hesitated pointing out the flaws in bad root cause systems because people might say … “You are just knocking the competition.”

    But I have seen so many bad applications of 5-Whys and Fishbone Diagrams that I just couldn’t hold my tongue any more.

    For more discussion of WHY the techniques don’t work, see:

    http://www.taproot.com/wordpress/2009/08/26/more-bad-root-cause-analysis-advice/

    For an example of how TapRooT® works see:

    http://www.taproot.com/blog/Using%20the%20TapRooT®%20System.pdf

    To really see for yourself how TapRooT® compares to any system you currently use, attend one of our public TapRooT® Courses held around the world. I would suggest the 5-Day if you are primarily responsible to investigating problems at your site. For the schedule, see:

    http://www.taproot.com/courses.php

    These courses come with a guarantee:

    Attend a TapRooT® Course. Go back to work and apply what you have learned. If you don’t find root causes that you previously would have overlooked and if you, and your management, don’t agree that you are developing much more effective corrective actions, just return the course materials/software and we will refund the entire course/software fees.

    That’s how confident we are that you will see how much more effective TapRooT® is at solving problems.

    So, when I see people failing to solve problems that could cost someone their life, could cause environmental damage, could cause people to lose their jobs (due to poor quality, high costs, or schedule delays), … I just can’t stay quiet. It has become a personal quest for me. I can’t allow root cause analysis malpractice to exist unchallenged.

  3. Mark Adams says:
    August 16, 2011 at 9:32 am

    Mark,

    I had a chance once to share with you a RCA tool I adapted that used Fishbone, Pareto, multivoting, 5-Why and visual management. I called it the Tailed Fishbone (see the website link I provided and go to bottom of page for presentation on subject). I am curious, with the comment and post you made above, do you feel the technique I showcased is a poor one?

    I am all for learning new RCA techniques because I feel each has a time and a place. I will even pitch to my leadership to send me to your course once I see a FY12 schedule of courses and locations. However, I am curious at your take on my Tailed Fishbone as a legitimate RCA tool since you believe 5-why and Fishbone by themselves do not constitute as a legitimate RCA tool.

    Thanks Mark.

    Mark Adams, LSSBB
    United States Air Force

  4. Chris Vallee says:
    August 22, 2011 at 7:35 am

    Mark (from the USAF),

    Not sure if Mark (our company president) saw the slides, however I remember them and I thought you did advance the idea of the tools that you and I were taught in Lean Six Sigma Training. To show my age, we were taught TQM/TQC and paradigm shifts in the USAF.

    Back to your question of whether Fishbones are legitimate RCA tools. Legitimate yes because they are part of the lean six sigma tool boxes. Effective, robust and repeatable with different users analyzing the same issues, the answer is no.

    These tools require the user or a group of users to go in with a blank ruler and fill in their own hash marks. If the right person is not present, then the right question will not be asked. Lean and six sigma attempt to reduce waste and variability unfortunately the tools actually increase both.

    I shared with you the “unbalanced ishikawa diagram” that I presented at the ASQ conference. It was designed to show the limitations and to standardize what they were attempting at the same time I was introducing missing best practices that would not be looked for normally without our process.

    Hope this helps.

  5. Martin Songga-ab says:
    November 7, 2011 at 1:45 am

    Thanks I found it. It will really help me expound further to participants

    on Accident Investigation seminars I will be conducting.

    The root causes have been a hot issues in determining what really transpired during an accident.

Leave a Reply