October 20, 2010 | Barb Carr

Root Cause Analysis Tips; Conflicting Information

Welcome to this week’s root cause analysis tips column.  This is week I would like to talk about dealing with inconsistencies in information gathered during the process of building your SnapCharT®.

One of the questions I am asked frequently in our classes is; what if the person involved in an incident has a story that does not add up?  That is a tricky one, but here are my thoughts……

First of all, when you have inconsistencies, it is not always because the person is not telling the truth or trying to cover their tracks.  Sometimes it is because they remember things differently than they really occurred.  Usually when an incident occurs, things happen quickly.

Of course, there are going to be times when people intentionally mislead.  I can’t force people to tell the truth, but this speaks to corporate culture.  If you have a culture of blame, you will not get the truth.  That is a management issue.  Even if you have a good culture, some people will just try to cover their tracks anyway.  I can’t resolve that.

What I can tell you is that as you gather information, the statement of the person involved in an incident will likely not be the only evidence.  Your goal is to get to root cause, and just like in court, you are dealing with preponderance of the evidence.  In court, the criminal says he did not do it, but the DNA says otherwise.  Which one do you go with?  It is obvious.  Unfortunately, in incident investigation, we usually don’t have something as concrete as DNA!

I would never call someone a liar.  But there are ways to massage things during an interview.  In the 14 Step cognitive interview process we teach and practice in our 5-day course (and you can read about it in the TapRooT® book if you have been to a 2-day course), during step 9, we review the SnapCharT® with the person we are interviewing to make sure we have the story straight from what they have told us.  This step is when we have to address any inconsistencies.  Again, I am not calling anyone a liar, but statements such as “I am having a hard time resolving this; xyz evidence indicates the only way for abc to happen is if the valve handle is turned, the handle was found in the activated position after the incident, yet you did not turn the valve.  Can you help me with this?”   I call this the Columbo approach (remember the show?)  I have used this approach successfully.

If all the evidence shows the valve was turned and the guy says he did not turn it, you must go with the preponderance of the evidence and do your RCA and corrective actions based on that.   By the way, just because the person is not exactly being candid does not mean it is their fault.  Maybe there is a hole in our management system that caused them to make the mistake.  Don’t use “SPAC not used” as a crutch.

Clear as mud, right?  Most things in business are!  But there are ways to deal with ambiguity in our worlds.  I hope this discussion helps.

Until next time, happy investigating.

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