September 15, 2010 | Dave Janney

Root Cause Analysis Tips; Taking it to the Next Level

So you have been to a 2-day, 3-day, or 5-day TapRooT® course and have done some investigations.  Now what?

In life, continuous improvement is a must (in my opinion).  Professionals should always be looking for ways to increase their knowledge, skills, resume, and performance.  Maybe it is more education, obtaining a certification, learning a new technique, or maybe it is finding a way to improve the effectiveness of something you already do.

So what if you want to raise the bar on your use of TapRooT®?  Why not attend the Advanced TapRooT® Techniques course to be held in the two days before the TapRooT® summit next month.

So what is this course all about?  The idea behind this course is to update participants on the latest information, share best practices we have learned through working with clients and teaching courses, and to place a heavy emphasis on causal factors.

In this course, we take you through what has been added to the TapRooT® system as presented in the latest TapRooT® Book (2008); if it has been a few years since you have been to a course you will want this information.  Even if you went to a course in the last couple of years, this part of the course is a good refresher.

We then move into our best practices. Simply put:

Good SnapCharT®=

All Causal Factors=

Good Root Cause Analysis=

Effective Corrective Actions=

RESULTS!

We will share best practices from each component of the 7-Step process, because they are all important.

Last but not least, the main focus of the course; causal factors.  We know that if we do not identify all causal factors for an incident, we can’t find all of the root causes, and we can’t prevent recurrence of the incident.

In looking at causal factors, we have several tools to help us make sure we find all of them.  We have the definition of causal factors which helps us find them (if we have a good SnapCharT®), but sometimes we need more tools.  We have a 4-Step method for defining causal factors, and we can use Safeguards Analysis to help us as well.   Beyond those tools we teach in our current courses, in the advanced course we discuss probability and consequence as they relate to causal factors as well.

This is a lot of good information, but as you know, in TapRooT® courses, it is not just lecture, we want participants to get hands-on practice.  To that end, we have developed several causal factor exercises that I know you will enjoy.  These are real-life examples:

  • BP Texas City
  • Chemotherapy Overdose
  • Electrocution on drilling rig
  • Atlanta Bus Accident
  • Process Hazard Fire
  • Owner/Contractor incident
  • Lineman fatal fall
  • Pipeline explosion

We also have short sections on two topics that generate a great deal of discussion – working with contractors and enforcement.

So that’s it.  If you want to get better at using TapRooT®, you should join us.  Any don’t forget to stay for the rest of the summit! See you then.

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