Root Cause Analysis General Definition

Root cause analysis, generally speaking, is a procedure for ascertaining and “analyzing” the causes of operations problems in an effort to determine what can be done to solve or prevent them.

Nearly all root cause analysis methods would subscribe to this definition. But not all root cause analysis methods are created equal.

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Root Cause Analysis Needs to Accomplish

The goal of root cause analysis goes beyond merely “fixing” the problem. It seeks to actually prevent it from happening again.

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Root Cause Analysis Needs to Include

Over 30 years of research and development teach us that effective and reliable root cause analysis must provide three essential qualities:

1. Root cause analysis process must take advantage of people’s knowledge while preventing their biases from controlling the direction of the investigation.

Root cause analysis methods which allow or even encourage the analysts themselves to choose which aspects of a problem to focus their search for solutions run a strong risk of failing to identify the best solutions. Management is better equipped to determine which solutions are the best, so we want them to have visibility of all of the available avenues toward prevention.

A process for identifying all factors contributing to a problem so that management can consider all possible avenues toward prevention is an important feature of the REASON system that other root cause analysis systems lack.

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2. Root cause analysis process must depict the facts of the case so that the causal relationships are clear and the causal relevance of those facts can be verified.

Root cause analysis needs a process which validates our thinking so that we can be sure we have included all of the relevant facts, and at the same time, only the relevant facts.

The REASON method orders and displays the facts of the event in a format that makes it easy to check for accuracy and completeness at each step.

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3. Root cause analysis process must also help us understand what actions must be taken to implement potential solutions and who in the organization needs to take those actions.

Once every possible avenue toward prevention is identified, the analyst must understand what specific actions need to be taken. Is a new policy needed? If a policy already exists, then why wasn’t it effective, and what steps do we need to take to make it effective in the future? And who in our organization needs to take those steps? These issues are part of the process of identifying preventative measures and must be integrated into the root cause analysis system.

The REASON method teaches the principles governing corrective action and integrates them into the root cause analysis process. 

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