How do I conduct a thorough root cause analysis?

For root cause analysis to be effective, you need to dig deep. This ultimately comes down to having the right resources present and ready and asking “Why?” until you get to a root cause.

Prepare the necessary data

First off, you can’t make decisions without evidence. For instance, if you’re missing key pieces of information, such as metrics of unscheduled downtime and accounts of events, your RCA won’t get very far.

Make sure everyone is present

Another key resource is the people who are involved in the issue you’re trying to solve. For instance, if one asset keeps breaking down, you’ll want the operations crew and maintenance technicians who have worked on it to be part of the discussion. If you’re missing key personnel, it will hamper your analysis.

Focus on procedural problems

Even as you make sure you have the people involved present, you’ll want to focus on issues in your process, not in your people. Sure, it’s true that most problems occur because of human error, but those factors often aren’t controllable. Instead, focus on gaps in your procedures that allowed human error to enter in.

For instance, if part of the cause was that someone shut off a valve that they shouldn’t have, find the reason why. The instructions they received might have been faulty, or the valves might have been mislabeled, or they didn’t have equipment schematics available. Asking about those will help you move beyond pointing fingers toward actually finding the root cause.

Keep asking “Why?”

As you dig into the problem, dig deep and dig out. This is the core of the “five why” process—you ask “Why?” over and over until you get down to the very root of the problem.

For instance, if a turbine fails, the chain of “whys” might look like this:

• The turbine failed because it was off balance
• It was off balance because it was misaligned
• It was misaligned because no one had aligned it
• No one aligned it because no one knew to check the alignment
• No one checked the alignment because our PM program doesn’t account for that

Dig down into the procedural issues that might be at play. This way, you’ll get to an actionable root cause.

It’s also worth noting that as you dig deep, you should dig outwardly as well. Most problems have multiple root causes, so take a look at areas such as your materials, management processes, or environmental factors.