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About

Root cause analysis (RCA) is a class of problem solving methods aimed at identifying the root causes of problems or events.[1] The practice of RCA is predicated on the belief that problems are best solved by attempting to correct or eliminate root causes, as opposed to merely addressing the immediately obvious symptoms. By directing corrective measures at root causes, it is hoped that the likelihood of problem recurrence will be minimized. However, it is recognized that complete prevention of recurrence by a single intervention is not always possible. Thus, RCA is often considered to be an iterative process, and is frequently viewed as a tool of continuous improvement.

RCA, initially is a reactive method of problem detection and solving. This means that the analysis is done after an event has occurred. By gaining expertise in RCA it becomes a pro-active method. This means that RCA is able to forecast the possibility of an event even before it could occur.

Root cause analysis is not a single, sharply defined methodology; there are many different tools, processes, and philosophies of RCA in existence. However, most of these can be classed into five, very-broadly defined "schools" that are named here by their basic fields of origin: safety-based, production-based, process-based, failure-based, and systems-based.[2]

General process

Below is the General process for performing and documenting an RCA-based Corrective Action

Notice that RCA (in steps 3, 4 and 5) forms the most critical part of successful corrective action, because it directs the corrective action at the root of the problem. That is to say, it is effective solutions we seek, not root causes. Root causes are secondary to the goal of prevention, and are only revealed after we decide which solutions to implement.

  1. Define the problem.
  2. Gather data/evidence.
  3. Ask why and identify the causal relationships associated with the defined problem.
  4. Identify which causes if removed or changed will prevent recurrence.
  5. Identify effective solutions that prevent recurrence, are within your control, meet your goals and objectives and do not cause other problems.
  6. Implement the recommendations.
  7. Observe the recommended solutions to ensure effectiveness.
  8. Variability Reduction methodology for problem solving and problem avoidance.

Reference

  1. Root Cause Analysis, Bill Wilson
  2. AHRQ Patient Safety Network. Root Cause Analysis: For Beginners. accessdate 2013 http://psnet.ahrq.gov/primer.aspx?primerID=10

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