2. WHAT IS ROOT CAUSE ANALYSIS?
a class of problem solving methods aimed at identifying
the root causes of problems or events
http://www.thinkreliability.com/Root-Cause-Analysis-CM-Basics.aspx
3. ROOT CAUSE METHODS : ISHIKAWA
are causal diagrams that show the causes of a specific event
an analyzing instrument which helps to identify, order and print
possible causes of a specific problem or a quality
characteristic
graphical representation of the relation between a result and
all the factors that have impact
http://www.isixsigma.com/tools-templates/cause-effect/cause-and-effect-aka-fishbone-diagram/
4. ROOT CAUSE METHODS : ISHIKAWA
EXAMPLE
http://www.chcr.brown.edu/pain/tools.htm
5. ROOT CAUSE METHODS : ISHIKAWA
http://www.isixsigma.com/tools-templates/cause-effect/cause-and-effect-aka-fishbone-diagram/
6. ROOT CAUSE METHODS : ISHIKAWA
People Anyone involved with the process
Methods How the process is performed and the specific
requirements for doing it, such as policies,
procedures, rules, regulations and laws
Machines Any equipment, computers, tools etc. required to
accomplish the job
Materials Raw materials, parts, pens, paper, etc. used to
produce the final product
Measurements Data generated from the process that are used to
evaluate its quality
Environment The conditions, such as location, time, temperature,
and culture in which the process operates
7. EXERCISE
Identify possible causes for the following topics:
Group 1: Burned barbecue on 1st of May event
Group 2: Blurry pictures on the 1st of May event
8. ROOT CAUSE METHODS : 5 WHY
The 5 Whys is a question-asking technique used to explore
the cause-and-effect relationships underlying a particular
problem
http://www.bulsuk.com/2009/07/5-why-analysis-using-table.html#axzz1u70e6jBm
9. ROOT CAUSE METHODS : 5 WHY
The vehicle will not start. (the problem)
Why? - The battery is dead. (first why)
Why? - The alternator is not functioning. (second why)
Why? - The alternator belt has broken. (third why)
Why? - The alternator belt was well beyond its useful service life and
not replaced. (fourth why)
Why? - The vehicle was not maintained according to the recommended
service schedule. (fifth why, a root cause)
Why? - Replacement parts are not available because of the extreme
age of the vehicle. (sixth why, optional footnote)
Start maintaining the vehicle according to the recommended
service schedule. (possible 5th Why solution)
Purchase a different vehicle that is maintainable. (possible 6th
Why solution)
http://en.wikipedia.org/wiki/5_Whys
10. ROOT CAUSE METHODS : 5 WHY
CLASSIC EXAMPLE
Benjamin Franklin's 5-Why Analysis:
For want of a nail a shoe was lost,
for want of a shoe a horse was lost,
for want of a horse a rider was lost,
for want of a rider an army was lost,
for want of an army a battle was lost,
for want of a battle the war was lost,
for want of the war the kingdom was lost,
and all for the want of a little horseshoe nail.
11. EXERCISE
Using the results from the previous exercise, now
apply 5 Why method to identify the root cause