ROOT CAUSE ANALYSIS

DEFINITION

• ROOT CAUSE ANALYSIS (RCA) IS A CLASS OF

PROBLEM SOLVING METHODS AIMED AT
IDENTIFYING THE ROOT CAUSES OF PROBLEMS OR
EVENTS.

• RCA IS BASED 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.
 PRINCIPLES OF RCA?
• AIMING CORRECTIVE ACTIONS AT ROOT CAUSES IS
MORE EFFECTIVE THAN JUST TREATING THE
SYMPTOMS OF A PROBLEM.
• TO BE EFFECTIVE, RCA MUST BE PERFORMED
SYSTEMATICALLY AND CONCLUSIONS MUST BE
BACKED UP BY EVIDENCE.
• THERE IS USUALLY MORE THAN ONE ROOT CAUSE FOR
ANY GIVEN PROBLEM AND THEREFORE THERE MAY BE
MORE THAN ONE CORRECTIVE ACTION.
 GENERAL PROCESS FOR
PERFORMING ROOT CAUSE
ANALYSIS
1. DEFINE THE PROBLEM.
2. GATHER DATA/EVIDENCE.
3. IDENTIFY ISSUES THAT CONTRIBUTED TO THE PROBLEM.

4. FIND ROOT CAUSES. IDENTIFY

WHICH CAUSES TO
REMOVE OR CHANGE TO PREVENT
REPEATED PROBLEM.
5. DEVELOP SOLUTION RECOMMENDATIONS THAT EFFECTIVELY
PREVENT REPEATING THE PROBLEM.
6. IMPLEMENT THE RECOMMENDATIONS / CHANGES.
7. OBSERVE THE RECOMMENDED SOLUTIONS/CHANGES TO ENSURE
EFFECTIVENESS OF ELIMINATING THE PROBLEM.
CAUSE MAPPING OF ROOT CAUSE
ANALYSIS

• “ROOT” REFERS TO THE CAUSES BENEATH THE SURFACE.

IT IS THE SYSTEM OF CAUSES THAT SHOWS ALL THE
OPTIONS FOR SOLUTIONS.
• DO NOT FOCUS ON A SINGLE CAUSE AS THIS CAN LIMIT
THE SOLUTIONS SET RESULTING IN MISSING A BETTER
SOLUTION.
• A CAUSE MAP PROVIDES A SIMPLE VISUAL LOOK AT ALL
THE ELEMENTS THAT PRODUCED THE PROBLEM.
 THREE BASIS STEPS OF CAUSE
MAPPING

1. DEFINE THE ISSUE BY ITS IMPACT TO OVERALL GOALS

2. ANALYZE THE CAUSE IN A VISUAL MAP.

3. PREVENT OR MITIGATE ANY NEGATIVE IMPACT OF

THE GOALS BY SELECTING THE MOST EFFECTIVE
SOLUTIONS.
  5 WHYS TOOLS FOR RCA
 PERATO CHART
 FISHBONE OR ISHIKAWA DIAGRAM
 CHART AND/OR GRAPHS

Why? 50% 25

Why? 80%

Why?
Why? 0%
10%
5% 5%
0
Incidences

Why?
P ri ce Pro m ot io n P e o pl e P r o ce s se s

D e t a il D e t a il D e t a il D e t a il
D etail D e t a il Deta il D e t a il
D e t a il D e t a il D e t ai l D e t a il

T h e P rob l e m

D e t a il D e t a il D e t ai l D e t a il
D e t a il D e t a il D e t a il D e t a il
D e t a il D e t a il D e t a il D e t a il

P l ac e / P la n t P o li cie s P ro c e du r es P rod u ct
 Man Method Materials

Problem

Management System Machine Environment

Ishikawa or Fishbone Diagram

(Cause and effect)
 BRAIN STORM POSSIBLE CAUSES
Man Method Materials

Cause A
Cause D Cause E

Problem

Cause F
Cause C
Cause B

Management System Machine Environment

 5 WHYS

• WHY
• WHY
• WHY
• WHY
• WHY
Pareto Chart
THE TACKLE IS THE ONE THAT HAS THE HIGHEST SCORE. THIS
ONE WILL GIVE YOU THE BIGGEST BENEFIT IF YOU SOLVE IT.

DEFINING THE PROBLEM

THE PARETO CHART (CON’T)
Ordered Summary Table For Causes
Of Incomplete ATM Transactions
 THE PARETO CHART (CON’T)

The “Vital
Few”
 VISUALIZING CATEGORICAL DATA:
THE PARETO CHART

Pareto Chart For Banking Preference

100% 100%

80% 80%
% in each category

Cumulative %
(line graph)
(bar graph)

60% 60%

40% 40%

20% 20%

0% 0%
In person Internet Drive- ATM Automated
at branch through or live
service at telephone
branch
PARETO CHART
CHARTS AND GRAPHS
 SUMMARY TABLE
 A SUMMARY TABLE TALLIES THE FREQUENCIES OR PERCENTAGES OF ITEMS IN A
SET OF CATEGORIES SO THAT YOU CAN SEE DIFFERENCES BETWEEN CATEGORIES.

Main Reason Young Adults Shop Online

Reason For Shopping Online? Percent

Better Prices 37%
Avoiding holiday crowds or hassles 29%
Convenience 18%
Better selection 13%
Ships directly 3%

Source: Data extracted and adapted from “Main Reason Young Adults Shop Online?”
USA Today, December 5, 2012, p. 1A.
 WHY STUDY IN CANADA?

Possibility of Immigration 39%

Affordable Education 23%
Qualifications Valued Around the World 18%
Land of Possibilities 10%
Healthy and Safe Communities 3%
World-Class Language Education 2%
Exciting Campus Lifestyle 2%
Research Opportunities 2%
Multicultural Society 1%
 A CONTINGENCY TABLE HELPS
ORGANIZE TWO OR MORE
CATEGORICAL VARIABLES DCOVA

• USED TO STUDY PATTERNS THAT MAY EXIST BETWEEN THE

RESPONSES OF TWO OR MORE CATEGORICAL VARIABLES

• CROSS TABULATES OR TALLIES JOINTLY THE RESPONSES OF

THE CATEGORICAL VARIABLES

• FOR TWO VARIABLES THE TALLIES FOR ONE VARIABLE ARE

LOCATED IN THE ROWS AND THE TALLIES FOR THE SECOND
VARIABLE ARE LOCATED IN THE COLUMNS
 CONTINGENCY TABLE - EXAMPLE
DCOVA
• A RANDOM SAMPLE OF 400
INVOICES IS DRAWN. Contingency Table Showing
Frequency of Invoices Categorized
• EACH INVOICE IS CATEGORIZED By Size and The Presence Of Errors
AS A SMALL, MEDIUM, OR LARGE No
Errors Errors Total
AMOUNT.
Small 170 20 190
• EACH INVOICE IS ALSO Amount
EXAMINED TO IDENTIFY IF THERE
Medium 100 40 140
ARE ANY ERRORS. Amount
• THIS DATA ARE THEN ORGANIZED Large 65 5 70
Amount
IN THE CONTINGENCY TABLE TO
THE RIGHT. 335 65 400
Total
 CONTINGENCY TABLE BASED ON
PERCENTAGE OF OVERALL TOTAL
No
DCOVA
Errors Errors Total 42.50% = 170 / 400
Small 170 20 190 25.00% = 100 / 400
Amount 16.25% = 65 / 400
Medium 100 40 140
Amount No
Large 65 5 70 Errors Errors Total
Amount Small 42.50% 5.00% 47.50%
Total 335 65 400 Amount
Medium 25.00% 10.00% 35.00%
Amount
83.75% of sampled invoices
Large 16.25% 1.25% 17.50%
have no errors and 47.50% Amount
of sampled invoices are for Total 83.75% 16.25% 100.0%
small amounts.
 VISUALIZING CATEGORICAL DATA:
THE BAR CHART
 IN A BAR CHART, A BAR SHOWS EACH CATEGORY, THE LENGTH OF WHICH
DCOVA
REPRESENTS THE AMOUNT, FREQUENCY OR PERCENTAGE OF VALUES
FALLING INTO A CATEGORY WHICH COME FROM THE SUMMARY TABLE OF
THE VARIABLE.
Banking Preference

Banking Preference? % Internet

ATM 16%
In person at branch
Automated or live 2%
telephone
Drive-through service at 17% Drive-through service at branch
branch
In person at branch 41% Automated or live telephone
Internet 24%
ATM

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

 VISUALIZING CATEGORICAL
DATA:
DCOVA
THE PIE CHART
 THE PIE CHART IS A CIRCLE BROKEN UP INTO SLICES THAT
REPRESENT CATEGORIES. THE SIZE OF EACH SLICE OF THE PIE
VARIES ACCORDING TO THE PERCENTAGE IN EACH CATEGORY.

Reason For Shopping Percent

Online?
Better Prices 37%
Avoiding holiday crowds or 29%
hassles
Convenience 18%
Better selection 13%
Ships directly 3%
SIDE BY SIDE CHART
SIDE BY SIDE CHART
 7 BEST PRACTICES TO REMEMBER
1. YOUR ROOT CAUSE ANALYSIS IS ONLY AS GOOD AS THE INFO
YOU COLLECT.
2. YOUR KNOWLEDGE (OR LACK OF IT) CAN GET IN THE WAY OF A
GOOD ROOT CAUSE ANALYSIS.
3. YOU HAVE TO UNDERSTAND WHAT HAPPENED BEFORE YOU
CAN UNDERSTAND WHY IT HAPPENED.
4. INTERVIEWS ARE NOT ABOUT ASKING QUESTIONS.
5. YOU CAN’T SOLVE ALL HUMAN PERFORMANCE PROBLEMS
WITH DISCIPLINE, TRAINING, AND PROCEDURES.
6. OFTEN PEOPLE CAN’T SEE EFFECTIVE CORRECTIVE ACTIONS
EVEN IF THEY CAN FIND THE ROOT CAUSE.
7. ALL INVESTIGATIONS DO NOT NEED TO BE EQUAL (BUT SOME
STEPS CAN’T BE SKIPPED.