Root Cause

What we need to do today is make management aware through education and awareness that our cultures live with these chronic events that typically end up costing 100 times more than the occasional sporadic event. Unfortunately, the sporadic events get all the attention. When our cultures are enlightened, we will begin to enjoy the fruits of our efforts in the form of return on investment (ROI) figures as high as 7000-8000 percent. Then the believers will come.

Root Cause Analysis represents one of the greatest challenges in reliability program development, requiring a broad understanding of management processes, structured problem solving and behavior. Developing a Root Cause Analysis work process will require effort and persistence as well as new thinking about organizational structure and resource priorities. The potential improvements from developing an effective Root Cause Analysis work process are significant. Most manufacturing processes have opportunities for improvement and cost reduction that have not been obtainable with current efforts. In some cases, these opportunities could represent competitive advantages in manufacturing strategies and processes.

From my own RCA experiences at industrial sites and manufacturing facilities, I have found that there is little consensus regarding what constitutes an Root Cause Analysis activity, what it is supposed to accomplish, how it will be applied, who should do the activity, when it will be applied, etc. Very little agreement exists on these basic RCA points. Ask these RCA questions in your work environment and listen to the diversity of opinions you will hear in reply.

Root Cause Analysis (RCA) is a valuable tool for reliability improvement in manufacturing and production operations. Yet, most efforts to implement an RCA program fail to achieve meaningful results despite significant investments in employee training. What needs to be done to assure that RCA becomes a functional work process in organizations?

With RCFA being a buzzword of the 90’s, companies are faced with a slew of new vendors with numerous RCFA methods and practices to help you attain quantum results. How do you decide who is going to make you money versus who is going to take your money?

When a bearing in a critical piece of equipment fails prematurely, a maintenance specialist knows the failure usually indicates there is more here than meets the eye. What the untutored eye sees is a failed bearing and little more. However, a premature bearing failure is symptomatic of other problems that, if left untreated, will cause the same kind of failure to occur again.

The business process is most commonly named Root Cause Failure Analysis (RCFA) or root cause analysis. The name itself implies the largest and most expensive problem when implementing problem solving in an organization. The results wanted from the process are to eliminate the problem, not to analyze the failure. To convey the desired result to the organization, the name should therefore be changed to Root Cause Problem Elimination (RCPE).   

I was recently engaged by a client to conduct failure analysis on a large (and expensive) hydraulic cylinder off an excavator. This hydraulic cylinder had been changed-out due to leaking rod seals after achieving only half of its expected service life. Inspection revealed that apart from the rod seals, which had failed as a result of the ‘diesel effect’, the other parts of the hydraulic cylinder were in serviceable condition.

There are many types of RCA tools available to organizations, including 5 Why?, Fault Tree Analysis, Interrelation Diagrams, Ishikawa Diagrams (Fishbone, Cause and Effect) and many others. A great example is the 5 Why? method: starting with the incident itself, an RCA team would continue asking “Why did this happen?” until they arrive at the root cause. Refer to the following example: