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Are you trying to improve performance, but find that the same problems keep getting in the way? Safety, health, environmental quality, reliability, production, and security are at stake. You need the long-term planning that will keep the same issues from recurring. Root Cause Analysis Handbook: A Guide to Effective Incident Investigation is a powerful tool that gives you a detailed step-by-step process for learning from experience. Reach for this handbook any time you need field-tested advice for investigating, categorizing, reporting and trending, and ultimately eliminating the root causes of incidents. It includes step-by-step instructions, checklists, and forms for performing an analysis and enables users to effectively incorporate the methodology and apply it to a variety of situations. Using the structured techniques in the Root Cause Analysis Handbook, you will: Understand why root causes are important. Identify and define inherent problems. Collect data for problem-solving. Analyze data for root causes. Generate practical recommendations. The third edition of this global classic is the most comprehensive, all-in-one package of book, downloadable resources, color-coded RCA map, and licensed access to online resources currently available for Root Cause Analysis (RCA). Called by users "the best resource on the subject" and "in a league of its own." Based on globally successful, proprietary methodology developed by ABS Consulting, an international firm with 50 years' experience in 35 countries. Root Cause Analysis Handbook is widely used in corporate training programs and college courses all over the world. If you are responsible for quality, reliability, safety, and/or risk management, you'll want this comprehensive and practical resource at your fingertips. The book has also been selected by the American Society for Quality (ASQ) and the Risk and Insurance Society (RIMS) as a "must have" for their members.
Root Cause Analysis Handbook: A Guide to Effective Incident Investigation presents a proven system designed for investigating, categorizing, and ultimately eliminating, rootcauses of incidents with safety, health, environmental, quality, reliability, and production-process impacts.Defined as a tool to help investigators describe what happened, to determine how it happened, and to understand why it happened, the Root Cause Analysis System enables businesses to generate specific, concrete recommendations for preventing incident recurrences.Using the factual data of the incident, the system also allows quality, safety, and risk and reliability managers an opportunity to implement more reliable and more cost-effective policies that result in major, long-term opportunities for improvement.Such process improvements increase a business' ability to recover from and prevent disasters with both financial and health-and-safety implications.Special features include a 17 inch by 22 inch pull-out Root Cause Map, a powerful tool for identifying and coding root causes.The book helps readers to understand why root causes are important, to identify and define inherent problems, to collect data for problem solving, to analyze data for root causes, and to generate practical recommendations.- - - - - - This edition is a reprinting of the 199 edition.- - - - - -ORGANIZATION OF THE ROOT CAUSE ANALYSIS HANDBOOKThe focus of this handbook is on the application of the Root Cause Map to the root cause analysis process. The Root Cause Map is used in one of the later steps of the root cause analysis process to identify the underlying management systems that caused the event to occur or made the consequences of the event more severe. The first five chapters of this handbook are an overview of the root cause analysis process. These provide the context for use of the Root Cause Map. Chapter 6 provides references.Chapter 1, "Introduction to Root Cause Analysis," presents a basic overview of the SOURCE (Seeking Out the Underlying Root Causes of Events) root cause analysis process.Chapter 2, "Collecting and Preserving Data for Analysis," outlines the types of data and data sources that are available. Chapters 3, 4, and 5 describe the three major steps in the rootcause analysis process.?Chapter 3, "Data Analysis Using Causal Factor Charting," provides a step-by-step description of causal factor charting techniques. Chapter 4, "Root Cause Identification," explains the organization and use of the Root Cause Map. Chapter 5, "Recommendation Generation and Implementation," provides guidance on developing and implementing corrective actions. The references section, Chapter 6, provides additional information for those interested in learning more about specific items contained in the handbook.Appendix A, "Root Cause Map Node Descriptions," describes each segment of the Root Cause Map and presents detailed descriptions of the individual nodes on the map. AppendixB is the Root Cause Map itself.
This best-seller can help anyone whose role is to try to find specific causes for failures. It provides detailed steps for solving problems, focusing more heavily on the analytical process involved in finding the actual causes of problems. It does this using figures, diagrams, and tools useful for helping to make our thinking visible. This increases our ability to see what is truly significant and to better identify errors in our thinking. In the sections on finding root causes, this second edition now includes: more examples on the use of multi-vari charts; how thought experiments can help guide data interpretation; how to enhance the value of the data collection process; cautions for analyzing data; and what to do if one can’t find the causes. In its guidance on solution identification, biomimicry and TRIZ have been added as potential solution identification techniques. In addition, the appendices have been revised to include: an expanded breakdown of the 7 M’s, which includes more than 50 specific possible causes; forms for tracking causes and solutions, which can help maintain alignment of actions; techniques for how to enhance the interview process; and example responses to problem situations that the reader can analyze for appropriateness.
The answer is root cause analysis, a process that allows you to find the cause of single events/problems in the workplace. The Root Cause Analysis Handbook presents a walkthrough example that illustrates the method and shows how to implement it. Because poor initial problem definition can (and often does) undermine the problem-solving process, Ammerman places special emphasis on this area to build a solid foundation for effective analysis. He also provides guidance on preparing the final report. The need for clear documentation on dealing with problems makes this book especially valuable for quality managers, engineers, safety managers, and teams implementing the ISO or QS standards. Written in a simple, user-friendly style, you will grasp the core concepts quickly and begin applying them to your work.
This updated and expanded edition discusses many different tools for root cause analysis and presents them in an easy-to-follow structure: a general description of the tool, its purpose and typical applications, the procedure when using it, an example of its use, a checklist to help you make sure if is applied properly, and different forms and templates (that can also be found on an accompanying CD-ROM). The examples used are general enough to apply to any industry or market. The layout of the book has been designed to help speed your learning. Throughout, the authors have split the pages into two halves: the top half presents key concepts using brief language—almost keywords—and the bottom half uses examples to help explain those concepts. A roadmap in the margin of every page simplifies navigating the book and searching for specific topics. The book is suited for employees and managers at any organizational level in any type of industry, including service, manufacturing, and the public sector.
This book presents a proven system designed for investigating, categorizing, and ultimately eliminating root causes of incidents with safety, health, environmental, quality, reliability, and production-process impacts. Defined as a tool to help investigators describe what happened, to determine how it happened, and to understand why it happened, the Root Cause Analysis System enables businesses to generate specific, concrete recommendations for preventing incident recurrences.
When the challenge is to get to the heart of a problem, you need a simple and efficient cause investigation methodology. And what would make a real difference would be an interactive map to lead you to the answer every time. Chester Rowe’s Simplifying Cause Analysis: A Structured Approach is your instruction book combined with the included downloadable Interactive Cause Analysis Tool you have been looking for. The author intends this book for professionals like you, who have some familiarity with cause analysis projects and are looking for a simple and efficient cause investigation methodology –is a more effective and insightful way of asking “why?” Introducing his multi-function event investigation tool, Chester Rowe says, “There are already many scientific tools to help us understand the physical causes for machine failures; the challenge now is to find a way of investigating human performance failure modes...humans are often a major source of slips, lapses, and mistakes.” Supporting his instructions with diagrams, charts, and real-world examples from companies like yours, the author takes you step-by-step through planning, completing, and documenting your investigation: Chapter 1 gives you a process to determine the level of effort that your investigation should encompass, assess the level of effort needed, and determine the rigor needed. Your investigation needs to be as risk-informed as possible. Chapters 2 through 5 presents a new and innovative structure –rigorous yet intuitively easy to remember – to identify the underlying causes for the event (Cause Road Maps) and conduct the investigation. Chapter 6 introduces conceptual human performance models and tells you how to begin focusing on the human behaviors involved. Chapters 7 and 8 present you with methods, tools, and techniques for carefully interviewing personnel. Chapters 9 through 13 “put the pieces together,” showing you how to analyze and model the event, determine corrective action, and document the investigations and findings. Chester Rowe developed the Cause Road Map over many years to provide a comprehensive taxonomy for every cause investigation. However, fully implementing the Cause Road Map requires the use of other tools to organize, analyze, and present the final results of your investigation. To get you started, Rowe includes his downloadable Interactive Cause Analysis Tool – an easy-to-use tool in familiar spreadsheet format – free with your verified purchase of the book.
Medical Device Use Error: Root Cause Analysis offers practical guidance on how to methodically discover and explain the root cause of a use error-a mistake-that occurs when someone uses a medical device. Covering medical devices used in the home and those used in clinical environments, the book presents informative case studies about the use errors
The purpose of this book is to share what the author has learned about effective problem solving by exposing the ineffectiveness of conventional wisdom and presenting a principle-based alternative called Apollo Root Cause Analysis that is robust, yet familiar and easy to understand. This book will change the way readers understand the world without changing their minds. One of the most common responses the author has received from his students of Apollo Root Cause Analysis is they have always thought this way, but did not know how to express it. Other students have reported a phenomenon where this material fundamentally re-wires their thinking, leading to a deeply profound understanding of our world. At the heart of this book is a new way of communicating that is revolutionizing the way people all around the world think, communicate, and make decisions together. Imagine a next decision-making meeting where everyone is in agreement with the causes of the problem and the effectiveness of the proposed corrective actions with no conflicts, arguments, or power politics! This is the promise of Apollo Root Cause Analysis.