Root Cause Analysis

Root Cause Analysis is used to solve process problems or to determine why something happened. The problem can be small (hole size of machined part is out of round) or large (what caused the tile to fall off the space shuttle)! In either case, you try to determine why something happened so that a corrective action can be implemented and steps taken to prevent it from happening again. Simple problems can be solved by experience or intuition such as the out of round hole. The OOR hole was due to metal build up in the drill bit. Corrective Action, clean the drill bit. Preventive Action, clean the drill bet every hour. Long term solution; find drill bits that prevent build up. Some problems require teams to solve the problem such as the tile falling off the space shuttle. You can imagine the complexity of a problem like this. Engineers from the tile manufacturer, NASA engineers, astronauts, Federal government inspectors all have to agree on the root cause. Under these circumstances, special tools are required (management and planning tools). Those are the principles covered in the one-day class for Root Cause Analysis.