Root Cause Analysis (RCA) was developed to resolve defects in manufacturing. When the error rate of a production process is too high, we use RCA to discover why and fix it. In manufacturing, RCA works pretty well. Sometimes it even works with software development and other processes that generate non-physical outputs. But when we try to apply RCA to problems among people, trouble appears.
We're usually unaware of RCA thinking. Some indicators are questions and statements like these:
- Who started this trouble?
- She's the common factor in all these problems.
- I did Y, but only because she did X.
- If we send Jeff to communication training, everything will get better.
Sometimes, RCA thinking does lead to noticeable improvement, but too often, it ends in exasperation or exacerbation.
We can understand why if we remember that RCA makes two critical assumptions. First, it assumes that we'll find causes that have no internal structure. Second, it assumes that these "atomic" causes are independent, adjustable forces. The very term "root cause" captures these two ideas.
In human systems, both assumptions can be invalid, and often are. For instance, consider the assumption of atomic causes. A simple example: our project is late because we keep changing things; so we add resources to speed it up; but adding resources is a change; that change further delays the project.
Because these so-called "causality loops" violate the assumption that we can always find atomic causes, people have extended the method to deal with this situation. But in organizational applications, the term causality loop doesn't quite capture the complexity of the difficulty — causality web is more accurate.
In seeking organizational
improvement, changing just
a few things rarely worksWhen we encounter causality webs, process repair can entail broad organizational change — a process so daunting that we convince ourselves that changing "just a few things" will do the trick. Often, when we do make changes, the web does break temporarily — until the elements we chose not to address can restore its structure.
Assuming independent, adjustable forces also fails from time to time. For instance, in a business unit troubled by toxic, destructive conflict, an objective application of RCA might find causes such as manipulative management, oppressive schedules, or human resource policies that lead to high turnover. Since such environments rarely allow even discussion of these factors, adjusting them is often precluded.
In many cases, even though these causes are independently adjustable, the structure of organizational power can prevent their adjustment. Unable to deal with what everyone can see and nobody can acknowledge, the organization sometimes falls into "analysis paralysis."
It's useful to remember that we seek not the cause of organizational failures, but their elimination. Confusing the two objectives is a cause — if not a root cause — of the misapplication of root cause analysis. Top Next Issue
Are your projects always (or almost always) late and over budget? Are your project teams plagued by turnover, burnout, and high defect rates? Turn your culture around. Read 52 Tips for Leaders of Project-Oriented Organizations, filled with tips and techniques for organizational leaders. Order Now!
Your comments are welcomeWould you like to see your comments posted here? rbrenmhXARWRMUvVyOdHlner@ChacxgDmtwOKrxnripPCoCanyon.comSend me your comments by email, or by Web form.
About Point Lookout
Thank you for reading this article. I hope you enjoyed it and found it useful, and that you'll consider recommending it to a friend.
Support Point Lookout by joining the Friends of Point Lookout, as an individual or as an organization.
Do you face a complex interpersonal situation? Send it in, anonymously if you like, and I'll give you my two cents.
More articles on Personal, Team, and Organizational Effectiveness:
- Learn from the Mastodon
- Not long ago, Mastodons roamed North America in large numbers. Cousins to the elephant, they thrived
in the cool, sub-glacial climate. But the climate warmed, and human hunters arrived. The Mastodon couldn't
adapt, and now it's extinct. Change is now coming to your profession. Can you adapt?
- When we steer the discussion away from issues to attack the credibility, motives, or character of our
debate partners, we often resort to a technique known as the ad hominem attack. It's unfair, it's unethical,
and it leads to bad, expensive decisions that we'll probably regret.
- Personal Trade Secrets
- Do you have some little secret tricks you use that make you and your team more effective? Do you wish
you could know what secret tricks others have? Here's a way to share your secrets without risk.
- Assumptions and the Johari Window: I
- The roots of both creative and destructive conflict can often be traced to differing assumptions of
the parties to the conflict. Working out these differences is a lot easier when we know what everyone's
- Illusory Incentives
- Although the theory of incentives at work is changing rapidly, its goal generally remains helping employers
obtain more output at lower cost. Here are some neglected effects that tend to limit the chances of
achieving that goal.
Forthcoming issues of Point Lookout
- Coming April 1: Incompetence: Traps and Snares
- Sometimes people judge as incompetent colleagues who are unprepared to carry out their responsibilities. Some of these "incompetents" are trapped or ensnared in incompetence, unable to acquire the ability to do their jobs. Available here and by RSS on April 1.
- And on April 8: Intentionally Misreporting Status: I
- When we report the status of the work we do, we sometimes confront the temptation to embellish the good news or soften the bad news. How can we best deal with these obstacles to reporting status with integrity? Available here and by RSS on April 8.
I offer email and telephone coaching at both corporate and individual rates. Contact Rick for details at rbrenmhXARWRMUvVyOdHlner@ChacxgDmtwOKrxnripPCoCanyon.com or (650) 787-6475, or toll-free in the continental US at (866) 378-5470.
Get the ebook!
Past issues of Point Lookout are available in six ebooks:
- Get 2001-2 in Geese Don't Land on Twigs (PDF, )
- Get 2003-4 in Why Dogs Wag (PDF, )
- Get 2005-6 in Loopy Things We Do (PDF, )
- Get 2007-8 in Things We Believe That Maybe Aren't So True (PDF, )
- Get 2009-10 in The Questions Not Asked (PDF, )
- Get all of the first twelve years (2001-2012) in The Collected Issues of Point Lookout (PDF, )
Are you a writer, editor or publisher on deadline? Are you looking for an article that will get people talking and get compliments flying your way? You can have 500 words in your inbox in one hour. License any article from this Web site. More info
- The Power Affect: How We Express Our Personal Power
Many people who possess real organizational power have a characteristic demeanor. It's the way they project their presence. I call this the power affect. Some people — call them power pretenders — adopt the power affect well before they attain significant organizational power. Unfortunately for their colleagues, and for their organizations, power pretenders can attain organizational power out of proportion to their merit or abilities. Understanding the power affect is therefore important for anyone who aims to attain power, or anyone who works with power pretenders. Read more about this program.