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The RCA

I tend to write about all things Root Cause Analysis (RCA).  I come from a background that engrained a holistic view of Reliability Engineering into me.  This involved equipment, process and human Reliability.  I write about the following types of RCA topics:


1.  The Definition of ‘RCA’ and Why I Think the Current Term is Useless


2.  When Should RCA’s be Conducted? Addressing the Application of RCA Proactively versus Reactively


3.  What’s the Difference Between Root Cause Analysis and Shallow Cause Analysis? Why Do ‘RCA’ Efforts Fail


4.  The Critical Task of Evidence Collection and Preservation to an Effective RCA


5.  The Correlation Between Reliability/RCA and Safety, Does Such a Correlation Exist?


7.  The Measurement of an RCA System’s Effectiveness


8.  The Creation of an RCA Knowledge Base and its Sustained Growth to Store ‘Corporate Memory’ and Leverage Using AI

by Robert (Bob) J. Latino Leave a Comment

Fact or Myth #1: All ‘RCA’ Thinking is Linear

Fact or Myth #1: All ‘RCA’ Thinking is Linear

In my travels over the past 35+ years talking to RCA analysts around the world, as well as those outsiders who look into our ‘RCA’ bubble, I find many misconceptions about RCA. This happens in every space, just think about RCM, RBM, APM, CBM and the like; everyone experiences how other people view their craft.

[Read more…]

Filed Under: Articles, on Systems Thinking, The RCA

by Robert (Bob) J. Latino Leave a Comment

‘Fantasy’ Maintenance: The Illusion of Best Practices

‘Fantasy’ Maintenance: The Illusion of Best Practices

The following article was published in Plant Services earlier this year with the title, “Don’t get stuck in reactive mode – The world of fantasy maintenance is calling you”. The alias of the author is Captain Unreliability, so all credit should go to the Captain:-).

To the veterans in the field, you will connect with this article in a heartbeat. You will be laughing all along the way. In the end, I will add a commentary about while this may appear comical, it sadly is reality in many places that we all work (or have worked). But I’ll leave that up to you, to be the judge. In the end, please relate your own experiences and let me know if this is B.S. in your world or not!

[Read more…]

Filed Under: Articles, on Systems Thinking, The RCA

by Robert (Bob) J. Latino Leave a Comment

Why Can’t Learning Teams (LT) and RCA Teams be Friends?

Why Can’t Learning Teams (LT) and RCA Teams be Friends?

A Little History About How I Came Across Learning Teams.

A little over three years ago I was asked to speak at a conference that was entitled, Human Performance, Root Cause and Trending or HPRCT (great conference BTW and I encourage you to attend). This was a different world for me as I typically attended and spoke at Reliability and Maintenance trade conferences, but I was interested to see what it was all about (plus a good friend of mine was the one who invited me).

[Read more…]

Filed Under: Articles, on Systems Thinking, The RCA

by Robert (Bob) J. Latino Leave a Comment

Is System’s Thinking Critical to Root Cause Analysis’s (RCA) Success?

Is System’s Thinking Critical to Root Cause Analysis’s (RCA) Success?

Put another way, Can RCA be successful without the incorporation of system’s thinking? What prompted this question was that according to Drs. Leveson and Dekker in their 2014 paper Get To The Root of Accidents, systems thinking is not currently utilized in the application of RCA.

In this paper they cite:

 “An often-claimed ‘fact’ is that operators or maintenance workers cause 70–90% of accidents. It is certainly true that operators are blamed for 70–90%”. 

[Read more…]

Filed Under: Articles, on Systems Thinking, The RCA

by Robert (Bob) J. Latino 3 Comments

Germination of a Failure-Why Does Stuff Really Break Down? – Q&A p2

Germination of a Failure-Why Does Stuff Really Break Down? – Q&A p2

I recently presented a webinar for SMRP and Empowering Pumps, on the title above. There were several questions, post-presentation, that I felt were worthy of expanding on in the form of a blog.

Question #2 (of a total of 5)

How do you manage a situation where people just decide not to use simple tools like RCFA, just comfortable doing things same way? Even when you keep driving it.

[Read more…]

Filed Under: Articles, on Systems Thinking, The RCA

by Robert (Bob) J. Latino Leave a Comment

Germination of a Failure-Why Does Stuff Really Break Down? – Q&A

Germination of a Failure-Why Does Stuff Really Break Down? – Q&A

I recently presented a webinar for SMRP and Empowering Pumps, on the title above. There were several questions, post-presentation, that I felt were worthy of expanding on in the form of a blog.

Question #1 (of a total of 5)

Do we need to categorize the RCAs (based on actual/potential impacts) to decide on the need for the depth of RCA up to Latent Roots? Are all Failures supposed to be analyzed until we reach Latent Roots?

[Read more…]

Filed Under: Articles, on Systems Thinking, The RCA

by Robert (Bob) J. Latino Leave a Comment

A Different View of the Swiss Cheese Model

A Different View of the Swiss Cheese Model

Much has been written about James Reason’s original Swiss Cheese Model described in his book Managing the Risks of Organizational Accidents. Figure 1 is a basic representation of this model. Many today consider this model to be obsolete because of the evolving complexity of systems due to emerging technologies. Therefore, the linearity of failure expressed in this original model, is not as applicable as it was when introduced.

[Read more…]

Filed Under: Articles, on Maintenance Reliability, The RCA

by Robert (Bob) J. Latino 2 Comments

How Can v Why: What’s the Difference?

How Can v Why: What’s the Difference?

When facilitating a Root Cause Analysis (RCA), the proper questioning process will make or break the effectiveness of the entire analysis. When we hear of the 5-Why’s as a valid RCA approach, is simply asking ‘Why?’ 5x good enough….or IS IT JUST OK?

Think about it this way, if I asked you ‘How Could’ the crime have occurred versus ‘Why’ the crime occurred, would your answers be different?

I am going to take a very basic (101) case study and format it using a logic tree (graphical expression of cause-and-effect logic). As we are guided through this mental process we will discuss the differences between asking ‘How Can?’ and ‘Why?’.

[Read more…]

Filed Under: Articles, on Maintenance Reliability, The RCA

by Robert (Bob) J. Latino Leave a Comment

What’s Wrong with the Term “Root Cause”?

What’s Wrong with the Term “Root Cause”?

There is great variation when it comes to a common understanding of the term ‘Root Cause Analysis’ or RCA. 

In a previous, lengthy paper, I wrote an article entitled “The Stigma of RCA: What’s In a Name?“. It focused on common understandings (or misunderstandings) of what RCA means and then described the basic steps of any investigative occupation. I just left it up to the reader to determine if their ‘RCA’ approach had room for improvement. 

[Read more…]

Filed Under: Articles, on Maintenance Reliability, The RCA

by Robert (Bob) J. Latino Leave a Comment

People Forget to be Afraid

People Forget to be Afraid

“Preventing process accidents requires vigilance. The passing of time without a process accident is not necessarily an indication that all is well and may contribute to a dangerous and growing sense of complacency. When people lose an appreciation of how their safety systems were intended to work, safety systems and controls can deteriorate, lessons can be forgotten, and hazards and deviations from safe operating procedures can be accepted.

[Read more…]

Filed Under: Articles, on Maintenance Reliability, The RCA

by Robert (Bob) J. Latino Leave a Comment

What is ‘Reliability Engineering’​?

What is ‘Reliability Engineering’​?

I have been very involved recently with ongoing LI discussions with respected and noted experts in the Safety community, revolving around the perceptions those in Safety have of Reliability, and vice-versa.

In Safety today, there are ‘new’ approaches emerging being lead by noted Safety researchers like Sidney Dekker, Erik Hollnagel and Todd Conklin. Such ‘new’ approaches are being labeled Safety Differently, Safety II, Human and Organizational Performance (HOP), Resilience Engineering and a few more.

[Read more…]

Filed Under: Articles, on Maintenance Reliability, The RCA

by Robert (Bob) J. Latino Leave a Comment

The Pro’s and Con’s of Using Pre-Existing Logic in Root Cause Analysis (RCA)

The Pro’s and Con’s of Using Pre-Existing Logic in Root Cause Analysis (RCA)

There has been an ongoing debate for decades as to whether or not the use of pre-existing logic for conducting Root Cause Analyses helps or hinders the analysis results. Does the use of such pre-existing logic expand the thinking of the team members or does it lead the team to pre-determined conclusions and away from other conclusions not considered in the pre-existing logic? We will explore the fine line between these opposing views and see if there is a middle ground for consensus. [Read more…]

Filed Under: Articles, on Maintenance Reliability, The RCA

by Robert (Bob) J. Latino Leave a Comment

The Need to be a “Little Bit Bold & Outrageous” to Change the Reliability Status Quo

The Need to be a “Little Bit Bold & Outrageous” to Change the Reliability Status Quo

This phrase ‘a little bit bold & outrageous’ was constantly used by my father, Charles J. Latino early in his Reliability career. Charles founded and led one of the first corporate, global Reliability Engineering R&D groups in the U.S. for a company called Allied Chemical at the time (known as Honeywell today). This was in 1972!

[Read more…]

Filed Under: Articles, on Maintenance Reliability, The RCA

by Robert (Bob) J. Latino Leave a Comment

Is the Human Being Really an ‘Asset’?

Is the Human Being Really an ‘Asset’?

We often hear our organizations referring to their workforce as their greatest ‘asset’. But are they really?

Let’s first define ‘asset’ from a financial perspective:

“In financial accounting, an asset is an economic resource. Anything tangible or intangible that can be owned or controlled to produce value and that is held by a company to produce positive economic value is an asset. Simply stated, assets represent value of ownership that can be converted into cash (although cash itself is also considered an asset)”

[Read more…]

Filed Under: Articles, on Maintenance Reliability, The RCA

by Robert (Bob) J. Latino Leave a Comment

Grade Your RCA Effort and Print Out Your Private Report Card…

Grade Your RCA Effort and Print Out Your Private Report Card…

If you had to give a grade to your current Root Cause Analysis (RCA) initiative, what would it be? How would you come to that conclusion (grade)? The paradox many face with such initiatives is drawing the distinction between compliance and actual effectiveness. What would our RCA grade be based on? In this article we will focus on the key elements to quantifiably measure your RCA initiative, so the organization can focus on the elements of the initiative that are lacking.

[Read more…]

Filed Under: Articles, on Maintenance Reliability, The RCA

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logo for The RCA article series image of BobArticle by Robert (Bob) J. Latino
CEO of Reliability Center, Inc.

in the The RCA article series

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