Apollo Root Cause Analysis


Apollo Root Cause Analysis

The primary purpose of root cause analysis is to identify the causes of undesirable events such that they do not happen again. Apollo root cause analysis can also be used to identify the causal relationships of desirable events such that they can be repeated again. As discussed in the article on Root cause analysis, there are [http://www.realitycharting.com/root-cause-analysis/comparisons/ many root cause analysis methods] . Most of them, like change analysis, differences analysis, hazards analysis, barrier analysis, failure modes and effects analysis, fault tree analysis, and categorical cause trees are unprincipled. That is, they are not based on essential principles of causation, known as a principium that applies to every event, every time. Indeed, the fact that there are so many different approaches indicates the lack of a principium for causality. Apollo Root Cause Analysis is distinguished from other methods in that it is principle-based and thus repeatable for any event analysis. It reflects many years of continual improvement in event-based problem solving. As noted in the discussion on Causality the philosophical analysis of causality or causation has proved exceedingly difficult. A 2007 publication in the Stanford Encyclopedia of Philosophy regarding [http://plato.stanford.edu/entries/causation-process/ Causal Processes] provides the history of this difficulty. These difficulties are primarily caused by linear and categorical thinking along with the inability of our language to express the reality of cause and effect. [ [http://www.realitycharting.com/data/pdf/ARCA_Appendix.pdf Comparison of Common Root Cause Analysis Tools and Methods ] ] ARCA overcomes these difficulties by providing a principium or set of fundamental truths on which a simple process is built. This principium is further defined in the [http://www.realitycharting.com/data/pdf/C&E%20Principle.pdf Cause and Effect Principle] .

RealityCharting

At the core of ARCA is a Realitychart and like Cause Mapping, ARCA creates a visual representation of the causal relationships associated with a defined problem (See Figure 1 Realitychart of an open fire). This unique causal chart is called a Realitychart and is created using "post-It" notes or an intuitive software program called [http://www.realitycharting.com/ RealityCharting©] . [ [http://www.realitycharting.com/ RealityCharting® Root Cause Analysis Software ] ] RealityCharting is an iterative process that first identifies what is known and then provides simple rules and processes to help identify what we need to know to find effective solutions to a defined problem/event. ARCA requires that the problem first be defined and then creates a Realitychart consisting of evidence-based causes and their often complex causal relationships.

History [ [http://www.realitycharting.com/root-cause-analysis/causal-thinking History of Causal Thinking ] ]

ARCA was created by Dean L. Gano after working to resolve the many problems associated with the Three Mile Island nuclear power plant accident where a partial reactor core melt down occurred in 1979. In using the various problem-solving methods of the day, he discovered that none of them worked very well. Being an inquisitive person he began to study the human problem solving process. After several years of study he identified a principium of cause and effect. This principium contains four principles. First, that a cause and an effect are the same thing only viewed from a different point in time. Buddha and later St. Thomas Aquinas posited that causes are seen as a sequence in time from event to cause, where what was once an effect, becomes a cause. Note: If we use current time as the starting point, which we must do with any event, causality is actually an effect caused by a known cause, not cause and effect. For example: A car crash (the effect) might be caused by a "car striking tree" and "tree in path of car" (the causes). If we ask why did the car strike the tree, what was just now a cause must become and effect in order to ask why of it. The second principle, which states that causes and effects are part of an infinite continuum of causes, was discussed by St. Thomas Aquinas’ in his cosmological argument. Indra's Net, also posits the notion of an infinite set of interrelated causes. The third principle, first identified by Gano, states that each effect has at least two causes in the form of actions and conditions. This observation builds upon the first and second principles but corrects previous oversights that failed to identify the structure of causation. Historically, various notions of causation have focused on actions and less often on conditions, but they were never put in context with each other. The third principle does just that. For example, see Figure 1 regarding the causes of an open fire.

In this example, an open fire is caused by the conditions of oily rags, oxygen, existence of a match and the action of striking a match. This principle is what sets ARCA apart from conventional thinking and hence solves the riddle of causality. Another aspect of this element is that it further amplifies the second element regarding the infinite set of causes. As we ask why and get two or more causes, ask why again and get more causes for each of the previous causes/effects, it is easy to see how the reality of causal relationships can become very complicated very fast. The fourth principle, which states that an effect only exists if its causes exist at the same point in time and space, was derived from an engineering analysis tool know as Fault Tree Analysis (FTA), originally developed by Bell Telephone Laboratories for the Minuteman missile system in the early 1960’s. Events and Causal Factors Charting and Probability Risk Analysis (PRA), also use this notion. These methods specify that events occur at the same time and space. Unfortunately they do not recognize these events as consisting of action and condition causes – they are just events usually described in a story with few causal relationships.

Creating a Realitychart [Gano, Dean L. “Apollo Root Cause Analysis – A New Way of Thinking” Apollonian Publications, LLC, Third Edition, copyright 2007 ISBN 978-1-883677-11-4]

Creating a Realitychart as depicted in Figure 1 starts by asking “why?” of each identified problem. To satisfy the first principle, causes are determined and arranged in time from present to past by placing the words “caused by” between each set of causes. To ensure that these causes are not someone’s opinion, sensed evidence is required for each cause on the chart - shown below each cause. To satisfy the second principle, we continue to ask "why?" until we no longer have an answer or we choose to stop and state why we stopped. The third principle is satisfied by providing at least one conditional cause and one action cause for each effect. Before ending the analysis, the forth principle is evaluated by checking to make sure the causes of each effect exist at the same point in time and space. This process is repeated by asking all interested parties (stakeholders) to review the Realitychart and provide input regarding their understanding of the causal relationships. As this iterative process evolves, causal relationships are created that reflect a common reality shared by the group.

Implementation

Once the causal relationships of the defined event are agreed upon, solutions can be assigned to causes in the Realitychart. Finding effective solutions involves a creative brainstorming process which evaluates each cause to identify solutions. There are no restrictions on proposed solutions at this point - the more out of the box thinking the better. Once identified, these solutions are evaluated to determine if they will prevent recurrence, meet goals and objectives, and are within the control of stakeholders.

See also

* Critical Thinking
* Causality
* Evidence
* Cause and Effect
* 5 Whys
* Fault Tree Analysis
* Quality

External links

* http://www.realitycharting.com/root-cause-analysis/comparisons/ Quantitative comparison of the most common root cause analysis tools and methods.
* http://www.apollorca.com Which industries use root cause analysis.
* http://www.realitycharting.com/data/pdf/RCA%20and%20Quantitative%20Methods.pdf Comparison of Root Cause Analysis to Quantitative Probability/Reliability and Fault Tree Analysis

References


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