PROGRAM DETAILS

Program Overview

Root cause analysis involves searching backwards from an undesirable effect or outcome to identify its causes. While “root cause” implies that there is a single cause responsible for a given problem, some effects actually have multiple causes that trigger them. Sometimes the multiple effects are independent of each other; other times, causes are interrelated where, if one cause is removed, the problem can no longer occur.

Root cause analysis is a process to identify and resolve the root cause behind problems to prevent recurring failures. As part of any business process, root cause analysis is an essential element of determining the corrective actions.

Learning Objectives

 This course has the following objectives:

• Learn how to establish an effective team environment for root cause analysis.
• Clarify what the problem is and is not.
• Beginning with that symptoms of the problem, map a trail from the symptom to the root cause(s).
• Using data and investigative tools, identify the root cause.
• Generate ideas to solve the root cause problem and select the most appropriate solution using decision matrices.
• Implement measures to ensure the gains made are held.
• Recognize common barriers to root cause analysis and apply techniques to overcome those barriers.
• Provide students with the knowledge and skills necessary to facilitate an effective problem analysis.
• This course is ideal for anyone whose job involves problem solving. As a minimum, all supervisors and lead personnel should take this course
• Each student will be given the opportunity to facilitate a group in effective analysis.

Training methodology

The training will be delivered by a tutor who possesses first-hand practical experience of training program will combine presentations with interactive practical exercises, supported by video material and case studies.

Participants are expected to share their experiences by active participation throughout all parts of this training program.

• Participant will undergo a self-assessment test.
• Participants will be divided into appropriate teams for workshops & real cases.
• Participants will walk-out with some specific tools.
• A manual will be supplied which will support development of the Module by helping participants to structure the main acquired competencies.

Training Tools

 This training will be delivered through a mix of theoretical lecturers, use and demonstrations through Simulation software (Petrel, Eclipse, Petrojex) and several case studies which will ensure delegates have both theoretical as well as practical knowledge on the subject.

Program Content 

Module 1 – Introduction to Root Cause Analysis

•  Definitions
• Why determine root cause
• When should root cause analysis be performed?
• How to determine root cause?
• Common errors in root cause analysis
• Introduction to root cause analysis

Module 2 – Root Cause Analysis Process

• Problems
• Problems types
• Problem Definition – What When Where
• Why “who” is not important
• Causes and Time Lines
• Whys and Beyond
• Cause and Effect Charts
• The need for evidence
• Solution brainstorming
• Solution Qualification
• Selecting Effective Solutions!
• Problem solving process
• Problem definition
• Tools for problem definition
• Tools for problem cause
• Tools for problem cause data analysis
• Pareto charts and histograms

Module 3 – Root cause identification

•  Root Cause Identification Tools
• Tools for root cause identification
• Five why’s
• Cause and effect diagram (or the fishbone diagram)
• How to develop cause-and-effect diagram?
• Fault tree analysis
• Fault tree development – key points

Module 4 – Key Steps to Conducting an Effective Root

•  Cause analysis
• Corrective actions
• Purpose of a corrective action plan
• Why it’s important to develop corrective actions?
• Requirements for corrective actions
• Corrective actions process
• Corrective action plan development
• Follow-up

Module 5 – IOSA and ISAGO Corrective Action Record 

• Root cause analysis under IOSA
• ISAGO program
• Planned corrective action
• Final corrective action

Module 6 – Root Cause Analysis Method for Managers 

• Managers and Root Cause Analysis
• Problems types
• Problem Definition – What When Where
• Why “who” is not important
• Causes and Time Lines
• Whys and Beyond
• Cause and Effect Charts
• The need for evidence
• Solution brainstorming
• Solution Qualification

Module 7 – Root Cause Analysis Method for Facilitators 

• Facilitators and Root Cause Analysis
• Problems
• Problem Definition – What When Where
• Why “who” is not important
• Causes and Time Lines
• 5 Whys and Beyond
• Review of Reality
• Charting software and practical experience using the software to generate charts and reports
• Cause and Effect Chart creation
• The need for evidence
• Solution brainstorming
• Solution Qualification
• Selecting Effective Solutions!
• Group Facilitation skills
• Common Traps
• Incident investigation – Program elements

Module 8 – Root Cause Analysis Method for Investigators

•  Investigators and Root Cause Analysis
• Benefits of Incident Investigation
• Role and qualification of an Investigator
• Team selection
• Data collection at site
• Interview techniques
• Incident causal analysis
• Cause & Effect chart production
• Reporting incl. recommended solutions

Module 9 – Root Cause Analysis Super User Workshop

•  Workshops and Root Cause Analysis
• Critical Elements of Successful Facilitation
• Facilitation Exercises
• Interview Exercises
• Managing Incidents
• Apollo RCA and Six Sigma
• Apollo RCA and Human Error
• Essential Elements of Managing a Root Cause Analysis Program
• RealityCharting® Exercises
• Databases and Tracking Actions
• Analyzing Systemic Causes

Module 10 – Root Cause Analysis for Refineries and Oil/Gas

•  Refineries and Root Cause Analysis
• System Boundaries
• RCA Review
• API 571 Overview
• ASME PCC-3 Typical Damage Mechanisms
• ISO 14224 reporting
• Case Study – Refinery Fire and Explosion
• Case Study – Poly Vinyl Explosion and Fir
• eCase Study – Upstream Oil and Gas
• Case Study – Petro Chemical Process