Root Cause Analysis (RCA)
Root Cause Analysis (RCA) is a popular and often-used technique that
helps people answer the question of why the problem occurred in the
first place. It uses a specific set of steps, with associated tools,
to find the primary cause of the problem, so that you can:
1. Determine what happened.
2. Determine why it happened.
3. Figure out what to do to reduce the likelihood that it will happen again.
You'll usually find three basic types of causes:
1. Physical causes – Tangible, material items failed in some way (for
example, a car's brakes stopped working).
2. Human causes – People did something wrong or did not doing
something that was needed. Human causes typically lead to physical
causes (for example, no one filled the brake fluid, which led to the
brakes failing).
3. Organizational causes – A system, process, or policy that people
use to make decisions or do their work is faulty (for example, no one
person was responsible for vehicle maintenance, and everyone assumed
someone else had filled the brake fluid).
The Root Cause Analysis Process
Root Cause Analysis has five identifiable steps.
Step One: Define the Problem
• What do you see happening?
• What are the specific symptoms?
Step Two: Collect Data
• What proof do you have that the problem exists?
• How long has the problem existed?
• What is the impact of the problem?
Step Three: Identify Possible Causal Factors
• What sequence of events leads to the problem?
• What conditions allow the problem to occur?
• What other problems surround the occurrence of the central problem?
Step Four: Identify the Root Cause(s)
• Why does the causal factor exist?
• What is the real reason the problem occurred?
Step Five: Recommend and Implement Solutions
• What can you do to prevent the problem from happening again?
• How will the solution be implemented?
• Who will be responsible for it?
• What are the risks of implementing the solution?
As an analytical tool, Root Cause Analysis is an essential way to
perform a comprehensive, system-wide review of significant problems as
well as the events and factors leading to them.