Failures, like weeds, can be stopped by eliminating the ROOTS.
Failure Roots, like weed roots, are always part of a system.
If you area dealing with the physical effect of the failures only, you have probably found the direct KEY FACTOR(S).
If you are dealing with the human error, the effect you see is "blaming" someone for their actions and you have probably found more direct KEY FACTOR(S).
If you are dealing with the operating systems that enabled the failure to occur, you are likely at the underlying KEY FACTOR(S).
To provide an understanding and skills on the use and application of WHY trees as root cause failure analysis (RCFA)tool and apply the method in practical examples
Affects 1 Failure/Incident
Physical
Key Factor
Affects 1 Person
Human
Key Factor
Affects The Whole Organization – Change Status Quo
in RCFA to uncover Key Factors through identification of physical, human and system causes.
WHY TREE
It's called a "WHY' tree because we keep asking "WHY?" to get to the key factors. It's also useful to ask "How can?" Differentiating between opinion and facts
why
why
why
why
why
why
WHAT IS A KEY FACTOR?
WHAT IS A KEY FACTOR?
WHY Trees use the simple but powerful logic of Cause and Effect:
CAUSE AND EFFECT IN WHY TREES
We apply cause and effect logic in WHY Trees by starting with the effect
