I'm going to review this one periodically. Comments? Take care, Bill Corcoran Mission: Saving lives, pain, assets, and careers through thoughtful inquiry. ...
Bob Nelms, I like where you're going. In the investigations I have been part of and/or studied the triggering factors have often been normal, reasonable, and...
Bob, You're making a powerful case for operational readiness reviews(ORR). Submariners make "Rig for Dive" a holy ritual. It is an operational readiness review...
Do you know of a better way of creating Gantt Charts? If so, please let me know. Better yet, send an example. I did the one below in MS Word using the Table...
Bill C., That looks like a reasonable way to make a "Gantt Chart". I don't know of any better way. What I would like to see is an example of a factor tree...
Bob Latino and Mike Mulligan have been discussing this one. It belongs in every rootician's Operating Experience database. 1.. What were the set-up factors? ...
“I have a saying that I impart on the senior management of the NTSB, and it goes like this: “If you do your job well, then you get to keep your job.“”...
A Gantt Chart displays the time variable, but it does not display causal linkage. The Factor Tree displays causal linkage, but does not display time extent. ...
Bill C., Under what circumstances would "time extent" be so important and so opaque that the inclusion of a "Gantt Chart" in an RCA report would be justified? ...
One of the things shown clearly by the Gantt Chart is how much time elapsed from when the adverse conditions were known until the consequences occurred. Take...
Here is a Gantt Chart of a simple accident just to show a simple and easy way to make Gantt Charts in PowerPoint. MS Word or WordPerfect would probably do as...
Just an observation: Unless the root is removed somehow during this event, should not it's XXX line continue for the chart's full time line? Initially, I...
Valerie, It's great to hear from you. You are certainly correct. Unless the root cause root (no pun intended) is removed it will be there to trip future...
Bill Salot, Thanks ever so much. I want to get it right the first time no matter how many times it takes. But my mother told me, "Anything worth doing is worth...
I give. What does TAFN stand for? I am enjoying some of this dialogue, pretty interesting and funny at the same time. OBTW: I had an employee conduct RCA on...
Duke provides a lot of information at http://dukenews.duke.edu/2003/02/clips02-24.html (Bob, Thanks for the fax.) Take care, Bill Corcoran Mission: Saving...
I start a dialogue on depth and breadth. The depth dialogue begins with the question: What were the factors that directly resulted in your "root cause?" The...
Scroll down for the slides of the week. My take: They're like lobster and beer. Each is good, but together they are better. OBTW: I left the runner's sadness...
Here's another one for your mix-up folder. I note with chagrin that CSB does not use the term mix-up. I am also concerned that CSB doesn't mention any of the...
Bill C, I share your "concern" about CSB's recommendation to use an X-ray fluorescence analyzer when re-assembling components. Manufacturers typically mark...
Bob and Bob, I pasted the article below. "5 Why?" is fundamentally flawed and yet it gets more press than solid approaches. What's so hard about the following?...
Bill, As a regular 5Why user and teacher, I don't have a problem with your comments. I also believe that there is nothing wrong with the set of questions you...
What does RHU mean? _____ From: Root_Cause_State_of_the_Practice@yahoogroups.com [mailto:Root_Cause_State_of_the_Practice@yahoogroups.com] On Behalf Of Dr. ...
Dave, Thanks ever so much. Would you be so kind as to explain how "5 Why?" can come up with multiple root causes? ... 5 Why's The 5 why's typically refers to...
Bill C., I may make some more serious comments on this later. For now, here are some less serious thoughts that may have occurred to less vocal members of this...
Hi Bill Interesting items on the 5 Whys. I have been through this debate before and there is an interesting point about different cultures. In the UK you learn...
I have the following comments: 1) Mixing carbon and low alloy steel piping components is a common error in the chemical and refining industries. 2) Sometimes...
Bill Salot, RHU=Resid Hydrotreater Unit I pasted a better MOM below. What can you suggest for adding? Take care, Bill Corcoran Mission: Saving lives, pain,...
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