Failsafe's most popular seminar is entitled "The Root Cause Experience." It was designed for a 30-person cross section of an organization, from hands-on to management people. This cross-sectional encounter fosters tremendous discussions, with the majority of attendees eventually realizing THEIR OWN ROLE in things that go wrong as they participate in the training.

But knowing that we are part of the problem is not enough. When an attendee leaves the classroom, there ought to be an expectation of what he/she ought to do differently. Even more, there ought to be an overall strategy to help an organization move from point A to point B. Involving everyone in root cause analysis requires a lot of energy. After all, fear, blame, pride, ego, discipline, and "the rat race" are the obstacles we'll encounter along the way! It will not happen automatically!

In order to move from point A to point B, you have to have a plan. Failsafe has this plan. It's been evolving for 20 years -- discarding what does not work, and embracing what does. One of the most important distinctions about Failsafe's approach to Root Cause Analysis is it's ORGANIZATIONAL PLAN.

The plan makes a distinction between Maxi, Midi, and Mini-RCA's. Do not be fooled by these phrases -- they are not what you might think. They are a way to get EVERYONE involved in learning from our failures -- that's what's important.

The plan involves the acknowledgement of a "Mother- Source" to DRIVE the effort. The plan even details the job functions of this Mother-Source.

I know of no other approach that intentionally tries to include EVERYONE in the Root Cause process in one way or another. And involving EVERYONE is vital because we are ALL the culprits!

Most, if not all other investigative approaches intentionally steer away from the people that "did it." But it's people that cause problems! In order to avoid blaming, fingerpointing, and "witch-hunts" most of us go too far in the other direction. Most people point to deficiencies in training programs, procedural flaws, or work practices INSTEAD OF acknowledging WHO DID WHAT!

• Who decided on that ludicrous training program?
• Who omitted writing that critical step in the procedure?
• Who has been looking the other way when peers have not followed the accepted work process?

I cause problems. You cause problems. Individual managers cause problems. Individual hourly folks cause problems. Individual husbands, wives, children, doctors, mechanics, etc. cause problems. Specific individuals are the cause of our problems. We ALL cause problems!

When we intentionally look the other way, and encourage people to focus on "management systems," we are encouraging people to ignore the attitudes, beliefs, and assumptions about life that are at the root of our behavior. We end-up pushing these kinds of things into our subconscious, burying them instead of addressing them!

People cause problems. We need to know WHO DID WHAT so that we can ask WHY? Failsafe's approach to root cause analysis intentionally focuses ON the human, instead of sidestepping him (or her).

But do not get the wrong impression. I'm certainly NOT suggesting that we start fingerpointing, blaming, and lashing-out at one another. We need to help people UNDERSTAND why they did what they did. After all, people do things for REASONS. It's our attitudes, beliefs and assumptions that drive almost everything we do. We need to know which of these "beliefs" are flawed, so that we can reform them!

With Failsafe's approach to RCA, everyone involved does their best to see THEIR OWN ROLE in the failure. Even more, each of us asks ourselves "what about the way I AM is problematical?"

I do not know of any other investigative approach that intentionally focuses on the people that contributed to the incident. Failsafe acknowledges that people cause problems, and that they will continue to cause problems until they CHALLENGED to THINK differently.

Early in my career, I worked with a fellow that was offended at the suggestion that he needed to be taught how to do an RCA. He said it was innate to human nature to to able to understand why things go wrong. At the time, I disagreed with him. If he was correct, I said to myself, then everyone would be doing RCA's.

That was 25 years ago. Looking back, I realize he was right. Most people in the RCA business have taken something that is innate to human nature and made it too complicated. They promote the use of fancy techniques, intricate charting methods, and catchy acronyms. Some have even computerized the RCA process! Along these lines, I've actually heard someone say "I had to wait 3 days to do the RCA because my laptop was broken."

As I tell my trainees all the time, "RCA is easy, or I would not be able to do it." In actuality, when I lead an RCA or teach an RCA class, all I do is SLOW PEOPLE DOWN. That's all that's really needed. Since most of us are travelling at "warp speed," when we slow down we can see things more clearly. More specifically, we can see EVIDENCE more clearly.

Yes, it is important to remind people of what they innately understand. We need to remember that when something goes wrong, PEOPLE know things about it. We also need to know that the MANIFESTATION ITSELF tells us things (whatever went wrong APPEARS in some way, and that can tell us things). We also need to remember that life is HISTORICAL in nature. We leave a TRAIL behind us. When something goes wrong, we need to look for the trail that we've left. Failsafe makes it easy by talking about the 3 Ps:

• PEOPLE Evidence
• PHYSICAL Evidence
• PAPER Evidence

When something goes wrong, either at home or at work, we need to SLOW DOWN, look at the EVIDENCE, and let it guide us to the point where we are SHOCKED into action. If you have been told that RCA is something that is more complicated than this, you have been duped. RCA, as practiced by Failsafe, is an endeavor innate to life itself -- something which many of us have forgotten because of the warp speed we are travelling.

I know of no other organization that is TRYING to simplify its approach to RCA, so that it is available to EVERYONE. Most seem to be making it more and more dependent on sophisticated tools and software.