Root Cause Analysis Handbook: A Guide to Effective Incident Investigation, 2005 Edition

This edition of the Root Cause Analysis Handbook is a reprinting of the version originally published in 1999. In the six years since the original book was published, organizations have come under increasing pressure to produce more with less and to produce higher quality outcomes (products and services). Organizations are constantly striving to meet these demands through the implementation of a variety of different strategies, such as:
Lean strategies (sharing of work between operations and maintenance)
Reliability improvements (reliability-centered maintenance, predictive maintenance, and improved use of maintenance resources)
Quality initiatives (ISO certification, setting up critical variables to monitor and adjust, quality circles and teams, and six-sigma)
Improved data collection and analysis (both internal and external to the business unit)
Workplace culture improvements (behavior-based safety and risk management)
Staff reductions, both in central corporate support and resources at production facilities.
However, certain issues remain constant: societal and management demands for continuous improvement in safety, reliability, environmental stewardship, and quality. Incidents that impact these areas are not acceptable and, worldwide, organizations are being required to improve their operations and culture to address these issues. While some industries have made significant progress, governmental entities and the public often demand more.
It is easy to say that it cannot be done. We are already so much better than we were in the past. But some organizations (including some of your competitors) continue to improve. To remain competitive, your organization must maximize the efficiency with which it spends resources. Your organization must recognize the...