The known set of all root causes

normzone

Trusted Information Resource
#1
Mulling over some input I've received in an other thread recently, I've reached the conclusion that some of the recent external audit nonconformances I experienced have root causes that would meet the description of " ineffective management process ".

This was in comparison to my original premise that they fell into " inadequate resources ".

Which leads me to the thought that I'll use to sustain my morale today - that there could in theory be some form of family tree, or some kind of Venn diagram, that contains an approximation of the relationship(s) all legitimate root causes.

They would have to be described in a generic manner, of course. At the bottom of the tree you would have the usual "operator error" and "did process incorrectly" old saws, and those would transition up into kind of a default Five Why sequence, becoming increasingly professionally described until at the top you would have the small group of "kiss of death" causes, such as "ineffective management process" and "inadequate resources".

I can't be the first one to think of this, and there are bound to be problems with the approach. Have any of you seen anything like this in your travels ?

That said, I'm leaning towards "ineffective management process" for some of my root causes I'll be documenting in the next week. That should be popular.
 
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Sidney Vianna

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#2
Just be careful on how you follow that trail; inadequacy of resources and ineffective management processes obviously lead to ISO 9001:2015 ¶ 5.1 - Leadership and "commitment". 5.1.1. a) & e). Are you prepared for the consequences of exposing the organization's leadership? Or lack thereof?

Risk. Based. Think.
 

normzone

Trusted Information Resource
#3
I don't see it going well for me regardless of what I do.

If I try to soft pedal it, my external auditor is unlikely to accept it unless I can couch it in elaborate sales-speak. I'm not very good at that. The issues in question are caused by people working million hour weeks to meet $hipping targets, and other commitments made in management review meetings fall by the wayside.

They answer to the guy at the top, who gives them those targets .... including " If you're giving 100%, then give 150% if that's what it takes "
 

Bev D

Heretical Statistician
Staff member
Super Moderator
#4
Don’t know if he invented it, but he certainly popularized it: Deming said management was responsible for 80-95ish% of all problems. And certainly this is one of the primary tenants of the Toyota Production System.

From a systemic standpoint I agree, but its not really very actionable - just more of the same old blame game; we’re just pointing the pistol at someone else.

We need to provide actionable information and to do this we have to truly understand the causal mechanism(s) at play.
 

Sidney Vianna

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#6
If I try to soft pedal it, my external auditor is unlikely to accept it unless I can couch it in elaborate sales-speak.
Akin to a doctor diagnosing the disease so an appropriate course of treatment and drugs can be prescribed, root cause analysis is just one step so you can apply the proper solution, a.k.a correction & corrective action.

If you elaborate the RCA and reach "leadership management is not doing their job", how do you propose that will be fixed?

Bev's post is spot on. Yes, in the overwhelming majority of the cases, it is a management failure. However, if you establish that management is incompetent, you have very few avenues to follow that point on. Maybe you are at the end of the rope and not concerned with the thing hitting the fan, but be aware. And good luck.
 

ScottK

Not out of the crisis
Staff member
Super Moderator
#7
I have used that, but it was after management had been nearly 100% changed.. it was along the lines of "Prior management failed to... provide resources, provide support, provide training, etc." followed by 'current management is committed to meeting the requirements and here is our plan to fix the situation'

So my advice would be to word it gently if it's the people that are the cause of the problem are the people still in charge.
 

normzone

Trusted Information Resource
#8
If you elaborate the RCA and reach "leadership management is not doing their job", how do you propose that will be fixed?
Well, given the reporting structure of the outfit (my role is somewhere between advisory and sacrificial) I'd wind up monitoring and reporting on progress made (or not) on a more formal and more often schedule.

Then the third level employee not getting it done, who is supervised by the second level level employee who has his own overload and oversight of the third level guy only on paper, would have to address this with myself and the guy at the top on a regular basis, to discuss solutions.

This communication happens already, but not often enough. Authoritative statements and commitments get made in meetings which are immediately discarded afterward. Rinse and repeat ....

EDIT: I've invited top management and the players involved to meet tomorrow - we'll see how this plays out. :bonk:
 
Last edited:

Mike S.

Happy to be Alive
Trusted Information Resource
#9
Let the ineffective management come up with the correction and corrective action.

If they think they are not the root cause, let those with the obviously superior intellect tell you what the root cause and corresponding correction and CA is and you can just write it up and have them sign it and submit it.

Don;t sacrifice yourself for unappreciative people. It'll all come out in the wash. :popcorn:
 
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