Identify the Problem – the key to Root Cause Analysis

18 August 2017 Lean in Industry Blog
by Ross Kennedy, 18 August 2017

Recently I ran a very successful public workshop on Frontline Problem Solving Root Cause Analysis. This approach is designed to assist all levels in a company from Manager to Shopfloor, to develop effective Root Cause Analysis skills – a critical foundation for Operational Excellence.

During the workshop we have the delegates form teams and work on a problem or incident they have brought along from their workplace.

One team’s problem was presented as a recent incident at their site involving a quality loss from filling the incorrect amount of product into the container on their high speed capsule bottling line. It was reported that some packs or bundles when checked at their weigh scales, failed indicating that some containers had less than the required 50 capsules. As they investigated the problem they found a crack in the glass of their visual sensing system on the filler. This was replaced, and the problem resolved. Hence they wanted to work on the problem of ‘Filled Bottles – incorrect bundle weights’.

As they progressed through the first four steps of the 7 Step process: Define ProblemContain ProblemAnalyse Problem and Develop Root Cause Solutions, they realised that the problem they should be working on is ‘Sensor Glass – cracked’, because in the workplace under the pressure of getting production out, they had assumed replacing the cracked glass would solve the problem. When in fact, as they started asking ‘Why’ a few times over, there were a lot of possible issues that should have been followed up on so that the glass never cracks again.

This is a great example, and not an uncommon example, we come across as we get people out of the workplace to start to appreciate what Root Cause Analysis is all about. It is not about learning how to fix a problem quicker in the workplace – they already had done that by being able to immediately stop the line, inspect the equipment, find the cracked glass and get it quickly replace. It is about how to stop the problem from happening again.

If you would like to learn more about CTPM – The Centre for Australasian TPM & Lean, and our approach to Frontline Problem Solving Root Cause Analysis, contact myself Ross Kennedy at


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