SlideShare ist ein Scribd-Unternehmen logo
1 von 54
Downloaden Sie, um offline zu lesen
‫المشكلة‬ ‫جذور‬ ‫أسباب‬ ‫تحليل‬
Root Cause Analysis (RCA)
Tracing a Problem to Its Origin
Abdelrahman Elsheikh Seedahmed , M.sc, PMOC,CBAP, PMP, RMP, ACP, PMI-SP,
KPI-A, EVM,CPRE, MCITP, MCTS, OCP, OCA, ITIL v3, CTFL, ISO20000, ISO27002
Abdelrahman Elsheikh Bio
 15 years experience as Strategic PMO Director, Strategy Execution
Consultant, PMO Consultant, Project Manager, Business Analyst and
Software Engineer.
• Master Degree in Software Engineering.
• Project Management Office Certification (PMOC).
• Certified Project Management Professional (PMP).
• Agile Certified Practitioner (PMI-ACP).
• Risk Management Professional (PMI-RMP).
• Schedule Professional (PMI-SP).
• Certified Business Analyst Professional (CBAP).
• Microsoft Certified IT Professional (MCITP).
• Key Performance Indicator Associate (KPI-A).
• OCP and OCA.
• Certified Professional for Requirement Engineer (CPRE).
• Certified Tester Foundation Level (CTFL).
• Earned Value Project Management (EVM).
• ISO/IEC 20000 Foundation.
• ISO/IEC 27002 Foundation.
• Certified ITIL Foundation Level.
Agenda
• Introduction.
• Root Cause Analysis (RCA) Definition.
• The Root Cause Analysis Process.
• Conclusion.
Agenda
• Introduction.
• Root Cause Analysis (RCA) Definition.
• The Root Cause Analysis Process.
• Conclusion.
Introduction
• In medicine, it's easy to understand the difference between treating
the symptoms and curing the condition.
• A broken wrist, for example, really hurts!
• But painkillers will only take away the symptoms; you'll need a
different treatment to help your bones heal properly.
Introduction
• But what do you do when you have a problem at work?
• Do you jump straight in and treat the symptoms, or do you stop to
consider whether there's actually a deeper problem that needs your
attention?
Introduction
• If you only fix the symptoms – what you see on the surface – the
problem will almost certainly return, and need fixing over, and over
again.
• However, if you look deeper to figure out what's causing the
problem, you can fix the underlying systems and processes so that it
goes away for good.
Agenda
• Introduction.
• Root Cause Analysis (RCA) Definition.
• The Root Cause Analysis Process.
• Conclusion.
Root Cause Analysis (RCA) Definition
• Root Cause Analysis (RCA) is a popular and often-used technique
that helps people answer the question of why the problem occurred
in the first place.
Root Cause Analysis (RCA) Definition
• It seeks to identify the origin of a problem using a specific set of
steps, with associated tools, to find the primary cause of the
problem, so that you can:
– Determine what happened.
– Determine why it happened.
– Figure out what to do to reduce the likelihood that it will happen
again.
Root Cause Analysis (RCA) Definition
• Root Cause Analysis (RCA) assumes that systems and events are
interrelated.
• An action in one area triggers an action in another, and another,
and so on.
• By tracing back these actions, you can discover where the problem
started and how it grew into the symptom you're now facing.
Root Cause Analysis (RCA) Definition
• You'll usually find three basic types of causes:
– Physical causes.
– Human causes.
– Organizational causes.
Root Cause Analysis (RCA) Definition
• Physical causes :
– Tangible, material items failed in some way (for example, a car's
brakes stopped working).
Root Cause Analysis (RCA) Definition
• Human causes:
– People did something wrong, or did not do something that was
needed.
– Human causes typically lead to physical causes (for example, no
one filled the brake fluid, which led to the brakes failing).
Root Cause Analysis (RCA) Definition
• Organizational causes:
– A system, process, or policy that people use to make decisions or
do their work is faulty (for example, no one person was
responsible for vehicle maintenance, and everyone assumed
someone else had filled the brake fluid).
Root Cause Analysis (RCA) Definition
• Root Cause Analysis (RCA) looks at all three types of causes.
• It involves investigating the patterns of negative effects, finding
hidden flaws in the system, and discovering specific actions that
contributed to the problem.
Root Cause Analysis (RCA) Definition
• This often means that Root Cause Analysis (RCA) reveals more than
one root cause.
• You can apply Root Cause Analysis (RCA) to almost any situation.
Root Cause Analysis (RCA) Definition
• Determining how far to go in your investigation requires good
judgment and common sense.
• Theoretically, you could continue to trace the root causes back to
the Stone Age, but the effort would serve no useful purpose.
Agenda
• Introduction.
• Root Cause Analysis (RCA) Definition.
• The Root Cause Analysis Process.
• Conclusion.
The Root Cause Analysis Process
• Root Cause Analysis (RCA) has five identifiable steps:
1. Define the Problem.
2. Collect Data.
3. Identify Possible Causal Factors.
4. Identify the Root Cause(s).
5. Recommend and Implement Solutions.
Step 1: Define the Problem
• What do you see happening?
• What are the specific symptoms?
Step 2: Collect Data
• What proof do you have that the problem exists?
• How long has the problem existed?
• What is the Likelihood of the problem?
• What is the impact of the problem?
Step 2: Collect Data
• You need to analyze a situation fully before you can move on to look
at factors that contributed to the problem.
• To maximize the effectiveness of your Root Cause Analysis (RCA), get
together everyone – experts and front line staff – who understands
the situation.
• People who are most familiar with the problem can help lead you to
a better understanding of the issues.
Step 2: Collect Data
• A helpful tool at this stage is CATWOE.
• With this process, you look at the same situation from different
perspectives:
– The Customers.
– The people (Actors) who implement the solutions.
– The Transformation process that's affected.
– The World view.
– The process Owner.
– Environmental constraints.
Step 2: Collect Data
Step 3: Identify Possible Causal Factors
• What sequence of events leads to the problem?
• What conditions allow the problem to occur?
• What other problems surround the occurrence of the central
problem?
Step 3: Identify Possible Causal Factors
• During this stage, identify as many causal factors as possible.
• Too often, people identify one or two factors and then stop, but
that's not sufficient.
• With Root Cause Analysis (RCA), you don't want to simply treat the
most obvious causes – you want to dig deeper.
Step 3: Identify Possible Causal Factors
• Use these tools to help identify causal factors:
– Appreciation (Situational).
– 5 Whys.
– Drill Down.
– Cause and Effect Analysis.
Appreciation (Situational)
• Appreciation helps us uncover factors that we might have ordinarily
missed.
• Using Appreciation is easy.
Appreciation (Situational)
• Starting with a fact, you first ask the question "So what?" – in other
words, what are the implications of that fact? Why is this fact
important? to determine all the possible consequences of a fact.
• You then continue asking that question until you have drawn all
possible conclusions from it.
5 Whys
• Ask "Why?" until you get to the root of the problem.
• You can use 5 Whys for troubleshooting, quality improvement and
problem solving, but it is most effective when used to resolve simple
or moderately difficult problems.
5 Whys
• You need to be more careful when you're tackling complex or
critical problems.
• 5 Whys can lead you to pursue a single track, or a small number of
tracks, of enquiry when there could be multiple causes.
Drill Down
• Break down a problem into small, detailed parts to better
understand the big picture.
• Drill Down" helps you to break a large and complex problem down
into its component parts, so that you can develop plans to deal with
these parts.
• It also shows you which points you need to research in more detail
Drill Down
Cause and Effect Analysis
• Create a chart of all of the possible causal factors, to see where the
trouble may have begun.
• Also known as Cause and Effect Diagrams, Fishbone Diagrams,
Ishikawa Diagrams, Herringbone Diagrams, and Fishikawa
Diagrams.
Cause and Effect Analysis
• When you have a serious problem, it's important to explore all of the
things that could cause it, before you start to think about a solution.
• That way you can solve the problem completely, first time round,
rather than just addressing part of it and having the problem run on
and on.
• Cause and Effect Analysis gives you a useful way of doing this.
Step 4: Identify the Root Cause(s)
• Why does the causal factor exist?
• What is the real reason the problem occurred?
Step 4: Identify the Root Cause(s)
• Use the same tools you used to identify the causal factors (in Step
Three) to look at the roots of each factor.
• These tools are designed to encourage you to dig deeper at each
level of cause and effect.
Step 5: Recommend and Implement Solutions
• What can you do to prevent the problem from happening again?
• How will the solution be implemented?
• Who will be responsible for it?
• What are the risks of implementing the solution?
Step 5: Recommend and Implement Solutions
• Analyze your cause-and-effect process, and identify the changes
needed for various systems.
• It's also important that you plan ahead to predict the effects of your
solution.
• This way, you can spot potential failures before they happen.
Step 5: Recommend and Implement Solutions
• Use these tools to help Recommend and Implement Solutions:
– Failure Mode and Effects Analysis (FMEA).
– Impact Analysis.
– Kaizen.
Failure Mode and Effects Analysis (FMEA)
• This tool builds on the idea of risk analysis to identify points where a
solution could fail.
• FMEA is also a great system to implement across your organization;
the more systems and processes that use FMEA at the start, the less
likely you are to have problems that need Root Cause Analysis
(RCA) in the future.
Failure Mode and Effects Analysis (FMEA)
• By looking at all the things that could possibly go wrong at design
stage, you can cheaply solve problems that would otherwise take
vast effort and expense to correct, if left until the solution has been
deployed in the field.
Failure Mode and Effects Analysis (FMEA)
• More than this, FMEA provides a useful approach for reviewing
existing processes or systems, so that problems with these can be
identified and eliminated.
Impact Analysis
• Also known as Change Impact Analysis, Impact Change Analysis and
Solution Effect Analysis
• This helps you explore possible positive and negative consequences
of a change on different parts of a system or organization.
Kaizen (Continuous Improvement)
• This is the idea that continual small changes create better systems
overall.
• Kaizen also emphasizes that the people closest to a process should
identify places for improvement.
• Again, with Kaizen alive and well in your company, the root causes
of problems can be identified and resolved quickly and effectively.
Agenda
• Introduction.
• Root Cause Analysis (RCA) Definition.
• The Root Cause Analysis Process.
• Conclusion.
Conclusion
• Root Cause Analysis (RCA) is a useful process for understanding and
solving a problem.
• Figure out what negative events are occurring.
• Then, look at the complex systems around those problems, and
identify key points of failure.
• Finally, determine solutions to address those key points, or root
causes.
Conclusion
• You can use many tools to support your Root Cause Analysis (RCA)
process.
• 5 Whys and Cause and Effect Analysis are integral to the process
itself, while Failure Mode and Effects Analysis (FMEA) and Kaizen
help minimize the need for Root Cause Analysis (RCA) in the future.
Conclusion
• As an analytical tool, Root Cause Analysis (RCA) is an essential way
to perform a comprehensive, system-wide review of significant
problems as well as the events and factors leading to them.
Agenda
• Introduction.
• Root Cause Analysis (RCA) Definition.
• The Root Cause Analysis Process.
• Conclusion.
https://www.facebook.com/abdelrahmansida/
https://www.youtube.com/c/abdelrahmanelsheikh
https://www.linkedin.com/in/abdelrahmanelsheikh/
https://twitter.com/AbdelrahmanSida
https://www.slideshare.net/abdelrahmanelsheikh1
Root Cause Analysis تحليل أسباب جذور المشكلة
Root Cause Analysis تحليل أسباب جذور المشكلة

Weitere ähnliche Inhalte

Was ist angesagt?

Root Cause Analysis (RCA)
Root Cause Analysis (RCA)Root Cause Analysis (RCA)
Root Cause Analysis (RCA)
Operational Excellence Consulting
 
Problem solving techniques pdf
Problem solving techniques pdfProblem solving techniques pdf
Problem solving techniques pdf
Ranvijay Akela
 

Was ist angesagt? (20)

Root Cause Analysis Presentation
Root Cause Analysis PresentationRoot Cause Analysis Presentation
Root Cause Analysis Presentation
 
Global 8D Problem Solving Process Training Module
Global 8D Problem Solving Process Training ModuleGlobal 8D Problem Solving Process Training Module
Global 8D Problem Solving Process Training Module
 
5-Why Training
5-Why Training5-Why Training
5-Why Training
 
Root Cause Analysis - Tools, Tips and Tricks to Get to the Bottom of Root Cause
Root Cause Analysis - Tools, Tips and Tricks to Get to the Bottom of Root CauseRoot Cause Analysis - Tools, Tips and Tricks to Get to the Bottom of Root Cause
Root Cause Analysis - Tools, Tips and Tricks to Get to the Bottom of Root Cause
 
Root cause analysis
Root cause analysisRoot cause analysis
Root cause analysis
 
5 why analysis
5 why analysis5 why analysis
5 why analysis
 
Root Cause Analysis
Root Cause AnalysisRoot Cause Analysis
Root Cause Analysis
 
Kaizen
Kaizen Kaizen
Kaizen
 
Root cause analysis - tools and process
Root cause analysis - tools and processRoot cause analysis - tools and process
Root cause analysis - tools and process
 
Root Cause Analysis (RCA)
Root Cause Analysis (RCA)Root Cause Analysis (RCA)
Root Cause Analysis (RCA)
 
Problem solving & Decision making
Problem solving & Decision makingProblem solving & Decision making
Problem solving & Decision making
 
5 why training_presentation
5 why training_presentation5 why training_presentation
5 why training_presentation
 
Root Cause Analysis By Deepak
Root Cause Analysis By DeepakRoot Cause Analysis By Deepak
Root Cause Analysis By Deepak
 
Problem solving techniques pdf
Problem solving techniques pdfProblem solving techniques pdf
Problem solving techniques pdf
 
A Guide to the Five Whys Technique
A Guide to the Five Whys TechniqueA Guide to the Five Whys Technique
A Guide to the Five Whys Technique
 
Root cause analysis using 5 whys
Root cause analysis using 5 whysRoot cause analysis using 5 whys
Root cause analysis using 5 whys
 
Root cause analysis by: ICG Team
Root cause analysis by: ICG TeamRoot cause analysis by: ICG Team
Root cause analysis by: ICG Team
 
5 why analysis training presentaion
5 why analysis training presentaion5 why analysis training presentaion
5 why analysis training presentaion
 
Mini-Training: Using root-cause analysis for problem management
Mini-Training: Using root-cause analysis for problem managementMini-Training: Using root-cause analysis for problem management
Mini-Training: Using root-cause analysis for problem management
 
Root Cause Analysis | 5 whys | Tools of accident investigation I Gaurav Singh...
Root Cause Analysis | 5 whys | Tools of accident investigation I Gaurav Singh...Root Cause Analysis | 5 whys | Tools of accident investigation I Gaurav Singh...
Root Cause Analysis | 5 whys | Tools of accident investigation I Gaurav Singh...
 

Ähnlich wie Root Cause Analysis تحليل أسباب جذور المشكلة

root cause analyse
root cause analyseroot cause analyse
root cause analyse
Abdou El
 
root-cause-analysis.pdf
root-cause-analysis.pdfroot-cause-analysis.pdf
root-cause-analysis.pdf
NelgineGepuit
 

Ähnlich wie Root Cause Analysis تحليل أسباب جذور المشكلة (20)

Root cause analysis
Root cause analysisRoot cause analysis
Root cause analysis
 
2 5 root cause
2 5 root cause2 5 root cause
2 5 root cause
 
root cause analyse
root cause analyseroot cause analyse
root cause analyse
 
2 5 root cause
2 5 root cause2 5 root cause
2 5 root cause
 
Root Cause Analysis
Root Cause AnalysisRoot Cause Analysis
Root Cause Analysis
 
2 5 root cause
2 5 root cause2 5 root cause
2 5 root cause
 
Root-Cause-Analysis.pptx
Root-Cause-Analysis.pptxRoot-Cause-Analysis.pptx
Root-Cause-Analysis.pptx
 
Root cause analysis arg sc
Root cause analysis arg scRoot cause analysis arg sc
Root cause analysis arg sc
 
ОКСАНА ГОРОЩУК «Improving Quality Through Root Cause Analysis»
ОКСАНА ГОРОЩУК «Improving Quality Through Root Cause Analysis»ОКСАНА ГОРОЩУК «Improving Quality Through Root Cause Analysis»
ОКСАНА ГОРОЩУК «Improving Quality Through Root Cause Analysis»
 
Problem Solving Tools and Techniques by TQMI
Problem Solving Tools and Techniques by TQMIProblem Solving Tools and Techniques by TQMI
Problem Solving Tools and Techniques by TQMI
 
Problem Solving Tools and Techniques by TQMI
Problem Solving Tools and Techniques by TQMIProblem Solving Tools and Techniques by TQMI
Problem Solving Tools and Techniques by TQMI
 
Root-Cause-Presentation-Tampa.pptx
Root-Cause-Presentation-Tampa.pptxRoot-Cause-Presentation-Tampa.pptx
Root-Cause-Presentation-Tampa.pptx
 
E book 11problemswithyourrca_process
E book 11problemswithyourrca_processE book 11problemswithyourrca_process
E book 11problemswithyourrca_process
 
Problem solving
Problem solvingProblem solving
Problem solving
 
Root_Cause_Analysis_RCA
Root_Cause_Analysis_RCARoot_Cause_Analysis_RCA
Root_Cause_Analysis_RCA
 
root-cause-analysis.pdf
root-cause-analysis.pdfroot-cause-analysis.pdf
root-cause-analysis.pdf
 
Apollo Introduction
Apollo IntroductionApollo Introduction
Apollo Introduction
 
Cause and effect diagrams
Cause and effect diagramsCause and effect diagrams
Cause and effect diagrams
 
Root Cause Analysis ( RCA )
Root Cause Analysis ( RCA )Root Cause Analysis ( RCA )
Root Cause Analysis ( RCA )
 
Mgt-Summit-RCA-presentation.ppt
Mgt-Summit-RCA-presentation.pptMgt-Summit-RCA-presentation.ppt
Mgt-Summit-RCA-presentation.ppt
 

Mehr von Abdelrahman Elsheikh PMOC,PMP,CBAP,RMP,ACP,SP,MCITP,ITIL

PMBOK 7th Edition What is Changing?
PMBOK 7th Edition What is Changing?PMBOK 7th Edition What is Changing?
Pareto analysis تحليل باريتو
Pareto analysis  تحليل باريتوPareto analysis  تحليل باريتو
Pareto analysis تحليل باريتو
Abdelrahman Elsheikh PMOC,PMP,CBAP,RMP,ACP,SP,MCITP,ITIL
 
Benefits Realization Management إدارة تحقيق المنافع
Benefits Realization Management  إدارة تحقيق المنافعBenefits Realization Management  إدارة تحقيق المنافع
Benefits Realization Management إدارة تحقيق المنافع
Abdelrahman Elsheikh PMOC,PMP,CBAP,RMP,ACP,SP,MCITP,ITIL
 
Strategic PMO Implementation تأسيس وتشغيل مكتب إدارة المشاريع الإستراتيجي
Strategic PMO Implementation  تأسيس وتشغيل مكتب إدارة المشاريع الإستراتيجيStrategic PMO Implementation  تأسيس وتشغيل مكتب إدارة المشاريع الإستراتيجي
Strategic PMO Implementation تأسيس وتشغيل مكتب إدارة المشاريع الإستراتيجي
Abdelrahman Elsheikh PMOC,PMP,CBAP,RMP,ACP,SP,MCITP,ITIL
 
Project Deliverables Workflow دورة حياة تسليمات ومخرجات المشروع
  Project Deliverables Workflow دورة حياة تسليمات ومخرجات المشروع  Project Deliverables Workflow دورة حياة تسليمات ومخرجات المشروع
Project Deliverables Workflow دورة حياة تسليمات ومخرجات المشروع
Abdelrahman Elsheikh PMOC,PMP,CBAP,RMP,ACP,SP,MCITP,ITIL
 
بيانات ومعلومات وتقارير أداء عمل المشروع Project Work Performance Data, Info...
بيانات ومعلومات وتقارير أداء عمل المشروع  Project Work Performance Data, Info...بيانات ومعلومات وتقارير أداء عمل المشروع  Project Work Performance Data, Info...
بيانات ومعلومات وتقارير أداء عمل المشروع Project Work Performance Data, Info...
Abdelrahman Elsheikh PMOC,PMP,CBAP,RMP,ACP,SP,MCITP,ITIL
 
دور مدير المشروع في الإدارة الرشيقة للمشاريع - القيادة بفاعلية
دور مدير المشروع في الإدارة الرشيقة للمشاريع -  القيادة بفاعليةدور مدير المشروع في الإدارة الرشيقة للمشاريع -  القيادة بفاعلية
دور مدير المشروع في الإدارة الرشيقة للمشاريع - القيادة بفاعلية
Abdelrahman Elsheikh PMOC,PMP,CBAP,RMP,ACP,SP,MCITP,ITIL
 

Mehr von Abdelrahman Elsheikh PMOC,PMP,CBAP,RMP,ACP,SP,MCITP,ITIL (20)

PMBOK 7th Edition What is Changing?
PMBOK 7th Edition What is Changing?PMBOK 7th Edition What is Changing?
PMBOK 7th Edition What is Changing?
 
Artificial Intelligence (AI) in Project Management
Artificial Intelligence (AI) in Project ManagementArtificial Intelligence (AI) in Project Management
Artificial Intelligence (AI) in Project Management
 
The Next Generation PMO
The Next Generation PMOThe Next Generation PMO
The Next Generation PMO
 
The New Trends in Project Management الاتجاهات الحديثة في إدارة المشاريع
The New Trends in Project Management  الاتجاهات الحديثة في إدارة المشاريعThe New Trends in Project Management  الاتجاهات الحديثة في إدارة المشاريع
The New Trends in Project Management الاتجاهات الحديثة في إدارة المشاريع
 
العصف الذهني Brainstorming
العصف الذهني  Brainstormingالعصف الذهني  Brainstorming
العصف الذهني Brainstorming
 
Pareto analysis تحليل باريتو
Pareto analysis  تحليل باريتوPareto analysis  تحليل باريتو
Pareto analysis تحليل باريتو
 
Benefits Realization Management إدارة تحقيق المنافع
Benefits Realization Management  إدارة تحقيق المنافعBenefits Realization Management  إدارة تحقيق المنافع
Benefits Realization Management إدارة تحقيق المنافع
 
The Agile PMO مكتب إدارة المشاريع الرشيق
The Agile PMO مكتب إدارة المشاريع الرشيقThe Agile PMO مكتب إدارة المشاريع الرشيق
The Agile PMO مكتب إدارة المشاريع الرشيق
 
PMO Services خدمات مكتب إدارة المشاريع
PMO Services خدمات مكتب إدارة المشاريعPMO Services خدمات مكتب إدارة المشاريع
PMO Services خدمات مكتب إدارة المشاريع
 
Strategic PMO Implementation تأسيس وتشغيل مكتب إدارة المشاريع الإستراتيجي
Strategic PMO Implementation  تأسيس وتشغيل مكتب إدارة المشاريع الإستراتيجيStrategic PMO Implementation  تأسيس وتشغيل مكتب إدارة المشاريع الإستراتيجي
Strategic PMO Implementation تأسيس وتشغيل مكتب إدارة المشاريع الإستراتيجي
 
Project Deliverables Workflow دورة حياة تسليمات ومخرجات المشروع
  Project Deliverables Workflow دورة حياة تسليمات ومخرجات المشروع  Project Deliverables Workflow دورة حياة تسليمات ومخرجات المشروع
Project Deliverables Workflow دورة حياة تسليمات ومخرجات المشروع
 
بيانات ومعلومات وتقارير أداء عمل المشروع Project Work Performance Data, Info...
بيانات ومعلومات وتقارير أداء عمل المشروع  Project Work Performance Data, Info...بيانات ومعلومات وتقارير أداء عمل المشروع  Project Work Performance Data, Info...
بيانات ومعلومات وتقارير أداء عمل المشروع Project Work Performance Data, Info...
 
إدارة القيمة المكتسبة Earned Value Management
إدارة القيمة المكتسبة Earned Value Managementإدارة القيمة المكتسبة Earned Value Management
إدارة القيمة المكتسبة Earned Value Management
 
بطاقة الأداء المتوازن Balanced Scorecard
  بطاقة الأداء المتوازن Balanced Scorecard  بطاقة الأداء المتوازن Balanced Scorecard
بطاقة الأداء المتوازن Balanced Scorecard
 
SWOT Analysis التحليل الرباعي
SWOT Analysis التحليل الرباعيSWOT Analysis التحليل الرباعي
SWOT Analysis التحليل الرباعي
 
إعداد خطة إستراتيجية قابلة للقياس والتطبيق
إعداد خطة إستراتيجية قابلة للقياس والتطبيقإعداد خطة إستراتيجية قابلة للقياس والتطبيق
إعداد خطة إستراتيجية قابلة للقياس والتطبيق
 
Agile certificates, PMI -ACP and Agile practice guide
Agile certificates,  PMI -ACP and Agile practice guideAgile certificates,  PMI -ACP and Agile practice guide
Agile certificates, PMI -ACP and Agile practice guide
 
دور مدير المشروع في الإدارة الرشيقة للمشاريع - القيادة بفاعلية
دور مدير المشروع في الإدارة الرشيقة للمشاريع -  القيادة بفاعليةدور مدير المشروع في الإدارة الرشيقة للمشاريع -  القيادة بفاعلية
دور مدير المشروع في الإدارة الرشيقة للمشاريع - القيادة بفاعلية
 
Agile project from visibility to closing (مشروع الإدارة الرشيقة من الفكرة الى...
Agile project from visibility to closing (مشروع الإدارة الرشيقة من الفكرة الى...Agile project from visibility to closing (مشروع الإدارة الرشيقة من الفكرة الى...
Agile project from visibility to closing (مشروع الإدارة الرشيقة من الفكرة الى...
 
Agile Mindset (عقلية وطرق التفكير في الإدارة الرشيقة للمشاريع)
Agile Mindset (عقلية وطرق التفكير في الإدارة الرشيقة للمشاريع)Agile Mindset (عقلية وطرق التفكير في الإدارة الرشيقة للمشاريع)
Agile Mindset (عقلية وطرق التفكير في الإدارة الرشيقة للمشاريع)
 

Kürzlich hochgeladen

The Psychology Of Motivation - Richard Brown
The Psychology Of Motivation - Richard BrownThe Psychology Of Motivation - Richard Brown
The Psychology Of Motivation - Richard Brown
SandaliGurusinghe2
 
internship thesis pakistan aeronautical complex kamra
internship thesis pakistan aeronautical complex kamrainternship thesis pakistan aeronautical complex kamra
internship thesis pakistan aeronautical complex kamra
AllTops
 
Beyond the Codes_Repositioning towards sustainable development
Beyond the Codes_Repositioning towards sustainable developmentBeyond the Codes_Repositioning towards sustainable development
Beyond the Codes_Repositioning towards sustainable development
Nimot Muili
 
Abortion pills in Jeddah |• +966572737505 ] GET CYTOTEC
Abortion pills in Jeddah |• +966572737505 ] GET CYTOTECAbortion pills in Jeddah |• +966572737505 ] GET CYTOTEC
Abortion pills in Jeddah |• +966572737505 ] GET CYTOTEC
Abortion pills in Riyadh +966572737505 get cytotec
 

Kürzlich hochgeladen (14)

The Psychology Of Motivation - Richard Brown
The Psychology Of Motivation - Richard BrownThe Psychology Of Motivation - Richard Brown
The Psychology Of Motivation - Richard Brown
 
digital Human resource management presentation.pdf
digital Human resource management presentation.pdfdigital Human resource management presentation.pdf
digital Human resource management presentation.pdf
 
Persuasive and Communication is the art of negotiation.
Persuasive and Communication is the art of negotiation.Persuasive and Communication is the art of negotiation.
Persuasive and Communication is the art of negotiation.
 
International Ocean Transportation p.pdf
International Ocean Transportation p.pdfInternational Ocean Transportation p.pdf
International Ocean Transportation p.pdf
 
Marketing Management 16th edition by Philip Kotler test bank.docx
Marketing Management 16th edition by Philip Kotler test bank.docxMarketing Management 16th edition by Philip Kotler test bank.docx
Marketing Management 16th edition by Philip Kotler test bank.docx
 
W.H.Bender Quote 62 - Always strive to be a Hospitality Service professional
W.H.Bender Quote 62 - Always strive to be a Hospitality Service professionalW.H.Bender Quote 62 - Always strive to be a Hospitality Service professional
W.H.Bender Quote 62 - Always strive to be a Hospitality Service professional
 
Gautam Buddh Nagar Call Girls 🥰 8617370543 Service Offer VIP Hot Model
Gautam Buddh Nagar Call Girls 🥰 8617370543 Service Offer VIP Hot ModelGautam Buddh Nagar Call Girls 🥰 8617370543 Service Offer VIP Hot Model
Gautam Buddh Nagar Call Girls 🥰 8617370543 Service Offer VIP Hot Model
 
Safety T fire missions army field Artillery
Safety T fire missions army field ArtillerySafety T fire missions army field Artillery
Safety T fire missions army field Artillery
 
How Software Developers Destroy Business Value.pptx
How Software Developers Destroy Business Value.pptxHow Software Developers Destroy Business Value.pptx
How Software Developers Destroy Business Value.pptx
 
Information Technology Project Management, Revised 7th edition test bank.docx
Information Technology Project Management, Revised 7th edition test bank.docxInformation Technology Project Management, Revised 7th edition test bank.docx
Information Technology Project Management, Revised 7th edition test bank.docx
 
internship thesis pakistan aeronautical complex kamra
internship thesis pakistan aeronautical complex kamrainternship thesis pakistan aeronautical complex kamra
internship thesis pakistan aeronautical complex kamra
 
Beyond the Codes_Repositioning towards sustainable development
Beyond the Codes_Repositioning towards sustainable developmentBeyond the Codes_Repositioning towards sustainable development
Beyond the Codes_Repositioning towards sustainable development
 
Abortion pills in Jeddah |• +966572737505 ] GET CYTOTEC
Abortion pills in Jeddah |• +966572737505 ] GET CYTOTECAbortion pills in Jeddah |• +966572737505 ] GET CYTOTEC
Abortion pills in Jeddah |• +966572737505 ] GET CYTOTEC
 
Siliguri Escorts Service Girl ^ 9332606886, WhatsApp Anytime Siliguri
Siliguri Escorts Service Girl ^ 9332606886, WhatsApp Anytime SiliguriSiliguri Escorts Service Girl ^ 9332606886, WhatsApp Anytime Siliguri
Siliguri Escorts Service Girl ^ 9332606886, WhatsApp Anytime Siliguri
 

Root Cause Analysis تحليل أسباب جذور المشكلة

  • 1. ‫المشكلة‬ ‫جذور‬ ‫أسباب‬ ‫تحليل‬ Root Cause Analysis (RCA) Tracing a Problem to Its Origin Abdelrahman Elsheikh Seedahmed , M.sc, PMOC,CBAP, PMP, RMP, ACP, PMI-SP, KPI-A, EVM,CPRE, MCITP, MCTS, OCP, OCA, ITIL v3, CTFL, ISO20000, ISO27002
  • 2. Abdelrahman Elsheikh Bio  15 years experience as Strategic PMO Director, Strategy Execution Consultant, PMO Consultant, Project Manager, Business Analyst and Software Engineer. • Master Degree in Software Engineering. • Project Management Office Certification (PMOC). • Certified Project Management Professional (PMP). • Agile Certified Practitioner (PMI-ACP). • Risk Management Professional (PMI-RMP). • Schedule Professional (PMI-SP). • Certified Business Analyst Professional (CBAP). • Microsoft Certified IT Professional (MCITP). • Key Performance Indicator Associate (KPI-A). • OCP and OCA. • Certified Professional for Requirement Engineer (CPRE). • Certified Tester Foundation Level (CTFL). • Earned Value Project Management (EVM). • ISO/IEC 20000 Foundation. • ISO/IEC 27002 Foundation. • Certified ITIL Foundation Level.
  • 3. Agenda • Introduction. • Root Cause Analysis (RCA) Definition. • The Root Cause Analysis Process. • Conclusion.
  • 4. Agenda • Introduction. • Root Cause Analysis (RCA) Definition. • The Root Cause Analysis Process. • Conclusion.
  • 5. Introduction • In medicine, it's easy to understand the difference between treating the symptoms and curing the condition. • A broken wrist, for example, really hurts! • But painkillers will only take away the symptoms; you'll need a different treatment to help your bones heal properly.
  • 6. Introduction • But what do you do when you have a problem at work? • Do you jump straight in and treat the symptoms, or do you stop to consider whether there's actually a deeper problem that needs your attention?
  • 7. Introduction • If you only fix the symptoms – what you see on the surface – the problem will almost certainly return, and need fixing over, and over again. • However, if you look deeper to figure out what's causing the problem, you can fix the underlying systems and processes so that it goes away for good.
  • 8. Agenda • Introduction. • Root Cause Analysis (RCA) Definition. • The Root Cause Analysis Process. • Conclusion.
  • 9. Root Cause Analysis (RCA) Definition • Root Cause Analysis (RCA) is a popular and often-used technique that helps people answer the question of why the problem occurred in the first place.
  • 10. Root Cause Analysis (RCA) Definition • It seeks to identify the origin of a problem using a specific set of steps, with associated tools, to find the primary cause of the problem, so that you can: – Determine what happened. – Determine why it happened. – Figure out what to do to reduce the likelihood that it will happen again.
  • 11. Root Cause Analysis (RCA) Definition • Root Cause Analysis (RCA) assumes that systems and events are interrelated. • An action in one area triggers an action in another, and another, and so on. • By tracing back these actions, you can discover where the problem started and how it grew into the symptom you're now facing.
  • 12. Root Cause Analysis (RCA) Definition • You'll usually find three basic types of causes: – Physical causes. – Human causes. – Organizational causes.
  • 13. Root Cause Analysis (RCA) Definition • Physical causes : – Tangible, material items failed in some way (for example, a car's brakes stopped working).
  • 14. Root Cause Analysis (RCA) Definition • Human causes: – People did something wrong, or did not do something that was needed. – Human causes typically lead to physical causes (for example, no one filled the brake fluid, which led to the brakes failing).
  • 15. Root Cause Analysis (RCA) Definition • Organizational causes: – A system, process, or policy that people use to make decisions or do their work is faulty (for example, no one person was responsible for vehicle maintenance, and everyone assumed someone else had filled the brake fluid).
  • 16. Root Cause Analysis (RCA) Definition • Root Cause Analysis (RCA) looks at all three types of causes. • It involves investigating the patterns of negative effects, finding hidden flaws in the system, and discovering specific actions that contributed to the problem.
  • 17. Root Cause Analysis (RCA) Definition • This often means that Root Cause Analysis (RCA) reveals more than one root cause. • You can apply Root Cause Analysis (RCA) to almost any situation.
  • 18. Root Cause Analysis (RCA) Definition • Determining how far to go in your investigation requires good judgment and common sense. • Theoretically, you could continue to trace the root causes back to the Stone Age, but the effort would serve no useful purpose.
  • 19. Agenda • Introduction. • Root Cause Analysis (RCA) Definition. • The Root Cause Analysis Process. • Conclusion.
  • 20. The Root Cause Analysis Process • Root Cause Analysis (RCA) has five identifiable steps: 1. Define the Problem. 2. Collect Data. 3. Identify Possible Causal Factors. 4. Identify the Root Cause(s). 5. Recommend and Implement Solutions.
  • 21. Step 1: Define the Problem • What do you see happening? • What are the specific symptoms?
  • 22. Step 2: Collect Data • What proof do you have that the problem exists? • How long has the problem existed? • What is the Likelihood of the problem? • What is the impact of the problem?
  • 23. Step 2: Collect Data • You need to analyze a situation fully before you can move on to look at factors that contributed to the problem. • To maximize the effectiveness of your Root Cause Analysis (RCA), get together everyone – experts and front line staff – who understands the situation. • People who are most familiar with the problem can help lead you to a better understanding of the issues.
  • 24. Step 2: Collect Data • A helpful tool at this stage is CATWOE. • With this process, you look at the same situation from different perspectives: – The Customers. – The people (Actors) who implement the solutions. – The Transformation process that's affected. – The World view. – The process Owner. – Environmental constraints.
  • 26. Step 3: Identify Possible Causal Factors • What sequence of events leads to the problem? • What conditions allow the problem to occur? • What other problems surround the occurrence of the central problem?
  • 27. Step 3: Identify Possible Causal Factors • During this stage, identify as many causal factors as possible. • Too often, people identify one or two factors and then stop, but that's not sufficient. • With Root Cause Analysis (RCA), you don't want to simply treat the most obvious causes – you want to dig deeper.
  • 28. Step 3: Identify Possible Causal Factors • Use these tools to help identify causal factors: – Appreciation (Situational). – 5 Whys. – Drill Down. – Cause and Effect Analysis.
  • 29. Appreciation (Situational) • Appreciation helps us uncover factors that we might have ordinarily missed. • Using Appreciation is easy.
  • 30. Appreciation (Situational) • Starting with a fact, you first ask the question "So what?" – in other words, what are the implications of that fact? Why is this fact important? to determine all the possible consequences of a fact. • You then continue asking that question until you have drawn all possible conclusions from it.
  • 31. 5 Whys • Ask "Why?" until you get to the root of the problem. • You can use 5 Whys for troubleshooting, quality improvement and problem solving, but it is most effective when used to resolve simple or moderately difficult problems.
  • 32. 5 Whys • You need to be more careful when you're tackling complex or critical problems. • 5 Whys can lead you to pursue a single track, or a small number of tracks, of enquiry when there could be multiple causes.
  • 33. Drill Down • Break down a problem into small, detailed parts to better understand the big picture. • Drill Down" helps you to break a large and complex problem down into its component parts, so that you can develop plans to deal with these parts. • It also shows you which points you need to research in more detail
  • 35. Cause and Effect Analysis • Create a chart of all of the possible causal factors, to see where the trouble may have begun. • Also known as Cause and Effect Diagrams, Fishbone Diagrams, Ishikawa Diagrams, Herringbone Diagrams, and Fishikawa Diagrams.
  • 36. Cause and Effect Analysis • When you have a serious problem, it's important to explore all of the things that could cause it, before you start to think about a solution. • That way you can solve the problem completely, first time round, rather than just addressing part of it and having the problem run on and on. • Cause and Effect Analysis gives you a useful way of doing this.
  • 37. Step 4: Identify the Root Cause(s) • Why does the causal factor exist? • What is the real reason the problem occurred?
  • 38. Step 4: Identify the Root Cause(s) • Use the same tools you used to identify the causal factors (in Step Three) to look at the roots of each factor. • These tools are designed to encourage you to dig deeper at each level of cause and effect.
  • 39. Step 5: Recommend and Implement Solutions • What can you do to prevent the problem from happening again? • How will the solution be implemented? • Who will be responsible for it? • What are the risks of implementing the solution?
  • 40. Step 5: Recommend and Implement Solutions • Analyze your cause-and-effect process, and identify the changes needed for various systems. • It's also important that you plan ahead to predict the effects of your solution. • This way, you can spot potential failures before they happen.
  • 41. Step 5: Recommend and Implement Solutions • Use these tools to help Recommend and Implement Solutions: – Failure Mode and Effects Analysis (FMEA). – Impact Analysis. – Kaizen.
  • 42. Failure Mode and Effects Analysis (FMEA) • This tool builds on the idea of risk analysis to identify points where a solution could fail. • FMEA is also a great system to implement across your organization; the more systems and processes that use FMEA at the start, the less likely you are to have problems that need Root Cause Analysis (RCA) in the future.
  • 43. Failure Mode and Effects Analysis (FMEA) • By looking at all the things that could possibly go wrong at design stage, you can cheaply solve problems that would otherwise take vast effort and expense to correct, if left until the solution has been deployed in the field.
  • 44. Failure Mode and Effects Analysis (FMEA) • More than this, FMEA provides a useful approach for reviewing existing processes or systems, so that problems with these can be identified and eliminated.
  • 45. Impact Analysis • Also known as Change Impact Analysis, Impact Change Analysis and Solution Effect Analysis • This helps you explore possible positive and negative consequences of a change on different parts of a system or organization.
  • 46. Kaizen (Continuous Improvement) • This is the idea that continual small changes create better systems overall. • Kaizen also emphasizes that the people closest to a process should identify places for improvement. • Again, with Kaizen alive and well in your company, the root causes of problems can be identified and resolved quickly and effectively.
  • 47. Agenda • Introduction. • Root Cause Analysis (RCA) Definition. • The Root Cause Analysis Process. • Conclusion.
  • 48. Conclusion • Root Cause Analysis (RCA) is a useful process for understanding and solving a problem. • Figure out what negative events are occurring. • Then, look at the complex systems around those problems, and identify key points of failure. • Finally, determine solutions to address those key points, or root causes.
  • 49. Conclusion • You can use many tools to support your Root Cause Analysis (RCA) process. • 5 Whys and Cause and Effect Analysis are integral to the process itself, while Failure Mode and Effects Analysis (FMEA) and Kaizen help minimize the need for Root Cause Analysis (RCA) in the future.
  • 50. Conclusion • As an analytical tool, Root Cause Analysis (RCA) is an essential way to perform a comprehensive, system-wide review of significant problems as well as the events and factors leading to them.
  • 51. Agenda • Introduction. • Root Cause Analysis (RCA) Definition. • The Root Cause Analysis Process. • Conclusion.