THE
HUMAN
FACTOR
Focus on Finlays
The importance of root cause analysis
Words: Michael Keating
When it comes to safety, we must ensure we keep asking ‘why?’ until we get to the real root cause, or causes, of an incident, and not stop when we identify a human factor unless it’s justified.
At Finlays, our approach to Health & Safety focuses on being positive and proactive by engaging all our people to prevent injuries or ill-health.
However proactive we are though, adverse incidents will sometimes occur, and these must be properly investigated to understand why, and action taken to minimize the potential for recurrence. This requires effective Root Cause Analysis (RCA), a capability we have been building, including the introduction of a Finlays Root Cause Problem Solving Standard, with training.
In 2023 we reviewed all incident investigations, which confirmed that our root-cause analysis has improved, while also identifying an opportunity for further improvement.
We found that around 50% of the investigations carried out attributed the root cause(s) to ‘human factors’, such as wrong assumptions, a willingness to take shortcuts, poor behavior and habit pattern. So were we stopping short of always getting to the real root cause?
However proactive we are though, adverse incidents will sometimes occur.
A common investigation methodology is the ‘5 Whys’ approach where the investigators keep asking ‘why?’ until they get to the root cause(s). Evidence indicates we sometimes stop asking ‘why?’ when we identify a ‘human factor’ instead of continuing to ask ‘why?’, e.g. why did they take a short cut or make the wrong assumption?
Root cause(s) often involve a combination of management, system, production and cultural challenges, that require real honesty and ownership to identify, but which can provide great opportunities for improvement.
We are continuing to improve our investigation skills at both business unit and group level, to ensure we’ve really asked the final ‘why?’, and to confirm we’re really identifying the root cause(s).
The root-cause analysis of any adverse incident is integral to the continual improvement cycle that underpins our positive and proactive approach. We also apply the principle to what’s working well, so we can maintain, share and replicate success.
Mike Keating
Group Head of Health and Safety Michael.keating@FInlays.net
