Scaled Management Systems

Part 8c – The Concepts of Incident Causation

Common examples of sophisticated causation analysis models

Kepner Tregoe Causation Model

www.pstc.org/files/public/Schramke.pdf

Stair – Step Model of Causation

International Journal of Engineering – Construction Accident Causal Models

Failure Modes Effects Analysis (FMEA)

Process Analysis Tool

Ishikawa Fishbone Diagram

asq.org-cause analysis tools-fishbone

 

Summary

We have seen how our thinking can be influenced by a wide range of social interpretations and how, in turn, our behaviours influence the way we approach incident investigation.

We can only hope to create a culture of continual improvement in the organisation if we change our thinking and assist others to not only follow but practice these improved skills.

The more people we encourage to adopt an analytical approach to systems design & improvement the faster will be the transition to a culture based on the prevention of error.