360

international

ROOT CAUSE
ANALYSIS (RCA)
Human Error Incident
Investigation & Analysis

13 - 15 MAY 2014
GULF HOTEL
MANAMA
BAHRAIN

THE
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COURSE OVERVIEW
WHAT IS ROOT CAUSE ANALYSIS (RCA)?
Root Cause Analysis (RCA) is a methodology for finding and correcting the most
important reasons for performance problems. It is different from troubleshooting and
problem-solving as these disciplines typically seek solutions to specific difficulties,
whereas RCA is directed at underlying issues.

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YOUR INTERNATIONA
INTERNATIONAL
COURSE FACILITATOR
Prof. Dominic Cooper
C.Psychol C.FIOSH

The basic RCA method is to simply ask "Why" over and over again until you arrive at a
Root Cause. The real question then becomes: how do we know when to stop asking
"Why"? At what point are we satisfied that we've identified a Root Cause? What is a
Root Cause? These are questions that constantly spark disagreement among RCA
practitioners.

Maslow's Law of Problem Solving:

If the only tool you have is a hammer, every problem looks like a nail.
This course teaches how to lead investigations and root cause analyses using various
techniques such as Causal Factor Charting, Fault Tree Analysis and Root Cause Charts.
This is a How To" course designed to teach these skills.

COURSE COVERAGE
How to develop and implement a structured incident investigations program
- Designed for learning from incidents
- Why and how to define misses
- Includes planning for trending of data

How to initiate and conduct an investigation

- Establishing an effective team quickly
- Methods for collecting different types of data & effective interviewing skills

How to apply causal factor and root cause analysis for investigating process
and non-process incidents
- Includes event and condition charting (causal factor charting)
- 5-Whys technique for finding root causes
- Exploring the behaviours involved in an incident
- Root Cause Charting for categorizing root causes

How to develop appropriate recommendations to address root causes

at various levels to avoid future incidents

How to structure reports

Learn key points and practice your new skills via actual industry examples
and workshops

Wilson's Corollary: Even if a problem really is a nail,

you've still got to know whether to bang it in or yank it out.
REQUIREMENTS FROM COURSE DELEGATES
All participants are required to bring at least two examples of incidents they were
involved in or raised via an accident investigation, management system audit,
incident / risk reporting system or a quality / safety problem they are aware of.
These will be used by each participant in the practical exercises. It is preferable if
these of are of moderate to low concern or are nearmiss incidents.

CEO
BSMS Inc

PROFILE
One of the world's leading authorities in Behavioral
Safety, Prof. Cooper is both a Business Psychologist and
a Safety Professional who has implemented
behavior-based processes internationally for over 20
years. A past Professor at Indiana University, he has
written 6 business books and over 150 articles on
Behavioral Safety, Safety Culture change, and Safety
Leadership.
Much more than an academic, Dr. Cooper has worked
shoulder to shoulder, on-site with frontline managers
and employees, creating and fine-tuning the most
effective Behavioral Safety process available. As the
CEO of his behavioral consulting firm B-Safe
Management Solutions, Dr. Cooper is actively engaged
with clients, is an internationally known speaker, and is
a member of several professional organizations.
Dr. Cooper developed B-Safe, an award winning
Behavioral Safety process, and co-founded BSMS Inc, an
international behavior-based safety consulting firm
operating in the Americas, Africa, Asia, Australasia,
Europe, and the Middle East. His clients consistently
achieve world class safety performance.
Dr. Cooper continues to innovate and refine Behavioral
Safety by actively working as an on-site consultant and
project manager. He maintains his grounding in
real-world safety issues by participating in, and
managing, multi-consultant, multi-site projects on
Behavioral Safety, Safety Culture improvement, and
Safety Leadership.
Professional Qualifications:
Ph.D. from the University of Manchester Institute of
Science and Technology (UMIST)
Chartered Psychologist, Associate Fellow of the British
Psychological Society (BPS)
Chartered Fellow of the Institute of Occupational
Safety & Health (IOSH)
Member of American Society of Safety Engineers (ASSE)
Member of the Society of Petroleum Engineers (SPE)

360 International Limited, Level 8, Pavilion KL, 168 Jalan Bukit Bintang, 55100 Kuala Lumpur, Malaysia.

www.360i-group.com

ROOT CAUSE ANALYSIS

Human Error Incident Investigation & Analysis

COURSE CONTENT

HOW THIS WORKSHOP WILL BE CONDUCTED

DAY1 METHODS OF ROOT CAUSE ANALYSIS

- PART ONE
Developing a structured incident investigation program
How to initiate and conduct an investigation
Basic Introduction to Human Error Theory
- What are the main error modes
- When is blame and punishment appropriate
An exploration of Performance Shaping Factors
- How system-based factors can influence errors in the workplace
Methods of Root Cause Analysis (1): The 5 Whys
A simple investigative method for quickly identifying the root of a
problem, that can be used in a multiple of situations.
Practical Group Exercise: Analyse incidents using the 5 Whys

DAY2 METHODS OF ROOT CAUSE ANALYSIS

- PART TWO

Methods of Root Cause Analysis (2): Causal Factor Charting

Focusing on Plant, People, Premises, Procedures and Processes this
analytic method examines cause and effect to identify root causes of
unwanted incidents and can also be used for problem solving across
a wide array of situations.

WHY THIS EVENT

This workshop has been designed for those who are
expected to conduct root cause analyses in the
workplace.
You will develop an understanding of four different
investigative methods, each method with its own
advantages and disadvantages. Which one is right
for your organization?
This interactive course will also provide you with
new skills critical to the management of safety and
other business activities such as quality and
productivity.
The combination of interactive presentations,
hands-on exercises and open discussion groups
along with real case studies, ensures you will obtain
maximum value from attending.

Practical Group Exercise: Causal factor charting of incidents

Methods of Root Cause Analysis (3): Influencing and causal factors
This method adopts a system-based method to identify and explore the
many organizational, environmental and personal factors that lead to
unwanted incidents.
Practical Group Exercises: Analyse incidents using the influencing and
causal factor method

DAY3 METHODS OF ROOT CAUSE ANALYSIS

- PART TWO

Methods of Root Cause Analysis (4): Applied behavioral Analysis

Discover why people do what they do, and how this information has
been utilized to develop a method to identify the root cause of incidents.
Practical Group Exercise: Analyse an incident using Applied
Behavioural Analysis

Presenting your findings

- How to draft effective recommendations
- How to structure your report
Practical Group Exercise: Prepare an incident report
Seminar Questionnaire Examination

Presentation was to the point & achieved the goal of simplifying the RCA process.
- Anindya Chatterjee, HSE Coordinator, Ras Laffan Power Company
A very good course and it will help us to improve our safety behaviour
- Ezzat Elthany, ADGAS, UAE
"Extremely well presented material with group interactive sessions.
Facilitator well experienced in actual events and practical analysis.
- Ken Wiseman, Div. Manager - RCM, QatarGas

WHO SHOULD ATTEND

Vice Presidents, Directors, General Managers

Safety Managers, Supervisors and Engineers
HSE Professionals and Safety Auditors
Site/Plant/Factory/Operations Managers
Maintenance Engineers and Managers
Facilities Management & Training Managers

COURSE SCHEDULE
8.00
8.30
10.00 - 10.20
12.30 - 13.30
14.40 - 15.00
16.00

360 International Limited, Level 8, Pavilion KL, 168 Jalan Bukit Bintang, 55100 Kuala Lumpur, Malaysia.

Registration & Coffee / Tea

Workshop commences
Morning coffee / tea
Lunch
Afternoon coffee / tea
End of day

www.360i-group.com