April 1, 2024 | Alex Paradies

Volume Negates Luck: Why You Should Investigate More

luck

I often hear people say they don’t have many major incidents to investigate so they are not able to grow their investigation skills. This is a problem because being great at investigations is a skill, and not luck.

Have you heard the story of the pottery teacher?

There is a pottery teacher who has two classes. In the first class, he gives them one assignment for the whole semester. Come back with one pot, the best you can make. In the second class, he gives a different assignment. Make the most total quantity of clay pots.

luck

Which class do you think had the better pots at the end of the semester? See the video to hear the full story.

How Does Volume Negate Luck When It Comes To Investigations?

TapRooT® is incredible at making sure you are asking the right questions but if you aren’t practicing the technique it can often feel overwhelming. The first time people go through the TapRooT® Root Cause Tree® they realize how much they left on the table. By the 10th time they are familiar with the questions and become faster at collecting evidence.

So, if you don’t have lots of major investigations to perform,
how can you build your skill?

Practice, Practice, Practice… Precursors?

To get the volume necessary to be a great investigator you need to be proactive. You can not wait for a major failure. There are 4 things you can use to practice your TapRooT® Skills.

  1. Low-Medium Risk Investigation
  2. Audit Findings
  3. Precursor Incidents
  4. Mapping How Work Is Actually Done vs Work As Imagined

1. Low-Medium Risk Investigation

If you are not already using TapRooT® at your default RCA method for all types of investigations, you are leaving opportunities on the table. Not only are you missing out on potential improvements in those investigations but you are also not getting the practice you need for a major investigation.

TapRooT® RCA has a Low-Medium Risk Investigation Model to help you quickly find real Root Causes for your more frequent investigations.

2. Audit Findings

One of the easiest ways to practice your TapRooT® Skills is to use it proactively for audits. If you haven’t attended a 5-Day Advanced TapRooT® RCA Team Leader Course you may not know the process using TapRooT® proactively.

Audits are often a huge missed opportunity for practice because even those companies do a ton of auditing they rarely do root cause analysis when they find significant issues. By combining TapRooT® RCA techniques with your Audits you can get practice going through the tree, find missing best practices, and write better corrective actions out of your audits.

3. Precursor Incidents

You many not be familiar with what a precursor incident is, they are one of the most important things to be practicing your TapRooT® Skills with. The definition of a precursor incident is:

PRECURSOR INCIDENT
Minor incidents that could have been a major accident
if one or two more Safeguards would have failed.

A “precursor” implies that something WILL happen in the future if we don’t do something. We were very close to a disaster that would happen if we didn’t make changes. So investigate these types of incidents even if they didn’t cause an injury.

4. Mapping How Work Is Actually Done vs Work As Imagined

One final way to be proactive is to map out work as it is done vs work as imagined. This is similar to the TapRooT® Auditing process. However, audits are a normal part of your management system so adding TapRooT® to the mix would not require doing extra work.

Analyzing Work as imagined vs work as done is a less formal exercise designed to better understand the gaps in work and improve processes over time. There are 4 steps to applying TapRooT® To this process shown below.

work as done vs work as imagined

Don’t Rely on Luck!

If you would like to learn to flexibly use advanced root cause analysis to investigate incidents, you should attend the 5-Day TapRooT® Advanced Root Cause Analysis Team Leader Course. To see our upcoming public 5-Day TapRooT® Courses, CLICK HERE.

TapRooT® Investigation

If you want to learn best practices for incident investigation and root cause analysis while networking with industry leaders, you’re in luck! Attend the Global TapRooT® Summit. To register for the Summit, CLICK HERE and stop a major accident from happening.

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