Root-cause analysis tools can help identify the underlying causes of problems. The document discusses several tools: Brainstorming is used to generate ideas in a structured group session, following principles like forbidding criticism and limiting sessions to 60 minutes. The 5 Whys tool asks "why" five times to drill down through problems to their root causes. Affinity diagrams group interrelated causes into categories to identify major causes. Pareto charts identify the most important causes addressing 80% of the problem. Fishbone diagrams show the relationship between effects and multiple potential causes. Other tools covered include interviewing staff, fault trees, and general tips for effective root cause analysis.

1. ESSENTIAL ROOT-CAUSE
ANALYSIS TOOLS

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Root-Cause-Analysis Tools: Brainstorming
“Brainstorming" is a
frequently used tool - but it
is just as often used
incorrectly or ineffectively.
To get useful results from a
brainstorming session, you
should follow a structured
and moderated process.
Brainstorming in Root Cause
Analysis is applicable when
facing Problem types of
simple complexity.
Phase 2: Sort and evaluate
After a break, all ideas are
now read out by the
moderator and discussed,
evaluated and sorted by
the participants. At first,
this is only about
thematic connections and
sorting out ideas that are
not relevant to the
problem
Phase 1: Find Ideas
The first step is to search for
ideas in a moderated group
session. All participants are
asked to name topics
spontaneously if possible.
These are noted on
individual pieces of paper or
cards.
All thoughts are allowed. It
is forbidden to criticize,
reject or evaluate ideas.

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Root-Cause-Analysis Tools: Brainstorming (cont.)
To run an effective Brainstorming session, you should stick to 7 basic principles:
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03
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07
01
Maximum 60 Minutes
No brainstorming should last more than 60 minutes. A topic should
be discussed for a maximum of 25 minutes - after that you should
take a break. If necessary, take another 25 minutes afterwards.
Save the details
Save the details for the end of the brainstorming
session. Avoid discussing the benefits of an idea in too
much detail in the beginning. This can rob the idea of
its energy right from the start and prevent further
suggestions
Focus
Define the task or problem precisely with a targeted
statement and make sure that the participants do
not deviate from the topic. The first step in solving a
problem is always to clearly define the starting
position.
Boss at the end
The safest way to make a brainstorming fail is to
let the boss talk first. Employees do not want to
contradict.
Numbers and Names
Number and name the ideas so that they can
be referred to again and again in the
subsequent discussion without losing the
overview.
Physically active
Use other tools that stimulate other parts of
the brain: modelling clay, building blocks, play
figures, tape, glue or scissors. Build your ideas.
Spread (physically)
Spread as many flipcharts or tables
around the room as possible so that
participants can write down ideas
(without having to stand in front of the
whole group).
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06

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Root-Cause-Analysis Tools: 5 Whys
The 5 Why’s Analysis is a
simple tool for drilling down
on the problem statement
until the root cause is
identified asking “WHY” 5
times.
It is applicable when you are
looking at one major cause
and if it needs drill down to
arrive at one root cause
 Avoid intentional or
unintentional bias while
answering
 Find the right person who
can answer
 Use other Tools
complementary
Problem
1. Why
2. Why
3. Why
4. Why
5. Why
Because our response
time for service inquires
is to long
The number of customer
problems was clearly
underestimated
There was no systematic
end-user testing before
the product was launched
Customers rate
service Quality low
Because we don’t
have enough people
working in Service
The product still has numerous
teething troubles and was not
yet ready for the market
Root Cause

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Root-Cause-Analysis Tools: 5 Whys (Example II)
The 5 Why’s Analysis is a
simple tool for drilling down
on the problem statement
until the root cause is
identified asking “WHY” 5
times.
It is applicable when you are
looking at one major cause and
if it needs drill down to arrive at
one root cause
 Avoid intentional or
unintentional bias while
answering
 Find the right person who
can answer
 Use other Tools
complementary
Problem
1. Why
2. Why
3. Why
4. Why
5. Why
There is often damage
in transit
Packaging specifications
are incomplete
No holistic
Quality Strategy
Failures in Products are
2 times the industry
average
Packaging is
insufficient
There are no technical
specifications for
packaging in the company
Root Cause

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Root-Cause-Analysis Tools: 5 Whys (cont.)
The Process
of the 5 Whys
is often
subdivided in
4 main steps:
Until and unless you define
the problem properly, solving
it is going to be an uphill task.
Spend some time ensuring
that you’ve defined the
problem well. The detailed
your definition of the
problem is, the easier will be
for you to solve it.
Check one layer at a time
and keep shooting a
“Why” as soon as you
come across a problem at
every level.
Fixing the problem alone
is not going to give you
the real value. Pay
attention to fixing the
error and the cause so you
a prevent any future
occurrences of the
problem.
Determine if a Cause is the
Actual Root Cause. Every time
you come across a cause, stop
there and take some time to
analyze if that is the root cause
or not.
You may have to repeat Step 2 &
3 a couple of times before
coming to a conclusion
about the actual
root cause.
1 2 3
4
Agree on
Problem
Execute the
Whys
Check the
Cause Fix it

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Root-Cause-Analysis Tools: Affinity Diagram
The Affinity Diagram is a simple tool for putting together a large number of
details and inter-related causes and group them according to broad topics.
This helps in focussing on the
bigger picture and major
root causes.
It is applicable when looking
at several, inter-related and
detailed causes which have
some things in common and
can be grouped together to
see the major causes
1. Define the Problem
Why is our
customer service
sub-standard?
2. Brainstorm Root Causes
Not enough
phone lines
Not enough
Staff
Untrained
Staff
Growth was
to
fast
Staff aren’t
compensated
Not enough
Top-Level
Support
No Guidelines
and no Control
Staff not
motivated
3. Group inter-related causes
Growth was to
fast
Not enough
Staff
Untrained Staff
No
Guidelines
and no
Control
Staff feel
unappreciated
Staff feel
unappreciated
Not enough
Top-Level
Support
Staff not
motivated
Not enough
phone lines
Staff aren’t
compensated

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3. Leadership Issues
4. Resources and Tools
2. Lack of processes
1. Human Resources Issues
Root-Cause-Analysis Tools: Affinity Diagram (cont)
No Guidelines
and no Control
4.
Identify
the
major
causes
Not enough
Staff
Untrained
Staff
Staff feel
unappreciated
Not enough
Top-Level
Support
Staff not
motivated
Not enough
phone lines
Staff aren’t
compensated

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Root-Cause-Analysis Tools: Pareto Analysis
The Pareto Chart is used to show
the relative importance of a set
of measurements. The Pareto
Analysis enables you to:
- Identify the most important
improvement areas
- Identify the most important
causes to address
- Prioritize the most important
solutions to implement
- Show improvement over time
(when executed and compared
regularly)
- Identify follow-up actions
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20
13
11 10
4
2
71%
80%
88%
96% 99% 100%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0#
5#
10#
15#
20#
25#
30#
35#
40#
45#
Error 1 Error 2 Error 8
Error 7
Error 4
56%
Error 3 Error 5 Error 6
32%
Cumulative %
Frequency

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Root-Cause-Analysis Tools: Pareto Analysis (cont.)
The Pareto Analysis uses the
Pareto Principle – which is also
known as the “80/20” rule:
Ideas behind the principle:
- 80% of problems are traced
to 20% of the causes
- 80% of the tasks can be
completed in 20% of the
disposable time. The
remaining 20% of tasks will
take up 80% of the time
- 80% of the productivity can
be achieved by doing 20% of
the tasks
06
Draw and label the one vertical
axis from 0 to 100 percent
Draw and label the left-hand
vertical axis with the unit of
comparison, such as frequency,
cost or time
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02
Total the raw data in each category,
then determine the grand total by
adding the totals of each category.
Determine the categories and the
units for comparison of the data,
such as frequency, cost, or time.
01
04
Determine the cumulative
percent of each category
Re-order the categories from
largest to smallest.
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08
Draw a line graph beginning to
represent the cumulative percent
for each category as measured on
the Percentage Axis
Beginning with the largest
category, draw in bars for each
category representing the total for
that category
07
Analyze the chart. Usually the top
20% of the categories will comprise
roughly 80% of the cumulative total
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Root-Cause-Analysis Tools: Fishbone Diagrams
The Fishbone Diagram is a tool used
for identifying the root cause based on
Cause & Effect relationship. They are
also called “Cause and Effect” or
“Ishikawa” Diagrams
 Fishbone Diagrams are very useful
for the analysis of complex
problems
 Grouping the courses can be based
on the major cause analysis shown
previously
The Fishbone Diagram is applicable
when looking at numerous major
causes and you need drill down to
arrive a numerous root causes based
on their Cause and Effect Relationships
A
B
A
B
A
B
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2 4 6
New Competitor
with
new technology
New Customer
Behavior
No Change
Management
No Project
Controlling
Disregard of R+D
Lack of Market
Research
structure does not
correspond to
Project
Management
Lack of
Motivation
No Standards for
Quality
Management
Contradiction
between Duties
and Power
Lack of Training
No Process
Controlling
External
Environment
Project
Management
Management
Structure People Process Approach
Reduced
Competitiveness

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Root-Cause-Analysis Tools: Fishbone Diagrams (cont.)
To build a good and actionable Fishbone
diagram:
Be sure everyone agrees on the effect
or problem statement before beginning
Be succinct
For each node, think what could be its
causes. Add them to the tree
Pursue each line of causality back to its
root cause
Consider grafting relatively empty
branches onto others
Consider splitting up overcrowded
branches
Consider which root causes are most
likely to merit further investigation
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Plan and implement actions to
address key causes
Discuss why the found causes
are there
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02
Write down the key effect or
symptom at the center-right of
the page and draw a horizontal
spine
Form a small team of people
with complementary skills to
work on the problem
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04
Use Brainstorming to build the diagram,
adding causes or cause areas to the
appropriate ribs or sub-ribs as they
appear
Draw the main cause area 'ribs'
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Root-Cause-Analysis Tools: Interviewing
When interviewing
your staff on
problems and root
causes, it is
important to ask the
right questions in
the right way –
otherwise you won’t
get actionable
information.
Open-Ended
Ask open ended
questions.
Current and Future
Consider actual and
potential problems.
Responsibility
Focus on the people
responsible – but get
information from all
relevant people.
Be prepared
Collect relevant data
first in order to ask
the right questions.
All levels
Question people on all levels
in the responsible functions in
order to get a comprehensive
view on the problem.
No consulting
Don’t lead or consult
during the interviews – let
somebody else conduct
the interview if you think
your presence might
influence.

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Root-Cause-Analysis Tools: Fault Trees
A fault tree is a graphical
representation of the logical structure
displaying the relationship between
an undesired potential event (top
event) and all its probable causes.
• Top-down approach to failure
analysis
• Starting with a potential undesirable
event (top event)
• Determining all the ways in which it
can occur
• Mitigation measures can be
developed to minimize the
probability of the undesired event
Terminology
Name Form Description
AND gate To show that the output event occurs only if all the
input events occur
OR gate To show that the output event occurs only if one or
more of the input events occurs
Basic event A basic event requires no further development
because the appropriate limit of resolution has been
reached
Intermediate event An intermediate event occurs because of one or more
antecedent causes acting through logic gates
Transfer A triangle indicates that the tree is developed further
at the occurrence of the corresponding transfer
symbol
Underdeveloped
event
A diamond is used to define an event which is not
further developed either because it is of insufficient
consequence or because of insufficient information

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Fault Trees (Steps)
Fault tree analysis is a
logic diagram for
finding deductive
failures in which using
logic flows to combine
different lower-level
factors. It is also used
for tracing all possible
important factors and
branches of events.
Normally the more
complex the case is,
the more extensive the
framework of fault tree
framework will be.
Define the
system and
determine the
top event.
What’s the scope
of the issue or
system that
you’re analyzing?
What constitutes
“failure”?
“How will this
impact my
business?”
Break down each
event as much as
possible.
If “failure” means
having stock left
over from a pop up
sale, your
intermediate
events could be
1) venue problems
AND/OR
2) stock problems
AND/OR
3) seller problems.
Explore each
branch in
successive detail.
Continue the
top-down
process until the
root cause for
each branch is
identified
(basically, when
you can’t
decompose
further).
Analyze and solve
the fault tree.
Now that you
know all the
possible causes of
failure, you can
analyze the fault
tree and create a
plan of action to
address risk
factors.
Perform
corrections and
make decisions.
This is the last
step in the failure
tree analysis
method. You have
your plan of
action–all that’s
left to do now is
implement it.
Define Structure Explore Analyze Decide
1 2 3 4 5
The Fault Tree Analysis is executed in 5 major steps:

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Fault Trees (Example)
Fault trees can help to:
• Quantifying probability of top
event occurrence
• Evaluating proposed system
architecture attributes
• Assessing design modifications
and identify areas requiring
attention
• Complying with qualitative and
quantitative safety/reliability
objectives
• Qualitatively illustrate failure
condition classification of a top-
level event
• Establishing maintenance tasks
and intervals from
safety/reliability assessments
Lack of Goods
Sales on the Web
shop are low
Lack of goods
People not
buying
Shop has
technical issues
Low
Inventory /
no sufficient
stock
Availability
of product
is low
Economy
slow sales
everywhere
Price is too
high
Product
Appeal
Internet is
slow
Software is
outdated

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Fault Trees (Rules)
The construction of fault
trees is a process that
evolved gradually over
years – and has been
adopted by many different
functions and sectors.
But what is important:
“Successful” fault trees are
drawn in accordance of
basic rules.
Specificity
Classifications
Distinctive
Protectiveness
Pinpoint
Be as specific as possible 
Replace abstract events by less abstract events
Use classifications 
Classify an event into more elementary events
Identify distinct causes for an event
Couple trigger events with “no protective
action”
Pinpoint a component failure event

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Root-Cause-Analysis: Hints and Tips
To perform a successful
Root Cause Analysis you
should observe a few
basic rules.
• It is important to select the right team to carry out the Root Cause Analysis.
Members should have the knowledge of the process and should be able to
explore the why, what and how
• Don’t jump in with solutions: the problem and the solution may not be obvious
• Make sure you are aware of the causal relationships – not just for the issue but
also for the solution
• Suggest improvements that you can implement and are owned and signed up
to by your team
• Having a facilitator with experience in the process will make things easier
• Practicing the tools and techniques will ensure that you maintain the skills
needed
• Only take responsibility for actions over which you have control: Don’t agree on
an action plan for something you can’t implement

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Root-Cause-Analysis Tools: Pitfalls
Root Cause Analysis
needs some practice
- but if you follow
the above rules
while avoiding the
adjacent pitfalls, it is
a very helpful tool.
• Not understanding the problem and therefore not
defining it correctly
• Not asking for help (internally and externally)
• Not considering all possible failure causes
• Not identifying all root causes
• Not understanding how the system should
operate
• Runaway tests and analysis
• Adopting a “remove & replace” mentality
• Returning the part/product without analysis
• Failing to follow-through
• Jumping to conclusions
• Tearing a system apart without a plan