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Root cause analysis: Difference between revisions
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It works less well when you are a pioneer, fighting through jungle thickets, seeking the Indies via a western route, or rolling in your wagon train into the salted deserts of what is now, but wasn’t then, Utah. These are complex systems. Accident investigation theory from {{author|Sidney Dekker}} has the following observation: | It works less well when you are a pioneer, fighting through jungle thickets, seeking the Indies via a western route, or rolling in your wagon train into the salted deserts of what is now, but wasn’t then, Utah. These are complex systems. Accident investigation theory from {{author|Sidney Dekker}} has the following observation: | ||
:''We think there is something like ''the'' cause of a mishap (sometimes we call it the [[root cause]] or the [[primary cause]]), and if we look in the rubble hard enough, we will find it there. The reality is that there is no such thing as ''the'' cause, or [[primary cause]] or [[root cause]]. Cause is something we construct, not find.''<ref>{{fieldguide}}, 33.<ref> | :''We think there is something like ''the'' cause of a mishap (sometimes we call it the [[root cause]] or the [[primary cause]]), and if we look in the rubble hard enough, we will find it there. The reality is that there is no such thing as ''the'' cause, or [[primary cause]] or [[root cause]]. Cause is something we construct, not find.''<ref>{{fieldguide}}, 33.</ref> | ||