A unified framework elucidates the equivalence and complementarity of root cause analysis techniques and their results' completeness

Milos Ferjencik and Stepan Jirman

Reliability Engineering and System Safety, 2025, vol. 264, issue PA

Abstract: Determining the causes of an undesirable event is essential for preventing the recurrence of similar events in the future. Countless methods/techniques based on several approaches have been developed to determine the underlying/root causes. Generally, root cause analysis (RCA) steps are described as WHAT – HOW – WHY. To explain the meaning of HOW and WHY, this article constructs a unified framework, resulting in the novel identification of the underlying/root cause set. Adoption of this framework provides cause analysis practitioners with several advantages. It highlights the connection between cause identification and safety control understanding, answering old objections to RCA. It makes RCA results' width and depth more apparent, thus improving the evaluation of the completeness of results. It improves the understanding of individual techniques/methods functioning and their suitability for specific situations. Adopting a unified framework results in a general flowchart called the Integrated Procedure for Incident Cause Analysis (IPICA) version 3.0. The procedure is divided into two stages and represents a guide for combining methods/techniques. The unified framework makes it possible to decide under what conditions the methods/techniques we use to identify underlying causes are complementary to each other and whether they provide equivalent results. When we distinguish primary and secondary RCAs, the advantages of a unified framework relate to every primary RCA and indirectly to any computerized secondary RCA. The unified framework can potentially be used to develop computerized cause determination further. An example of an old oil industry incident illustrates the article's argumentation.

Keywords: Root cause; Underlying cause; Hazard control; Control structure; Flawed substructure; Flaw propagation (search for similar items in EconPapers)
Date: 2025
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Persistent link: https://EconPapers.repec.org/RePEc:eee:reensy:v:264:y:2025:i:pa:s0951832025005137

DOI: 10.1016/j.ress.2025.111312

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