Beyond the Five Whys: Root Cause Analysis and Systems Thinking (Paterson James C.)(Pevná vazba) - diskuze

A straightforward explanation of root cause analysis and systems thinking, illustrating, with real-world examples and first-hand accounts, why things can ‘slip through our fingers’ and what to do to reduce the chances of things going off track. Beyond the Five Whys summarises, for the first time, many of the tried and tested ways of understanding problems using insights from aviation, high reliability organisations and a range of thought-provoking sources. The book provides readers with a clear and structured explanation how to analyse setbacks and head off problems in the first place. It will challenge much of the received wisdom, such as the idea there can be one root cause or that a person or bad culture could be a root cause. Specific areas covered: Learn what root causes are, how they differ from immediate and contributing causes and why it’s so important to go beyond the Five Whys technique for root cause analysis. Recalibrate the way you think about things going wrong, incorporating insights from systems thinking, so you can be clearer what ‘cultural’ or systemic problems mean in practice. Learn about the eight principal ways things can slip through our fingers. Go beyond the blame game and firefighting to avoid the never ending cycle of repeating issues. Strengthen your ability to read the output of a ‘lessons learned’ or enquiry report. Get a fresh perspective, using these techniques, on why the Titanic trag
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