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The definition of the word analysis is "to break down into parts." Analyzing an incident means breaking the incident down into its parts. These parts are really the causes of the incident. A thorough analysis of an incident provides a clear understanding of the specific cause and effect relationships (refs. 8-10). Anytime we are building a Cause Map we are analyzing the issue. The two aspects that make the Cause Map so effective are the systems approach to cause and effect and that the Cause Map is literally a visual map of the issue. Our thinking and speech tend to be very linear and the visual Cause Map helps move us to a systems view. Building a Cause Map for an incident is a significant improvement over just discussing an issue (ref. 11). The Cause Map can easily handle multiple points of view on one issue and we can add as much detail as necessary. When people argue because each of them has their own point to make we can now acknowledge both perspectives and recognize that they we’re talking about two different paths of the same Cause Map.
This is typically one of the biggest surprises when people begin using Cause Maps is that they can accommodate different points of view – from the machinist, to the operator, to the business manager, to the engineer. They may all be telling the truth, but if they’re thinking right-answer on a systems issue they will have disagreements. The Cause Map is about taking people that would typically disagree in conversation and asking them to put what they know in front of everyone. The Cause Map allows us to capture the sum of the intelligence of a group – something that most organizations don’t do effectively. There are also several excellent technology tools that make building and capturing cause maps extremely simple.
The Cause Map becomes an objective third party that asks a lot of "Why?" questions. Each cause on the map is followed up with another “Why?” question. The people in a conference room look at the map, not at each other when they disagree. People can add their specific causes so that others can “see” what they’re talking about. Anyone can add his or her specific causes without even saying a word by walking over to the map and adding them – this is extremely effective when using Post-It? notes. The map also becomes a document that we keep. The nature of discussions and disagreement will improve because people can see the map, point at it, touch it, and challenge it. If people move into new jobs we don’t necessarily have to re-learn our mistakes if we have been capturing them on Cause Maps as they happened. Cause Maps also become excellent troubleshooting guides. If a solution is implemented and the problem occurs again then that solution was obviously not effective. The next question is “Why?” and we go right back to the Cause Map that was made previously. Don’t reinvent the wheel! Take advantage of the all the knowledge within your organization and make it available to others.
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