Root Cause and Camels

In tertiary risk management courses, one is urged to look for “contributory factors” to an event.  An event can be a specific action or failure but a good investigation looks at the factors that led, or conspired, to the failure – “contributory factors” – as well as the failure itself.

For example, a common phrase is “the straw that broke the camel’s back” meaning a specific event that caused damage.  The common application of this phrase focuses on a single event in an already overburdened situation.

However occupational health and safety (OHS) expands this single event over time and work to analyse the cumulative effects on the camel of carrying innumerable straws.  It just so happened that one particular straw broke the camel’s back.

OHS is also about the cumulative effect of hazards on a company’s health.  There are a multitude of camels and a multitude of straws but the focus remains the same – investigate the combination of issues or hazards that culminated in an injury, event or disaster.

Decades ago investigators would look for a “root cause”, a phrase rarely applied in the technical discipline now but one that remains in common parlance.  However, root cause is not something that OHS professionals should forget or ignore.  A root cause can be an aim of an investigation but not one that dismisses other possibilities.  This may be why the term is out of vogue because it implies a fixation, an “Ahab”, which is a perspective that leads to very poor decision-making in all of the areas of work, business and life.

Kevin Jones

Categories business, consultation, OHS, risk, safety, Uncategorized, workplaceTags , ,

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