Root cause analysis (RCA) map of hyperlinks

Investigate causes after an incident to prevent it happening again

Figure 1. RCA sequence and tools

Root cause analysis (RCA) Mitigate AE Definition Incident Decision Tree RCA Indications Notify Authorities Second Victim Systems question list Interview witnesses: Cognitive Timelines RCA Instructions Secure evidence Collect relevant documents ECF chart Event Tree Analysis Tier Analysis Barrier analysis Fault Tree Analysis Non-conformance analysis Change analysis Human factors analysis Causal factor analysis Define root causes Lessons Learned Improvement Plan Report Investigation to Leaders Failure mode and effects analysis (FMEA) Progress Report Long-term followup Feedback to Leaders RCA Statistics

Module hyperlinks

Decision Process

Proximal Data Collection

Distal Data Collection

Analysis

Written Report

Rules & Theory