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At the recent OEUK HSE Conference 2024, COMET's very own dynamic duo, Potential Pete (Craig Smith) and Wreck-It Roy (Mark Rushton), took the stage to present insights into the capabilities of COMET software and the profound impact root causes can have on organisational safety and performance. Potential Pete symbolises dormant root causes, patiently waiting to escalate, while Wreck-It Roy embodies active causes, causing chaos impulsively. Despite the audience's thought-provoking questions, time constraints limited our ability to provide comprehensive answers during the presentation.
Now, let's take a deep dive into these questions and answers in this blog:
Q. Can you discuss your views on hindsight bias limitations when conducting an investigation, and what would you advise to avoid?
A. Obviously, the old saying 'with the benefit of hindsight' can often find its way into investigation teams particularly when reviewing why certain barriers, controls or methods were or weren't followed by the team on the particular day and/or event in question.
Investigators should always be open-minded and not allow their biases to block out potential important discoveries. That said, often when we have a 'gut feeling' about something that's because there likely is something worth exploring, even without other evidence. The important thing is not to draw unfair or biased investigation outcomes without evidence! Nine times out of ten a process helps – guiding you through a fuller spectrum of potential outcomes instead of just allowing you to focus on where you think causation lies.
Q. The potential of a root cause can be such a wide target in terms of focusing preventative measures; how do you ensure we target the correct issue?
A. We often state that actions or measures should not just focus on the root cause(s), but the context behind those root causes(s). That context can only come from the investigation and facts of the event, therefore if this is done well in the first instance and we truly understand 'what' happened, then our root cause(s) will have deeper meaning and context, which can then be addressed properly. Investigators need to understand the difference between preventive and corrective too – and ensure they fix the 'why' not the 'what'!
Q. We all have seen some great investigations following various root cause analysis (RCA) methods. Is one of the challenges 'finishing' with action close out to realise the benefit?
A. Absolutely, conducting a great investigation and root cause analysis without proper action management and effectiveness tracking is largely a pointless exercise. The action is just as important as the analysis, and should be subject to proper rigour and close-out management. That's how to give yourself the best chance of preventing re-occurrence! To do that actions need to be firmly focussed on their respective root causes and be resourced appropriately. For that to happen they should be realistic and achievable so a wider knowledge of what is possible is also advantageous.
Q. How do you see Artificial Intelligence (AI) and Machine Learning (ML) technologies influencing root cause learning (RCL)?
A. There are various ways in which AI can assist the investigator in reaching conclusions. The key is that we should not allow AI to make those decisions for us. The ability for AI to review data gathered during an investigation and provide well-structured 'potential' causes is wonderful, but the investigator should always retain control of final outcomes. We see the use of AI as strengthening decision-making, increasing confidence levels in key preventive decisions and ultimately removing the need for Health, Safety, Environmental and Quality (HSEQ) leaders to act on 'gut feel'. AI quickly sorts and understands patterns that suggest systemic trends and can be deep-dived by human experts to assess their overall credibility, this can mean finite budgets get pointed exactly where they need to in order to secure maximum ROI. A joined-up strategy is key to delivering 'repeat incident-free' performance.
Conclusion
In conclusion, these Q&A’s submitted to COMET’s Root Causes (Potential Pete & Wreck It Roy) at the OEUK HSE Conference provided valuable insights into the complexities of root cause investigations and the role of innovative technologies like AI in safety management. These discussions underscored the importance of maintaining objectivity, understanding contextual factors, and prioritising action management in incident prevention and safety improvement efforts. As COMET continues to lead the way in safety management solutions, partnerships, and thought leadership, we remain committed to empowering organisations to proactively address root causes, enhance safety culture, and achieve incident-free performance.
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Watch the highlights reel from the OEUK HSE Conference 2024 here:
