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Arabian American Center October Training & Development
Program Title:
Prepare RCA for Basic Incident, Perform Complex RCA, Launch Corrective Action, Liaise with Teams
Location:
Dubai
Date:
07.10.2018 - 11.10.2018
Fees:
$ 3900

Description

Course Overview

   This course provides the participants with an overview of incident investigation. The motivation for this course is to outline a procedure of incident investigation that is objective and satisfies most regulatory requirements. Many organizations fail to learn from their mistakes and near misses, some organizations even fail to learn from their accidents. Often, one can see the same accidents happening over and over again. There are many reasons why organizations do not learn to prevent the recurrence of accidents. When an accident occurs, it is important that it be investigated thoroughly. The results of a comprehensive accident report can help organizations pinpoint the cause of the accident.

 

   This information can then be used to prevent future accidents, which is the primary purpose of accident investigation. This course teaches how to lead investigations and root cause analyses using various techniques.


   It is often a common practice, either due to lack of time, lack of adequate information or knowledge (or both) that equipment and system failures are often investigated at a superficial level. As a result maintainers and operators keep running unreliable plant, causing repeated losses and become experts at fixing rather than preventing the problems.

 

  Root Cause Analysis (RCA) is a structured investigation of a defined problem that aims to identify the “true” cause and the actions necessary to eliminate it. The technique is used by many manufacturing companies to eliminate recurring and significant equipment failures.


  For high performers, Root Cause Analysis is one of the techniques required to attain the last few percent on equipment efficiency.


  Get to the root of your recurring problems and identify optimum solutions. This course gets you involved in using techniques to define the problem, determine the situation, analyze data, select the best solution, evaluate improvement, and follow-up results.


  As an investigative tool, RCA provides a broad assortment of options to deepen the understanding of root cause, such as incident linking, editable parameters, and Business success depends on how well we manage risk, so we begin with a discussion of quantitative and qualitative risks.  Human failures are more difficult to manage, but they matter a lot, so we will address this subject in some detail.  You will learn about Root Cause Analysis, a powerful reactive problem-solving tool, and get a good understanding of where and how to apply the method.

 

   Most incidents (accidents, near-misses) don’t “just happen”, something or someone causes them to happen. Their outcome – i.e. whether injury or damage actually results, or the severity of that injury or damage – is largely a matter of chance, therefore, it is essential that any incident which had a potential to cause significant harm or damage is investigated, irrespective of the actual outcome. Incidents indicate underlying problems that have either resulted in injury or loss, or could do so in the future.


Target Audience

   Controllers Production, Engineers, Supervisors, It is aimed at people with a stake in Operational and production Success working in the Oil & Gas Industry, Manufacturing Plants, Chemical, Pharmaceutical Industries, Contractors and other Service providers. You will learn the principal pro-active and reactive methods that will improve the performance of your plant as a result of better reliability and availability of your facilities.


Course Objectives

               • How to meet regulatory requirements for incident investigations.

               • How to develop and implement a structured program designed for learning from incidents.

               • How to initiate and conduct an investigation.

               • How and when to apply causal factor and root cause analysis for investigating process and

                   non-process incidents.

               • How to develop appropriate recommendations to address root causes at various levels to avoid

                  future incidents.

 

               • How to structure reports.

               • Understand the applicability of actuarial analysis in the application of RCM.

               • Participate in the development of a successful physical asset maintenance plan based on the

                  RCM principles.

               • Understand how to align the implementation of RCM and the resulting failure management

                  policies to the risks associated with processes, systems, and physical assets and their possible

                  failures.

               • Identify corrective action(s) that will with certainty prevent recurrence of each harmful effect,

                   including outcomes and factors. Check that each corrective action would, if pre-implemented

                   before the event, have reduced or prevented specific harmful effects.

 

               • Encourage ownership through involvement of operators and maintainers in defining solutions

               • Perform root cause analysis for all operating parameters and implement corrective action to

                   optimize production and maintain quality

               • Apply a methodical technique to identify the sequence of events that resulted in the serious

                   occurrence (time line analysis/data mapping/building blocks).

               • Use simple incident tree evaluation to obtain root cause.

               • Prepare corrective actions.


Training Methodology

   A highly interactive combination of lectures and discussion sessions will be managed to maximize the amount and quality of information and knowledge transfer. The sessions will start by raising the most relevant questions, and motivate everybody find the right answers. You will also be encouraged to raise your own questions and to share in the development of the right answers using your own analysis and experiences.  Tests of multiple-choice type will be made available on daily basis to examine the effectiveness of delivering the course.


   All presentations are made in excellent colorful power point. Very useful Course Materials will be given.

               • 30% Lectures

               • 30% Workshops and work presentation

               • 20% Group/individual Work or projects & Practical Exercises

               • 20% Videos& General Discussions, Case studies etc…


Course Contents:

               • Incident and accident investigation

                                Human contribution to accidents

                                The role of root cause Analysis in identifying management system failures

                                Accident investigation techniques I: Fault Tree Analysis 'FTA'

                                Working in small groups on the use of FTA

                                Preparation of action plans

                                Incident investigation techniques II: Events & Causal Factors Analysis 'E&CFA'

                                Group exercise on investigating a multiple-fatalities accident involving offshore

                                     drilling rig


               • Introduction to root cause analysis and techniques

                                Root cause analysis principles

                                Techniques for causal factor identification

                                Root cause mapping

                                Corrective actions

                                Reporting


               • How RCA's Work

                                Key RCA roles

                                NORMS-based analysis of information

                                Development of corrective and preventive actions

                                Review findings, assess, and implement actions

                                Writing a Good Report and lessons to be learned

                                Action plan and follow up


               • Form & Focus the Team

                                Form a Team

                                Focus the Team

                                Understand the Problem


               • Find the Root Cause

                                Create a cause & effect diagram

                                Explore chains of causes

                                Study interrelationships

                                Use data analysis & investigative tools

                                Identify root causes


               • Root Cause Analysis Concepts

                                Root cause analysis is a process

                                Causal factor charting

                                Root cause identification

                                Recommendation generation and implementation


               • The nature of process problems affecting performance

                                Performance defined in terms of generic variables: Speed; Quality; and Cost

                                Effort inputs in context - Asset based or Business Process based

                                Structured approach - The Operations Process redefined

                                Configuration; Operation; and Optimization

                                Maturity Indexing: Planning; Control, Congruence, Empowerment

                                6 Big Losses, 7 Wastes


               • Tools and Techniques - Practical Experience

                                Interactive and Dynamic variable relationships analysis

                                Techniques introduction

                                Tools introduction

                                Problem Analysis

                                Practical Use of Tools and Techniques

                                Case Studies

                                Tools & Techniques - selecting the right one  


               • Fix the Root Cause

                                Propose potential solutions

                                Select the "best" solution

                                Conduct a reality test

                                Develop Action Plan to implement solution

                                Verify the solution


               • Finalize the Solution

                                Validate the solution

                                Update documentation

                                Train

                                Start audits

                                Transfer knowledge


               • Overcoming Barriers

                                Barriers to Root Causes Analysis with potential remedies


               • Problem solving process - Root Cause Analysis

               • RCA techniques – Fault Trees/Change Analysis/Barrier Analysis/Pareto Analysis and

                  Fishbone Diagrams

               • Quantitative Risk

               • Qualitative Risk

               • Performance Measurement

 

               • Human Error and its Causes

               • Learning from Failures

               • RCM Principles and Methodology

               • FMECA

               • Control system response for ESD

 

               • Identifying control systems discrepancies

               • Monitoring equipment performance

               • Routine instrumentation

               • Controllers checks & reporting defective controls to maintenance

               • Conducting root cause analysis for all operating parameters

 

               • Task-bundling

               • Preventive Maintenance Routines and Maintenance Management Systems

               • Scheduling

               • Work execution

               • Compliance

 

               • Reward Systems

               • Explain the purpose, principles and benefits of incident investigation

               • Carry out the advance planning necessary for effective incident investigations

               • Complete the necessary documentation and report required for the incident investigation

                  process.

               • Evaluate overall recommendation areas against investigation findings.

 

               • Motivate employees to submit incident reports

               • Distinguish root cause from symptom

               • Use the six problem solving steps

               • Understand when and how to use:

                                Flowcharting

                                Brainstorming

                                Cause & effect diagrams

                                Check sheets

                                Nominal group techniques

                                Pareto analysis


               • Performance Monitoring

               • Implementation

               • Reporting Results

               • Lateral Learning

               • Holding the Gains

               • Apply to ISO 9001 requirements for preventive and corrective action


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