While the connection between process and cause-and-effect is obvious, organizations typically struggle to use this connection to their advantage during an investigation.  As a result, the investigations stop short of where some of the best solutions reside and typically focus only on what they call the human element of the problem.  For example, a common conclusion to a problem investigation is simply that a “procedure was not followed”.  The proposed solution: “reinforce the procedure” or “retrain on the procedure”.  Sound familiar?  If it does, then you can probably attest to the solutions’ ineffectiveness at actually solving the problem.

So why do we continually fall back into this trap?  We have a tendency to try and simplify the incident investigation which results in generalizing the causes.  If you have generic causes, you get generic solutions.   It’s at this point that the investigation should be taking the opposite approach and diving into the specific details of the process/procedure that was ineffective.  This is easier said than done, but there is a simple tool that can be extremely helpful… a process map.  Next week I will discuss how to use a process map to improve your investigations.

Reinforcing a procedure doesn’t do anything to address gaps within.  If someone doesn’t follow a procedure, it is important to identify “Why?” the procedure wasn’t followed.  Only then will you find that the details aren’t as straightforward as they seem.

“We fly thousands of unaccompanied minors every year and the procedures work when followed.”

Fortunately, neither girl was ever hurt and eventually made it to their final destinations, albeit delayed and a little frightened. No real harm done, so what’s the big deal? As long as we follow the procedures going forward everything should work out just fine.

Now imagine we replaced the word “unaccompanied minor” with “patient” and the word “wrong plane” with “wrong medication” and you immediately change the stakes. A 1999 report issued by the Institute of Medicine (IOM) estimated that between 44,000-98,000 patients die each year as a result of medical errors. Now let’s look at the above again in a different context…

“We perform hundreds of millions of medical procedures every year and the procedures work when followed.”

Doesn’t sound like a very good excuse anymore. The point is that a procedure is simply a series of steps to produce an end result. If we don’t get the outcome expected then the procedure is not effective, even if it works 99% of the time. To improve your processes you must break it down into specific steps and then it is much easier to pinpoint what didn’t go well. At this point in the root cause analysis, you can now dive into the cause-and-effect relationships. To see an example applied the plane incident described above check out the case study and PDF.

 Scroll Wheel to Zoom

A quicker and more effective way to accomplish this task is to use the scroll wheel on your mouse.  The default function for the scroll wheel when using Excel is to scroll up and down the spreadsheet.  To utilize the zooming function, simply hold down on the “Ctrl” button as you scroll.   Whatever your pointer has selected on the screen is what you will zoom into.   You can even try the function right now on this webpage to zoom in/out.          

 Can I change the Default Setting?

Now that you are familiar with this trick, you may end up using it more often than scrolling up and down a spreadsheet.  If so, you can change the default settings to reverse the functions.  To change the default, simply click on the Tools menu, select Options, then click on the General tab.  You should see a check box that says “Zoom on roll with IntelliMouse”.  Check the box and you will able to zoom without having to hold down the “Ctrl” button.  Of course when you want to scroll up and down the spreadsheet, you will now need to hold down “Ctrl”.   With this zooming trick you can quickly move around your cause maps and speed up your root cause analysis investigations.

If you are building a Cause Map directly into Excel, then your focus as the facilitator should be on getting the information captured in the boxes and showing the cause-and-effect relationships with the connectors, not necessarily on getting all of the boxes to align perfectly.  Once you have several causes captured, you can easily go back and align them in a straight line using a function on the drawing toolbar.    

Align and Distribute Function – Where to Find

The align and distribute functions are located on the drawing toolbar under the “Draw” menu, then under the menu titled “Align or Distribute” (figure 1).  To make the functions more accessible, I prefer to pull the functions away from the drop down menu and place them as a toolbar next to the drawing toolbar.  To drag the menu away as its own toolbar, hold your cursor over the top of menu (figure 1).  You should see pop up text that says “Drag to make this menu float.”  Click and pull the menu of functions away and then release.  You can then drag the functions as a toolbar next to the drawing toolbar. 

 Align and Distribute Function – How to Use

Once you have access to the functions, to use them, you simply select all of the objects that you want to line up.  Next, click on the appropriate align function that you need.  For example, to line up the boxes in figure 2, I first highlight the boxes using the white select object arrow (see Part 3 for selecting multiple objects). 

In this case I would want to use align top, middle or bottom.   Note that it is important to keep the sizes of the boxes the same in order for the functions to work as intended.  After clicking on the  ”Align Top” icon, the boxes are aligned with the highest box (figure 3).

If I now want to distribute the boxes so that there is equal spacing between them, with the boxes still highlight/selected, I would then click on the “Distribute horizontally” icon up in the toolbar (figure 4). 

These tips will help prepare your root cause analysis for presentation.

Selecting Boxes – The Basics

First we will begin with some basic notes on the setup within Excel.  Excel has provided two different methods for working with any drawing objects.  Traditionally, Excel is built to be used as a spreadsheet with individual cells.  When you are working with the cells, your cursor looks like a large “plus” sign (figure 1).  I refer to this as the “cell layer” since it is designed to be used to select and highlight individual cells on the spreadsheet.  When working in the “cell layer”, you also have the ability to select, edit, and move boxes.  The second layer available is what I call the “drawing layer” since it is designed to be used only for the drawing functions within Excel.   When you are working in the drawing layer, your cursor looks like a white arrow (figure 2).

Since you are typically using Excel for its spreadsheet capabilities, the default layer is the “cell layer”.  To utilize the “drawing layer”, you will need to click on the white arrow icon located on the drawing toolbar.  You will notice that if you hold your cursor over the white arrow, the name of the icon is “Select Objects” (figure 3).  Once you select the icon, it will stay locked until you unselect it.  You can also transition back to the “plus sign” icon by double clicking on one of the cells in the spreadsheet.

When using either icon/layer, you can move the boxes by clicking on them.  When you are working with the “plus sign” icon in the “cell layer”, you will need to click on the outside edge of the box to move it around.  When you are working with the “white arrow” icon in the “drawing layer”, you can click on any part of the box to move it around.  

Advantage of the “Drawing Layer” – Selecting Multiple Objects

As mentioned above, you can work with the drawing functions using either layer; however, you will find it easier to use the drawing layer when working with boxes, plus you get some additional functionality.  The most significant advantage of using the “drawing layer” is the ability to highlight and select multiple objects at the same time.  For example, if I am working in the “cell layer” with the “plus sign” icon and I try to select several the boxes, I am only able to highlight and select the cells behind the boxes.  I am in the “cell layer”.   

On the other hand, if I use the “white arrow” icon working in the “drawing layer”, and then I try to highlight the objects, I am able to select all of the objects within the dotted line.   Once selected, I can then move the entire group to another location on the spreadsheet.  Obviously, this function is extremely helpful when you need to move larger sections of your root cause analysis captured as a Cause Map.              

Accessing the Connectors Menu

For those who aren’t familiar with the connector function I’ll briefly explain how to locate and use them.  To access the connector functions you must get them from the AutoShapes menu on the Drawing Toolbar.  

Once you find the Connectors Menu, you can then drag it out of the AutoShapes Menu for easier access.  To do this, place your cursor at the top of the Connectors Menu.  A note will pop up and state “Drag to make this menu float”.  Click your mouse and then drag the menu away to create a separate toolbar for the connectors.   

Connecting Boxes

Now that you have found the connectors, using them is straightforward.  The connector that we typically use is the “Elbow Arrow Connector” which is located in the middle of the menu.  Click on the icon and then click on the blue dot connection point for the box you want to begin the connection, drag the cursor to the box you want to connect to, then release.

 The Multiple Connector Trick

Now that you know how to connect boxes together, I’ll show you a connector trick that not many people are aware of.  Let’s say that you have built a map with several boxes.  You now want to connect each of the boxes together.   

Typically, you would have to click on the “elbow arrow connector” icon for each connection that you want to make.  A shortcut, however, allows you to connect all of the boxes without having to click the icon each time.  The shortcut is simple.   Instead of clicking on the “elbow arrow connector” icon just once, DOUBLE CLICK the icon.  You have just put that function into a locked state.  Now you can draw as many connectors as you want without having to click on the toolbar for each one.  Give it a try.  With the shortcut from last week’s blog for copy and pasting a box, and this shortcut for attaching multiple connectors, you can really speed up the process of building your maps in Excel.  Check back next week for the next tip in the series.

Over the next few weeks I plan to blog about some of the shortcuts/tricks that I regularly use to speed up Cause Mapping in Excel.  Many of these tips are covered in the workshop, but they aren’t easy to remember once you need them.  This first week, I will review the quickest way to copy and paste a box, what we refer to as “control drag”.  Most Excel users are aware that there are many different ways to copy and paste an object. For example, typing “Ctrl” + “C” then “Ctrl” + “V” is a commonly used function to copy and paste an object.  To use the “control drag” function you simply click on and drag the box or object that you want to copy as if you are moving it to a different location (fig 1).   Before you release the box you hold down the “Ctrl” button.  Your cursor will change to an arrow with a plus sign (fig 2). You then release the left click on your mouse to drop a copy of the box.  Make sure that you are still holding down on the “Ctrl” button when you release the box. 

With a little practice you will find that this is a much faster way to copy an object since you can place it exactly where you want it on the map.  Check back next week for another Excel Tip.

The reason this question is so commonly asked is because people are concerned about over-analyzing a problem.   Everyone is under time constraints, and the thought of performing a detailed and thorough investigation seems time intensive.  This doesn’t have to be the case, as you will see…

The answer that I give is not always popular: In most all cases, as soon as you have gone too far, it becomes obvious.  Fortunately, this realization typically occurs as soon as you start overanalyzing, so time spent is negligible.    As soon as you realize it, you can then change your focus to another aspect of the investigation. 

Unsatisfied?  Another guideline that I often cite is to keep asking “Why?” questions until you get into things that you have no control or influence over.  After all, if you are taking the time to investigate the incident, then you are probably interested in all of the possible solutions that are available.  In order to easily identify those solutions, you need to know all of the causes. 

If anything, the concern that people should have when conducting a root cause analysis is the opposite, not going far enough or under analyzing the problem.  Of the cause maps that I’ve reviewed in my time, the most common error that is made is NOT asking too many “Why?” questions, it’s not asking enough of them.