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The Fallacy of Root Cause Analysis:
Use Baldrige to Avoid Wasteful Oversimplification

We were just reviewing an internal client assessment report of a long-standing
problem in a key program and we noticed the following conclusion:

Root Cause of Program Management Deficiencies: Employee Turnover,
Inexperience, and Lack of Training

Program management deficiencies are caused principally by turnover,
inexperience, and a lack of training within (the organization). These issues
derive from (the organization's) staffing system.

NO! One Category (in this case, Category 5: Workforce Management) is NOT a
root cause. A staffing system is NOT a root cause. There is no root cause.

Distressing, but all too common. Imagine the mountains of hidden costs to our
society and economy from misguided pursuits of THE ROOT CAUSE. In fact, is
the notion of root cause even honest and viable in modern organizations with
about a bazillion moving parts?

Root cause thinking hearkens back to an industrial age template that no longer
applies. Root cause thinking implies that if we surround ourselves with enough
analytical tools and ask "why" often enough we will come up with some nugget of
information that will lead to a solution. Wrong. Wrong. Wrong on multiple levels.

Root cause thinking automatically leads to chaos. You do not believe us? How
many organizations you know have achieved sustained improvements that matter?
Now check how many of these organizations have conducted root cause analyses.

It is not a mystery. Pursue ONE root cause, and you by definition focus on a small
piece of a much larger system.  And once you have a root cause, you have a
(false) solution. Fix the small piece, you may have a blip of an improvement, and
then nothing. Fix the larger system, and you will fix your organization, and emerge
stronger, fitter, and more competitive for the long run.

OK, so how do you get beyond root cause thinking in your organization? We
suggest, to our root-cause-analyzing client and others, three steps:

Step 1: Pursue new knowledge
Enough with recycling tired and broken ideas in your organization. There are
multiple paths to engaging the systems thinking needed to thrive today. The
easiest is to enter the words systems thinking into your favorite search engine and
spend 20 minutes poking around.

Step 2: Refuse to accept root cause thinking
Do not accept poor thinking and analysis. Use your newly acquired knowledge of
systems and organizations and challenge the status quo in your own organization.
You do not have to accept one category root cause arguments like my client is

Step 3: Collaborate and lead
You have allies. Many allies. Step up the pace of your networking and professional
development and build an informal alliance of like-minded practitioners who can
support and encourage your efforts to promote systems thinking. Look, the
bankruptcy of much of what passes for modern management in well understood;
your challenge is to embody a new perspective for success in your personal and
professional life. This is easier with allies who have been there, done that.