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Definition 3.6 (Root cause)

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One of multiple factors (events, conditions, or organizational factors) that contributed to or created the proximate cause and subsequent failure and, if eliminated, or modified would have prevented the failure.

For some failure modes, it may be possible to identify a single root cause, but most failure modes will have several contributing causes. All too often, failures are attributed to a proximate cause, such as human error or technical failure. These are often merely symptoms, and not the root causes of the failure. Very often, the root causes turn out to be much more, such as (i) process or program deficiencies, (ii) system or organization deficiencies, (iii) inadequate or ambiguous work instructions, and/or (iv) inadequate training.

To identify root causes of failures and to rectify these is important for any system in the operational phase. It does not help only to correct the proximate causes (such as to replace the battery of the flashlight in Example 3.10) when a failure has occurred. This way, the same failure may recur many times. If, on the other hand, the root cause is rectified, the failure may never recur. Root cause analysis is briefly discussed in Section 3.7.

System Reliability Theory

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