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I have participated in a Root Cause Analysis investigation during my work experience in a food service environment when there was an issue related to temperature monitoring in food storage. Some temperature logs were not being recorded consistently, which could potentially affect food safety. During the investigation, the team reviewed the procedures, checked the equipment, and discussed the process with staff members. The root cause was identified as a lack of clear understanding and training regarding the importance of temperature logging, so additional training and clearer instructions were provided to improve compliance. If the wrong root cause is identified during an investigation, it can negatively impact a company in several ways. First, the actual problem will remain unresolved, which may lead to repeated issues such as food safety incidents or product defects. Second, the company may waste time, money, and resources implementing corrective actions that do not solve the real problem. To conduct Root Cause Analysis effectively, several transferable skills are important, including critical thinking, attention to detail, and strong problem-solving abilities. Communication and teamwork skills are also essential because investigations often require collaboration between different departments, while organizational and analytical skills help ensure the investigation process is accurate and well-structured.

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During my co-op as a QA technician in a food production facility, I was involved in a root cause analysis after a foreign material was detected during my routine line check. The material was small and black, and it was observed at the baking stage. Since there were no ingredients in the product formulation that matched this material, the investigation began by checking the entire production process starting from mixing, proofing, and baking. We inspected equipment surfaces and components to determine whether the foreign material came from equipment wear or damage.

During the investigation, we noticed a piece of black rubber under a roller in the proofer conveyor, but after inspection it was determined that it could not enter the product path. Maintenance also inspected other equipment, including the divider, where some black material was present, but it did not match the foreign material found in the product. After continuing the investigation and observing the surrounding area, we identified a damaged plastic pallet used in the mixing area that had fraying pieces. The material matched the foreign material detected in the product, confirming it as the root cause.

If the wrong root cause had been identified, the company might have implemented incorrect corrective actions. For example, unnecessary repairs could have been made to production equipment, leading to downtime and financial loss, while the actual issue would remain unresolved. Additionally, the foreign material contamination could have continued to occur, potentially leading to product recalls or damage to the company's reputation. From this experience, I believe the most important transferable skills for conducting root cause analysis include attention to detail, systematic investigation, critical thinking, and effective communication with cross-functional teams such as maintenance and production.

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During a class activity in my Food Science Technology program, I participated in a Root Cause Analysis for a food safety issue in a simulated production process. Our team reviewed process steps, checked records, and used the 5 Whys method to identify possible causes. We found that improper handling at one stage of the process was the main issue. We then suggested corrective actions such as improving procedures and strengthening employee training.

If the wrong root cause is identified, the real problem may continue and happen again. For example, a company may fix equipment when the real issue is poor handling practices. Another outcome could be financial loss and damage to the company’s reputation due to repeated product issues or recalls.

Important skills include critical thinking, attention to detail, problem solving, and clear communication. These skills help investigators properly analyze problems and explain their findings and solutions.

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In one of courses, my group had mixed results in one of the experiments. As a way of investigating the issue, we inspected the whole process, examined the materials that were employed and examined the manner in which the equipment was being handled. We had a discussion on the steps after which we found the measuring equipment has not been calibrated appropriately. After calibration was done again, we performed the experiment and got valid results. When the root cause is determined incorrectly, this may have a bad impact on an enterprise. As an example, the firm can use the incorrect corrective action and the problem will persist. It is also associated with end up wasting time and resources in attempts to correct an issue that was not the cause. Other vital skills in the implementation of the Root Cause Analysis are critical thinking, attention to details and effective communication. The skills assist the teams to explore issues and locate the right cause.

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·        In a previous role, I participated in a Root Cause Analysis after a recurring operational issue caused delays in a routine workflow. To maintain confidentiality, I won’t mention any company or product names, but the investigation involved mapping the process, gathering data, and using tools like the 5 Whys to understand why the issue kept happening. Although some people initially assumed the problem was due to human error, the RCA revealed that the true cause was a missing verification step in the process design. Once that gap was fixed, the delays decreased significantly, showing how valuable a structured RCA can be.

·        Identifying the wrong root cause can have serious consequences for a company. One major impact is wasted resources—time, money, and labour may be spent fixing the wrong thing, retraining staff unnecessarily, or replacing equipment that isn’t actually the problem. Another impact is that the issue will continue to recur, which can damage internal trust, reduce productivity, and even harm customer confidence if the problem affects product quality or service reliability.

·        Individuals who conduct RCAs regularly rely on several important transferable skills. Critical thinking is essential because they must separate assumptions from evidence and analyze problems objectively. Strong communication skills are also crucial, as RCA investigators need to ask clear questions, collaborate with different teams, and present findings in a way that others can understand. Attention to detail, data interpretation, and systems thinking also play key roles in identifying how different parts of a process interact and where failures originate.

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One situation where I experienced a Root Cause Analysis was during a food preparation setting where a quality issue happened. Some food items were not stored at the correct temperature, which could have affected food safety. During the investigation, the team reviewed the storage procedures, checked the equipment, and looked at how the temperature was being monitored. After reviewing everything, it was found that the main cause of the problem was that the refrigerator temperature was not being checked regularly. To solve this, better monitoring practices and staff reminders were put in place to prevent the issue from happening again.

If the wrong root cause is identified, it can create problems for a company. For example, the company might take the wrong corrective action, which means the original problem will continue to occur. Another possible outcome is financial loss, because the company may spend time and money fixing something that is not actually causing the issue.

In my opinion, some important skills needed for people who conduct Root Cause Analysis are critical thinking, attention to detail, and good communication. These skills help people carefully analyze a situation, identify the real problem, and work with others to find the right solution.

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One experience I had with a Root Cause Analysis was during a laboratory activity in my biotechnology program. During one experiment, our results were inconsistent compared to other groups. Instead of repeating the experiment immediately, we discussed possible causes and reviewed each step of the procedure. After checking the materials and techniques used, we realized the issue was caused by improper aseptic technique that allowed contamination. Identifying the root cause helped us correct the procedure and obtain accurate results in the next trial.

If the wrong root cause is identified in an investigation, it can negatively impact a company. First, the real problem will remain unresolved, which can lead to repeated errors or product defects. Second, it can waste time and resources because the company may implement solutions that do not actually fix the problem.

The most important transferable skills for individuals who conduct Root Cause Analysis include critical thinking, attention to detail, and problem-solving. Communication skills are also important because team members must clearly discuss observations and possible causes to reach the correct conclusion.

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1.At Domino’s, we once had an issue where customer orders were being delayed during peak hours. I participated in a Root Cause Analysis to find out why. By observing the workflow, checking order prep times, and talking to team members, we discovered that the real issue was a bottleneck at the pizza assembly station, not the oven as initially assumed.

2.
If the wrong root cause is identified, the store might waste time and resources fixing something that isn’t the real problem, like replacing ovens unnecessarily. It could also lead to repeated delays, unhappy customers, and decreased team efficiency.

3.
Important skills include critical thinking, attention to detail, problem-solving, teamwork, and clear communication to explain findings and implement the correct solutions.

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One time during our food science project 2 class we had found unexpected mould growth in our product, something which was the opposite of what was supposed to happen, so after looking at all the possibilities in an RCA we realized that the solution hadn't been autoclaved and that led to the growth of microorganisms.

If a company makes a mistake during their RCA, this could lead to them only addressing the symptoms of the real problem or not addressing it at all, which can lead to a loss of capital, time, and effort.

I would say that the main transferable skills needed for RCAs are attention to detail and good problem-solving skills, as these skills are what make narowing down the root cause of problems possible.

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A few years ago, I had an experience at home that felt a lot like a mini Root Cause Analysis. Someone had eaten the leftover dessert I was saving in the fridge, and I had to figure out who it was. I asked questions, looked at who had been in the kitchen recently, and noticed a few crumbs in one of my roommate’s dishes. By piecing together the evidence, I realized it wasn’t intentional they just didn’t know it was mine. The outcome was that we started labeling our food, which solved the problem going forward. It was a small example, but it really showed me how gathering facts and analyzing them carefully can solve a problem efficiently.

I think if the wrong root cause is identified in a professional setting, it can have serious consequences. For example, a company might spend resources fixing the wrong problem, which wastes time and money. Or a safety issue might go unresolved, putting employees or customers at risk. Both outcomes could have been prevented with a proper investigation.

From this experience, I realized that some key transferable skills for RCA are attention to detail, critical thinking, and effective communication. You need to gather accurate information, analyze it without jumping to conclusions, and then clearly explain your findings so the right corrective actions can be taken. Even though my “investigation” was small and personal, it really gave me insight into how root cause analysis works in larger, more complex situations.

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1. While working as kitchen staff, I once took part in a situation that required a root cause analysis. During a busy service period, several food orders were coming out late and customers were waiting longer than usual. Instead of immediately blaming any staff member, the team decided to look deeper into what was causing the issue. We asked questions about the process and tried to understand where the delay was really happening. After discussing it as a team, we realized the main problem was that some ingredients were not fully prepared before service started. The storage area was also disorganized, which made it harder to quickly find what we needed. Once we identified the real cause, we improved our preparation routine before each shift and organized the storage space better. This helped the kitchen run more smoothly and reduced delays during busy hours.

2. If the wrong root cause is identified, it can create several problems for a company. One impact is that the real issue will continue because the company is trying to fix the wrong problem. For example, management might think employees need more training when the actual issue is a problem with equipment or workflow. Another impact is wasted time and resources. A company might invest money or effort into solutions that do not actually solve the problem, which can lower productivity and cause frustration among employees.

3. People who regularly conduct root cause analyses need strong problem-solving skills, good communication, and attention to detail. These skills help them gather the right information, ask useful questions, and understand what is really happening in a process. For example, while working in the kitchen, attention to detail is important when checking food preparation steps, storage, and timing. If something goes wrong, such as food being delayed, good communication and problem-solving skills help the team discuss what happened and figure out the real cause so the same problem can be prevented in the future.

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One of the times I engaged in an informal Root Cause Analysis (RCA) at a former place of work was whenever we realized that there was a common problem with food waste. The team initially believed that the root cause of the issue was that of over-ordering, however, following the investigation into the fridge, we quickly found out that the actual root cause of the problem was the absence of an appropriate rotation system. Older items in the back were expiring undetected as new deliveries were being pushed to the front. Immediately, as soon as we introduced a rule of First-In, First-Out (FIFO) and relocated older inventory to the front, all the waste was eliminated.

Detecting the false root cause can have drastic effects on a company. As an illustration of this, when the manager wrongly faults a slow process on lazy employees, he will spend money on unwarranted training yet the actual issue will be the faulty equipment. Second, it results in low morale since employees feel frustrated when they are coerced to employ solutions that will not exactly solve the problem at hand.

In my opinion, the critical thinking and effective communication are the most significant transferable skills in conducting RCA. You have to be capable of seeing beyond the surface states of the symptoms of the problem and you have to be capable of communicating with other people without causing them to feel accused of something so that they are willing to tell you the truth.

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During one of my food analysis lab our team noticed that the results from a food sample test were inconsistent compared with previous trials. Accurate results are important for evaluating product quality, we decided to review the procedure and conduct a simple Root Cause Analysis. The purpose to understand why the variation happened without assuming the cause. We carefully checked each step of the method, including sample preparation, equipment setup, and measurement procedures. After reviewing the process, we discovered that the analytical balance had not been calibrated properly before weighing the sample, which affected the accuracy of the measurements. Once the balance was calibrated and the equipment not fully clean before using and the test was repeated, the results became consistent and reliable.

If the wrong root cause is identified during an investigation, it can create serious problems for a company. For example, management might blame employees and provide additional training when the real issue is equipment malfunction or a process failure. As a result, the problem will continue to occur. Another outcome is that the company may spend time and money fixing the wrong issue, which can lead to product waste, production delays, or even food safety risks.

Individuals who conduct Root Cause Analysis regularly need several important transferable skills. Critical thinking helps them analyze problems logically and identify the real cause instead of assumptions. Attention to detail is important to detect small process errors that may lead to larger problems. Communication and teamwork are also essential because investigators often need to collect information from different employees and departments to understand what happened.

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During my time working as a QA technician, I participated in a Root Cause Analysis investigation after noticing a documentation issue during a routine review of metal detection records. I saw that one of the labels attached to the record used an outdated company logo instead of the current approved version. Our team wanted to determine why this happened and whether it affected any products. We reviewed the process and spoke with the employees involved, and we discovered that older label stock had been left at the workstation and was accidentally still being used. Once we identified the cause, the outdated labels were removed and replaced, and the team improved workstation checks to prevent it from happening again.

If the wrong root cause is identified during an investigation, it can create several problems for a company. One outcome is that the real issue may continue to occur because the corrective actions are targeting the wrong problem. For example, a company might retrain employees when the real issue was actually outdated materials or equipment being used. Another outcome is wasted time and resources. Companies might spend time implementing unnecessary procedures or changes that do not actually solve the problem, which can affect productivity and trust in the quality system.

Some important transferable skills for conducting RCAs include critical thinking, attention to detail, and strong communication. These skills help investigators carefully analyze situations, gather accurate information from team members, and identify the true cause of a problem so effective solutions can be implemented.

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When I was first promoted to supervisor at my retail job, one of my first tasks was to examine why associates were seemingly dumping items in the warehouse, where they did not belong. We asked associates why they tended to leave items on carts in the back, and the answer was they were unclear as to where items went. Looking into why it was unclear, it was evident that the current signage for storage was not impactful enough, as well as the warehouse in general being very crowded. New signage and training for associates were provided to mitigate this issue.

Identifying the wrong root causes the problem to reoccur. Secondly, this costs the company time and effort, which in business is money.

Critical thinking, attention to detail, and communication are vital for those who conduct RCA's. They must first look deeper into the problem as well as circumstances around the issue, as well as communicate effectively with those it affects.

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1. While working on egg wholesale, one restaurant reported to us, that part of the product was being crushed, easing the spoilage of a fraction of the product. We conduct a RCA as we always promise our customer the best quality possible, we found that the person responsible for the poor quality of the product was the truck driver that was always throwing heavy stuf on top of the egg boxes, so the fine or penalty wasn´t on our side.

2. RCA is pretty important for a company because it is a way to find all the possible paths that may be causing a problem, ensuring a quick solution by avoiding losing time on unrelated stuff. While also lead to a documentation of the problem in order to track it faster or prevent it from happening again.

3. Critical thinking, document control, data analysis.

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In one of my previous jobs in a food preparation area, our team noticed that some packaged items had the wrong expiry date printed on their labels, due to this they had to be discarded to avoid any food safety risk. The supervisor asked us to review the issue using a simple Root Cause Analysis to understand why the error happened. Our task was to find the real reason of the problem without blaming anyone. We carefully looked at the labeling process step by step and used questions similar to the “5 Whys” method. During the investigation, we found that the label printer had reset the previous evening and the date setting was not updated, so the machine printed the wrong expiry date. Because staff trusted the machine settings, no one double-checked the date before printing. After identifying the root cause, a checklist was added requiring employees to verify the machine date at the start of each shift, which prevented the issue from happening again. If the wrong root cause were identified in an investigation, it could negatively impact a company because management might blame employees and provide unnecessary training while the real problem (such as equipment malfunction) continues, or the company could lose money by fixing the wrong issue while product waste or safety risks keep occurring. People who regularly conduct Root Cause Analysis need strong transferable skills such as critical thinking to analyze problems logically, communication to gather information from different team members, and attention to detail so small process errors are not missed.

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During a busy shift at work, our team noticed that customer orders were taking longer than usual. At first, it seemed like the delay was because people were working slowly. However, instead of blaming anyone, we talked as a team to understand what was really causing the problem.

After discussing the situation, we realized that the main issue was poor communication and unclear task assignments during busy hours. Some team members were doing the same tasks while other tasks were being missed. Once we understood this, we decided to divide responsibilities more clearly and communicate better during busy times.

After making these changes, the workflow improved and customer orders were prepared faster. The team worked more smoothly, and the work environment became less stressful. This experience helped me understand how important it is to find the real cause of a problem before trying to fix it.

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During my part-time job at a cafe, I participated in a Root Cause Analysis when we had to dispose of a large amount of milk foam because it spoiled faster than usual during the hot summer. Initially, we thought the milk itself was the problem, but through an RCA, we discovered that the frequent opening of the refrigerator during the humid summer was preventing the milk from staying at the required storage temperature. This experience taught me that identifying the wrong root cause can lead to financial waste by repeatedly replacing ingredients while the actual environmental issue remains. Furthermore, if the true cause of a quality drop is not found, it could lead to serious food safety risks and a loss of consumer trust if a spoiled product is accidentally served. Since then, even if the expiration date hasn't passed, I always check the freshness of the foam before preparing a menu item to ensure quality. To prevent such issues, I believe critical thinking and attention to detail are the most important transferable skills for anyone conducting an RCA.

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During my work experience in a restaurant, I was once part of a small investigation when customers started receiving the wrong orders during a very busy shift. My supervisor asked the team what might have gone wrong. From my side, I explained that during rush hours we were handling many orders at the same time, and sometimes the order tickets were placed in the wrong order on the rack between the front counter and the kitchen. After discussing the situation with everyone, we realized that the main issue was miscommunication and poor organization of the order tickets. To fix the problem, we started double-checking order numbers before handing food to customers and made sure the tickets were arranged properly during busy periods.

If the wrong root cause is identified in an investigation, it can cause serious problems for a company. First, the real issue will continue to happen because the actual cause was never solved. This could lead to repeated mistakes and unhappy customers. Second, the company might waste time and money by implementing solutions that do not actually fix the problem, which can affect productivity and trust in the workplace.

I believe some of the most important transferable skills for people who regularly conduct Root Cause Analysis are critical thinking, communication, and attention to detail. These skills help someone carefully analyze what happened, ask the right questions, and work with others to find the real cause of the problem. These skills are very useful in many workplaces, especially in areas like quality control and food safety.

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Last month, I noticed my houseplants kept dying despite my careful watering. At first, I blamed myself for not having a "green thumb," but I decided to dig deeper using Root Cause Analysis. I asked "why" repeatedly and discovered the real issue: my pots had no drainage holes, so water collected at the bottom and rotted the roots. Once I transferred the plants to better pots, they thrived.

This experience showed me how identifying the wrong root cause can impact a company—for example, a bakery might retrain bakers for burnt cookies when the real issue is a broken oven, wasting money without solving the problem. Similarly, a restaurant could lose customers over salty food without realizing a new ingredient is the cause. T

he most important skills for conducting RCA are curiosity to keep asking "why," observation to look beyond the obvious, and open-mindedness to accept that the first answer is rarely the right one.

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While working as a junior chemist for a cosmetic company, I participated in a Root Cause Analysis (RCA) related to textural inconsistencies in a lipstick formulation. Some batches were reported to be grainy and less smooth during application. The investigation involved reviewing batch records, raw material specifications, and processing conditions. Using the 5 Whys approach, the team determined that the issue was linked to inconsistent cooling during the manufacturing process, which caused improper crystallization of wax components. Adjustments were made to the cooling step and process controls were implemented to ensure more consistent product texture.

If the wrong root cause is identified during an investigation, the company may implement corrective actions that fail to resolve the underlying issue. For example, the organization might replace raw materials or change suppliers when the real problem lies in processing conditions. This can lead to continued product defects, customer complaints, and potential damage to the company’s reputation. Another possible outcome is wasted resources, including time, labour, and financial investment in unnecessary process changes while the actual problem persists.

Several transferable skills are important for individuals who conduct RCAs on a regular basis. Analytical thinking is absolutely essential for systematically evaluating data, identifying patterns, and narrowing down possible causes. Attention to detail is also critical because small variations in procedures, documentation, or environmental conditions can contribute to quality issues.

As well as this, I believe strong communication skills are necessary for gathering accurate information from team members, asking effective questions during investigations, and clearly presenting conclusions and corrective actions.

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In my college life, I experienced something similar to a Root Cause Analysis during a group lab project. Our experiment results were completely different from what we expected, and at first we thought the chemicals were wrong. Instead of guessing, our group started checking each step of the procedure carefully. We reviewed the measurements, equipment setup, and timing of each step. After discussing it together, we realized the real root cause was that the incubator temperature had been set incorrectly, which affected the microbial growth in our samples. This experience showed me how important it is to find the real cause instead of just assuming the problem. If the wrong root cause is identified in a company, it can lead to serious problems. For example, the company might fix the wrong process, so the problem keeps happening again, which wastes time and money. Another outcome is that it could affect product quality or safety, which can damage the company’s reputation and customer trust. Some important transferable skills for people who conduct RCAs regularly include critical thinking, attention to detail, and good communication skills. These skills help teams analyze problems properly, discuss possible causes, and find the correct solution.

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During my microbiology lab, I realized that my Gram stain was incorrect. It’s supposed to come out purple, but when I look through the microscope, it’s bright pink. So, I decided to do a Root Cause Analysis instead.

My professor helped me with the 5 Whys technique:

Why was my sample pink instead of purple? Because the primary Crystal Violet stain didn't stay locked inside the cell walls during the procedure.

Why didn't the stain stay inside the cell walls? Because the decolorizer was left on the slide for too long, which stripped the purple dye out of everything.

Why did I leave the decolorizer on for so long? Because I was strictly following the lab manual, which told me to wait exactly 30 seconds before rinsing.

Why was 30 seconds too long for this specific slide? Because the bacterial smear I prepared was extremely thin. A thin layer of cells gets cleared by alcohol in about 5 seconds, whereas 30 seconds is only meant for a very thick, chunky smear.

Why didn't I know to adjust the timing based on the smear thickness? Because the lab protocol is written as a rigid one time rather than teaching us to watch for the visual endpoint, which is when the blue runoff from the slide turns clear.

So, the root cause isn't just that I'm clumsy; it's that the lab manual gave me one time instead of teaching me to look for a visual cue. Instead of just feeling bad about a student error, I can actually suggest a fix that we should update the manual to say stop when the liquid runs clear. That way, I'm not just fixing my mistake.

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During my work experience at a restaurant, I participated in a Root Cause Analysis after customer complaints about delayed orders during peak hours. Our team reviewed the workflow, observed staff movements, and analyzed order timing. Initially, it was assumed that employees were working slowly, but after investigation we found the real issue was poor task allocation and lack of clear communication during rush periods. Once roles were reassigned and a clearer system was implemented, service time improved significantly. If the wrong root cause had been identified, it could have led to unfairly blaming staff and lowering morale, or investing in unnecessary equipment while the real problem continued. The most important transferable skills for conducting RCAs include critical thinking, observation skills, teamwork, communication, and the ability to analyze situations objectively without assumptions.

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During a lab session, our group noticed that our microbial plate counts were much higher than expected. This meant our food sample appeared contaminated, and we had to repeat the experiment.

Instead of assuming someone handled the sample incorrectly, our instructor guided us through a Root Cause Analysis using the 5 Whys technique.

Why were the microbial counts too high?
Because contamination occurred during sample preparation.

Why did contamination occur?
Because sterile technique was not fully maintained.

Why was sterile technique not maintained?
Because students were rushing and the disinfectant spray was not readily available at each station.

Why wasn’t it available?
Because supplies were not restocked before the lab began.

We realized the root cause was not just student error, but a system issue — lack of preparation and organization of materials. After implementing a checklist to restock supplies before each lab and reinforcing sterile technique procedures, the issue improved significantly.

This experience showed me that RCA helps identify system weaknesses rather than blaming individuals.

If the wrong root cause is identified, it can negatively impact a company or lab.

The most important transferable skills for conducting RCA include:

Critical thinking, Attention to detail, Communication skills, Problem-solving skills.

In conclusion, RCA in a food science lab is essential because food safety depends on accuracy and proper procedures.

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During my previous academic lab experience, I was part of a small investigation when our microbial plate count results were inconsistent over several trials. Some plates showed unusually high counts, while others from the same dilution series showed almost no growth. At first, we thought the media might have been contaminated. However, instead of jumping to conclusions, we decided to step back and go through a simple Root Cause Analysis process.

We reviewed each step: media preparation, autoclave records, incubation temperature logs, and our aseptic techniques. After checking the autoclave log and temperature records, everything seemed normal. Finally, while observing one of the repeat trials, we noticed that the vortexing step before serial dilution was not being done consistently. Some tubes were not mixed thoroughly before transferring to the next dilution. That small inconsistency turned out to be the root cause of the variation in plate counts.

This experience showed me how easy it is to assume the problem is equipment or materials when sometimes it is human process variation. It also taught me the importance of observing the process directly instead of relying only on assumptions.

If the wrong root cause is identified in an investigation, it can seriously impact a company. First, the same problem will likely happen again because the actual issue was never fixed. This can lead to repeated product defects or safety concerns. Second, the company may waste money and time fixing the wrong issue—for example, replacing equipment when the real problem is a training gap. That not only increases costs but can also reduce employee confidence in management decisions.

I believe the most important transferable skills for conducting RCAs are critical thinking, attention to detail, and open-mindedness. Communication is also very important because investigations usually involve multiple people and departments. Finally, emotional control matters—especially in high-pressure situations—so that blame does not interfere with finding the real cause.

Overall, that experience helped me understand that RCA is less about finding someone to blame and more about understanding systems and improving processes. It changed the way I look at problems—not just in labs, but in daily life as well.

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During one of my college lab projects, our experiment kept giving wrong results, so our team did a Root Cause Analysis, or RCA, to find out why. We checked every step, looked at the materials and equipment, and finally realized the problem was a thermometer giving wrong readings, not the experiment itself. This showed us that finding the real cause is really important. If a company finds the wrong cause, it can waste money fixing the wrong thing or let the real problem continue, which can cause delays or complaints. Important skills for RCA are thinking carefully, noticing small details, and explaining your findings clearly. Doing this RCA taught me that solving problems properly means figuring out the real reason behind them.

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I was involved in a root cause analysis after a security incident occurred during a night shift when an unauthorized person entered a restricted area. We conducted an investigation using the 5 Whys method, reviewed access logs, and interviewed the officer on duty. At first, it seemed like the officer failed to follow procedure. However, we discovered the real issue was inadequate staffing during peak hours. One officer was assigned to monitor multiple entry points, and while responding to another situation, the access point was left unattended. As a result, schedules were adjusted to ensure proper coverage, and an additional verification step was added.

If the wrong root cause is identified, two major impacts can occur. First, the issue may happen again because the real problem was not fixed. Second, unfairly blaming employees can lower morale and reduce trust, which weakens the overall security culture.

The most important transferable skills for conducting RCAs are critical thinking, attention to detail, strong communication, and objectivity. These skills help ensure investigations focus on facts and lead to effective, long-term solutions rather than temporary fixes.

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I would like to share an experience from one of my chemistry experiments. In my earlier studies, me and my lab partner were supposed to use sodium nitrate, but our reaction completely failed because no precipitation formed and we could not continue with the derivative steps. To understand what went wrong, we applied an RCA approach and kept questioning each part of our process. We reviewed the procedure, retraced every step we had done, and checked whether our method, measurements, or conditions were followed correctly. When everything still seemed correct on paper, we looked deeper and inspected all the reagent bottles one by one we used. That is when we discovered the true root cause, we had accidentally used sodium nitrite instead of sodium nitrate. Both chemicals started with the same letter, had very similar names, and were stored right next to each other on the same shelf, so it was easy to pick up the wrong bottle without realizing it. Once we repeated the experiment with the correct reagent, the reaction worked normally and the expected product formed.

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I would like to share an experience from my Food Science laboratory course during a microbial analysis experiment.

We were preparing XLD agar plates to isolate Salmonella from a food sample. We carefully followed the standard protocol, including accurate weighing of the dehydrated media, proper heating and mixing, sterilization, and pouring plates under aseptic conditions. After inoculation and incubation at 37°C, we expected to observe characteristic colonies. However, no growth appeared on the plates, including the positive control.

Instead of immediately repeating the experiment, we conducted a simple Root Cause Analysis. We reviewed each step: balance calibration, autoclave cycle, incubation temperature, and plating technique. After systematically checking the materials used, we discovered that the dehydrated agar powder had expired several months earlier, which likely affected its performance.

Once we replaced it with a fresh batch and repeated the procedure, we observed proper microbial growth. This experience reinforced the importance of verifying reagent quality and expiration dates before assuming procedural errors and strengthened my understanding of Good Laboratory Practices.

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I've participated in an RCA meeting to discuss a clumping issue one of the gravies was having when going through screening to be packed. It was a combined effort of plant personnel, the quality department, and the scientist at the time who formulated the gravy. With 3 points of view on the problem, the meeting yielded a list of possible causes and what could be done to change it. It had been an ongoing problem for the past few months, and after this interdepartmental meeting, we resolved the clumping issue. If the wrong root cause is identified, it can damage the company's equipment, incur financial losses, and, because the wrong cause was identified, the problem persists, causing production downtime. I think that attention to detail is an important transferable skill when conducting an RCA.

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I had been involved in a root cause analysis when our chef noticed that the kitchen has been left dirty from last night's dinner service. An investigation was conducted and the team was interviewed using the 5 whys method to determine the main cause. The investigation determined that the problem was in the staff schedule. The schedule was done in a way where there was only one person to clean and close the entire kitchen since the last hour of service seldomly got customers. A big group came in late that previous night and the employee did not have time to finish all the cleaning and closing tasks before their shift was over. As a result, the scheduling was changed where start times are now staggered in a different way so there is now always 2 people left to close the kitchen and prevent such an event from happening again.

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I would like to share an experience from my Food Science Project 2 where we were using Oxford agar to prepare culture plates for microbial analysis.

We followed the entire media preparation procedure correctly, including weighing the Oxford agar, diluting it on the hot plate, and pouring the plates under proper conditions. All the preparation steps were performed accurately according to the standard protocol.

However, after plating the samples, we did not observe any microbial colonies on the plates, which was unexpected. Instead of immediately repeating the experiment, we decided to perform a simple Root Cause Analysis.

We reviewed each step of the process, including weighing accuracy, dilution, incubation conditions, and sterilization procedures. After asking “why” multiple times and checking the materials used, we found that the Oxford agar we had used had actually expired a long time ago.

Once we replaced the expired agar with a fresh batch and repeated the experiment, we were able to observe proper microbial growth on the plates. This experience helped me understand the importance of verifying materials before assuming procedural errors.

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I would like to briefly share my experience with a Root Cause Analysis investigation. While working in a food service environment, we identified recurring inconsistencies in the texture and taste of a prepared food item. A Root Cause Analysis was conducted using the 5 Whys method. The investigation revealed that the issue was not related to ingredients or equipment, but rather the absence of a documented standard operating procedure. Preparation methods varied because training was provided verbally and lacked standardization. Once a formal SOP and structured training process were implemented, the issue was successfully resolved.

Identifying the wrong root cause can significantly impact a company. First, it can result in financial losses if resources are allocated to incorrect corrective actions. Second, the problem may persist, leading to repeated incidents and potential damage to the company’s reputation and customer trust.

The most important transferable skills for conducting Root Cause Analyses include critical thinking, analytical reasoning, attention to detail, effective communication, objectivity, and strong problem-solving abilities.

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1. To identify the fundamental, underlying cause of a problem or event to prevent recurrence.

2. Recurring problems and wasted resources; Escalating issues and safety risks.

3.: Critical thinking, communication, and problem-solving.

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During my work in a food production environment, I participated in a Root Cause Analysis (RCA) after a product failed routine quality inspection due to inconsistent consistency. The team reviewed production records, checked equipment settings, and interviewed staff involved in the process. Using the 5 Whys method, we investigated possible causes to identify where the problem occurred.

The investigation found that the root cause was poor temperature monitoring during processing, which affected product quality. Corrective actions included retraining staff, improving monitoring procedures, and updating standard operating procedures. As a result, the issue did not occur again, and overall production quality and process control improved.

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While working in event security, I was once asked to help figure out why a key storage area was left unlocked after an event. I wasn’t directly involved, but I had seen a lot of people around that area. At first, it seemed like someone just forgot, but after asking around, we realized a temporary staff member had used a copied key that wasn’t tracked. That discovery led to a better key sign-out process. If we had blamed the wrong person, it could’ve caused unfair consequences and not fixed the real issue. In a company, identifying the wrong root cause can lead to wasted money—like replacing equipment that isn’t broken—or failing to solve real problems, like confusing poor shipping with bad customer service. To do RCA well, I think the most important skills are being observant, asking the right questions, and staying neutral. Clear communication is also key to making sure the real issue is understood and addressed.

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During my co-op at Golden Boy Foods as a Quality Assurance Technician, I was involved in addressing a recurring issue with inconsistent product quality in one of our packaged food lines. To resolve this, our team conducted a Root Cause Analysis (RCA) to identify the fundamental reasons behind the problem. We collected production data, reviewed quality control records, and interviewed operators on the floor. The RCA revealed that the main cause was a variation in temperature settings during processing, which affected the product’s texture and shelf life.

Based on these findings, we standardized the temperature controls and implemented stricter monitoring procedures during production. Additionally, we provided refresher training to the operators to ensure they understood the critical parameters that must be maintained. After applying these corrective actions, we noticed a marked improvement in product consistency and a reduction in customer complaints. This experience reinforced for me how important RCA is in pinpointing true causes and implementing effective solutions in food quality assurance.

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During my co-op, I was involved in a situation where one of our batch tests consistently failed quality control. I assisted in an RCA investigation to identify the source of the issue. We followed a structured process—starting with documenting the problem, then collecting data on equipment, reagents, and procedures.

We discovered that the buffer solution used during sample prep had incorrect pH due to a miscalibrated pH meter. After recalibrating the equipment and retraining staff, the test results returned to normal. This experience taught me how systematic troubleshooting and asking "why" multiple times can uncover the real issue behind a problem.

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1. When I was working in the Quality Assurance team at a food company, I had the opportunity to collaborate in a root cause analysis investigation after found that a raw material was allegedly contaminated with a piece of a plastic tag. Through the investigation we were able to find in which stage of the process the ingredient was in contact with the plastic tag, the complete batch was put on hold till the department verify the quality and safety usage of the ingredient. After the investigation, the missing plastic tag was founded and the ingredient was release for further usage.

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One of the first times I did a Root Cause Analysis wasn’t even at work—it was at home. I had some takeout leftovers in the fridge that mysteriously disappeared. I asked my roommates, and of course, no one admitted to eating it. So, I checked the trash, narrowed down who was home at the time, and eventually found out one roommate ate it by mistake, thinking it was theirs. It was a small thing, but it made me realize how helpful it is to step back and actually investigate instead of assuming.

Later at work, I helped a manager figure out why a certain process kept getting delayed. Everyone thought it was a tech issue, but after asking around and breaking things down, we found out it was actually a communication gap between two teams. Fixing that made a real difference.

If you get the wrong root cause, it can waste time and money—and even hurt trust if people feel unfairly blamed. That’s why I think active listening and critical thinking are super important skills for anyone doing RCA. Whether it’s about food or workflow, getting to the real “why” matters.

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In a previous role as a QA technician at a food manufacturing facility, I was involved in a Root Cause Analysis after we noticed several batches of a confectionery product showing inconsistent coloring and texture. At first, the blame was placed on a raw material issue, but after checking supplier records and batch data, everything appeared normal.

Digging deeper, I found the real issue was due to room temperature fluctuations during the coating process, caused by a malfunctioning cooling unit. The environmental conditions affected how the coating adhered, which led to visible quality defects. Once we fixed the unit and updated monitoring procedures, the issue was resolved.

This made me realize how damaging it can be to identify the wrong root cause. First, it wastes time and resources chasing the wrong solution. Second, it can strain relationships with suppliers or teams who were wrongly blamed — which damages internal trust.

For me, the most important transferable skills in RCA are critical thinking, attention to detail, and communication. You need to ask the right questions, interpret data carefully, and work collaboratively to get to the true cause — not just the obvious one.

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In my previous role as a medical technologist, I was involved in a Root Cause Analysis after we discovered a specimen mix-up between two patients—a husband and wife—when one of the test results didn’t match the patient’s medical history. After looking into it, we found that the issue happened because the blood tubes were labeled before the actual collection, and with so many patients arriving at once, the samples were accidentally switched. If the wrong root cause had been identified, the same error could’ve easily happened again, or time and resources might’ve been wasted on fixing the wrong part of the process. From this experience, I learned how important skills like attention to detail, clear communication, and the ability to analyze a situation calmly are when conducting an RCA and making sure the right changes are put in place.

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During my work in a laboratory setting, I participated in a Root Cause Analysis following an incident where a batch of test results was delayed, leading to workflow disruption. The goal of the RCA was to determine why the delays occurred and how to prevent them in the future.

We used tools like the 5 Whys and Fishbone (Ishikawa) diagram to guide the investigation. Initially, the assumption was that the problem stemmed from equipment malfunction. However, after deeper probing, we discovered the actual root cause was a miscommunication in scheduling due to recent changes in the software interface, which staff were not fully trained on. Addressing this helped us implement a targeted training plan and update our protocols to avoid recurrence.

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When I was working in a food testing lab, I got pulled into a root cause analysis (RCA) after we discovered that expired media had been used in microbial testing, which threw off our results and delayed a product batch release. It was frustrating because the issue popped up during a routine quality check when we noticed inconsistent results, and we had to act fast to figure out what went wrong. Using the "5 Whys" and a causal tree, we started by pinpointing that a technician had grabbed expired media. Digging deeper, I helped uncover some real systemic problems: our inventory system didn’t flag expiring media, expired stock wasn’t separated from the good stuff, and the technician, who was pretty new, hadn’t been trained on checking expiration dates. Our standard operating procedures (SOPs) also didn’t require a double-check for media before testing. At first, some team members got defensive, worried they’d be blamed, but I made it a point to stress that we were focusing on fixing the system, not pointing fingers, which really helped everyone open up and share what they knew.

The RCA process was eye-opening and led to changes I’m proud we pushed through. We updated the inventory system to send alerts for expiring media, set up a clear separation for expired materials, and rewrote the SOPs to include a mandatory expiration date check before any testing. We also made sure new staff, like our technician, get thorough training with a checklist to follow. When we checked back later, there were no repeat issues, and the team felt more connected, like we were all in it together to make the lab better. This experience really hit home for me—focusing on the system, not the person, made all the difference in preventing errors and keeping our food safety testing on point.

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In a previous role in food production, I was involved in a Root Cause Analysis (RCA) after foreign plastic material was found in a finished product. I helped inspect the production area and review equipment maintenance logs, where we discovered a damaged conveyor belt was shedding plastic pieces. The issue was resolved by replacing the belt and updating inspection procedures. Identifying the wrong root cause—like blaming employee error instead of equipment failure—can lead to repeated contamination and product recalls. Strong skills in problem-solving, attention to detail, and communication are essential for conducting effective RCAs and preventing future issues.

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I was involved in a Root Cause Analysis (RCA) to find out why some specimen tubes were labeled wrongly in a busy medical laboratory. This happened because there were many patients at the same time, and the process for labeling was not clear or double-checked. Through the RCA, we discovered that the real cause was the lack of a second check during labeling and a poor setup for handling patient flow. If the wrong cause is found in an RCA, the same mistake can happen again, which may put patients at risk, or the company might waste time and money fixing the wrong problem. To carry out a good RCA, important skills include clear thinking, attention to detail, good communication, understanding how the steps in a process work together, and staying fair and focused on solving the problem, not blaming people.

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Root Cause Analysis

We often think investigations only happen at work, but in reality, they can occur in our everyday lives—even at home. One personal experience I had with a Root Cause Analysis (RCA) involved my 2-year-old son. One day, while I was preparing his milk, he suddenly cried loudly. I found him on the floor, but since he couldn’t yet speak clearly, I had no idea what had really happened. To understand the situation better, I reviewed our CCTV footage at home.

After watching closely, I discovered that he had slipped because there was spilled liquid on the floor. This incident taught me how important it is to take time to observe carefully and find the true cause of a problem. Jumping to conclusions without evidence can lead to wrong assumptions. Just like in RCA, we need to gather all the facts before deciding what went wrong.

If the wrong root cause is identified in an investigation, the problem can happen again—and sometimes with worse consequences. For example, if I had assumed that my son slipped just because of the floor itself and didn’t clean the spilled liquid, the same thing could have happened again. In a company, this kind of mistake could result in wasted resources and repeated accidents, affecting both safety and productivity.

For those who do RCA regularly, I believe some of the most important transferable skills are critical thinking, attention to detail, effective communication, and patience. These skills help make sure that the investigation leads to a real solution—not just a temporary fix.

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During my Microbiology Project-2 at Centennial College, I conducted an experiment to evaluate the antimicrobial effects of medicinal plant extracts—specifically ginger, basil, and aloe vera—on common pathogenic bacteria. In one of the initial trials, none of the plant extracts showed any zones of inhibition, which was unexpected given prior successful results. This outcome required a detailed Root Cause Analysis (RCA) to determine what went wrong.

Upon reviewing the materials, methods, and environmental conditions, I discovered that the ethanol used in the extraction process had not been completely evaporated. The presence of residual ethanol likely disrupted the natural antimicrobial compounds in the extracts, rendering them ineffective in the test. After repeating the experiment with properly evaporated extracts, clear zones of inhibition were observed, confirming that the plant extracts were indeed effective.

Impact of Identifying the Wrong Root Cause:

If the incorrect root cause had been identified during this process, it could have had the following negative outcomes:

1. Wasted Resources and Time: I might have altered other variables like extract concentration or bacterial strain, which were not the true source of the problem, leading to unnecessary repetition and delays.

2. Inaccurate Conclusions: Had I reported the extracts as ineffective without identifying the true issue, it would have compromised the credibility of my data and potentially affected further related research.

Transferable Skills Gained:

This experience helped me build several transferable skills essential for effective RCA:

Attention to Detail: Carefully analyzing each procedural step allowed me to identify subtle but crucial errors like incomplete solvent evaporation.

Analytical Thinking: I systematically examined all possible causes, ruling out each one based on scientific reasoning and observations.

Problem-Solving: I was able to correct the issue and successfully repeat the experiment, demonstrating adaptability and technical troubleshooting.

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In a previous laboratory position, I was involved in a Root Cause Analysis (RCA) when our quality control tests began consistently failing. We did not reflexively blame reagents but considered procedures, equipment history, and environmental conditions attentively. Long story short, we eventually figured out that the root cause lay in a very minor change to temperature calibration in maintenance. That experience showed me how important RCA is in identifying and addressing fundamental issues effectively. If an incorrect root cause is determined, it can have serious repercussions—e.g., a business can waste money on fixing the wrong problem or have reputational exposure if safety issues are not addressed. The essential transferable skills to successful RCA are critical thinking, thoroughness, and superior communication, all of which are vital to determining the problem and preventing future failure.

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During my time working as a high school lab technician, I had to perform an experiment showing the photoelectric effect and stopping current. The teacher and I tried on the experiment during recess time before class and it worked well. However, no effect was shown during the class demonstration, and we ended up showing the video instead.

After the class, I tried the experiment again and examined the power supply, the photoelectric cell, the multimeters and wires and all functioned well. At last I found that it was because of not having enough light intensity to generate the current as the teacher switched off some of the lights in the lab.

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Back when I was working part-time at a local café, we kept getting customer complaints about drinks tasting “off”—especially the iced coffees. The manager thought it was the beans and ordered a new batch, but the problem continued. Then we blamed the ice machine, cleaned it thoroughly, still no change. I was curious and decided to dig a little deeper. One slow afternoon, I did a mini RCA just out of habit—started tracing each step of the drink-making process. That’s when I noticed the milk frothing jug being washed but never fully dried before going back into use. Moisture left in the jug, especially after sitting near the espresso machine, was causing a slight sourness in the drinks. No one had considered that. Once we started properly drying the equipment, the complaints disappeared. That small investigation made me realize how easy it is to jump to conclusions and how powerful it is to slow down, ask questions, and look at the full picture. It also earned me a free latte and some respect from my manager

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Hey everyone, I once took part in a Root Cause Analysis when a significant issue arose during a group project in college. Our experiment kept failing, and we initially thought it was because of a problem with the materials. After retracing our steps and delving into deeper inquiries, we realized that the actual problem stemmed from a simple misinterpretation of the procedure—one team member had misunderstood a step in the protocol, leading to the inconsistency. This experience highlighted for me the importance of investigating thoroughly rather than jumping to conclusions. In a work environment, misidentifying the actual root cause can result in serious repercussions. For instance, if a company wrongly attributes a malfunction to equipment failure rather than user error, they could end up spending a fortune replacing machines that are actually functioning well. Even worse, if contamination in a laboratory is wrongly assigned to the incorrect process, the true issue might remain unaddressed and continue to recur—threatening safety and product quality. Individuals who routinely conduct RCAs require strong transferable skills such as attention to detail, analytical thinking, and effective communication. They need to maintain objectivity, ask insightful follow-up questions, and meticulously analyze data to prevent assumptions. RCA is not merely about resolving issues—it’s about addressing the correct issue, and that distinction is crucial.

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Hi everyone , my experience with the root cause analyis was during the part time at our convention center, the coffee machine was malfunctioning during high-traffic events, producing weak coffee or failing to brew. This was affecting both staff and guest satisfaction. We initially thought the coffee machine was broken, so we checked its internal components and power supply. After continued issues, we inspected the filter system and reviewed the maintenance log. It turned out that the coffee filter being used was too large for the machine, causing water to bypass the filter and resulting in weak coffee. The incorrect filter size caused the brewing failure. The wrong filter didn’t fit properly, leading to improper water flow and overheating. We replaced the filters with the correct size and set up a checklist to ensure filters are checked regularly. If the wrong root cause was identified, we might have spent unnecessary resources on repairing the coffee machine and continued to face guest dissatisfaction.

This experience highlighted the importance of attention to detail and clear communication when identifying issues. Even small mistakes, like the wrong filter, can cause significant disruptions.

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Hey everyone,

I want to share a story from one of my past part-time jobs when I worked in a kitchen. It wasn’t anything fancy—just a busy place with a lot of moving parts. One weekend, we had a major issue. The refrigerator in the prep area stopped working overnight, and when the morning staff came in, a huge amount of perishable food had spoiled. It caused a lot of stress since we had to toss ingredients and delay food prep, which threw off the whole day.

The supervisor asked a few of us if we’d noticed anything unusual or if we had any ideas about what happened. I remembered hearing the fridge make some weird clicking sounds the night before but didn’t think much of it at the time. That little observation helped kick off what turned into a small Root Cause Analysis.

We looked into it and found out that the plug had been loosely connected to an outlet that wasn’t fully secure. Vibration over time caused the plug to shift just enough to cut off power. So the real issue wasn’t the fridge itself—it was the electrical outlet.

What I took away from that was how small details matter. If I hadn’t mentioned that sound, we might have assumed the fridge was faulty and replaced it, which would have cost more and not fixed the actual problem. That’s the whole point of RCA, right? Getting to the real cause so it doesn’t happen again.

Now, I always try to be more observant and speak up when something doesn’t seem right—because even something small can prevent a bigger issue.

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During a lab project, I participated in a Root Cause Analysis after we noticed unexpected bacterial growth on our control plates, which shouldn’t have happened. Our first assumption was that it was a simple handling error—maybe someone accidentally contaminated the plate during the experiment. We documented that as the root cause and repeated the test, only to find the same issue again. That’s when we took a deeper look and discovered the actual problem: the autoclave cycle hadn’t completed properly, so the media used wasn’t fully sterilized. This experience made me realize how damaging it can be to identify the wrong root cause. In a company setting, that kind of mistake could lead to repeated production failures, wasted resources, or worse—sending out unsafe or defective products that damage a brand’s reputation. People who regularly conduct RCAs need strong critical thinking, attention to detail, and the ability to communicate findings clearly, especially when working across teams with different areas of expertise.

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I’d like to share a quick experience I had with Root Cause Analysis in customer service.

I was involved in an RCA when we noticed a rise in delayed responses to customer inquiries. After analyzing data and using tools like the 5 Whys, we found the issue was a system update that misrouted tickets. Fixing the routing logic and retraining staff resolved the delays.

Identifying the wrong root cause can lead to recurring problems—like blaming staff instead of the system—and waste time and resources fixing the wrong issue.

To do RCA effectively, critical thinking, good communication, and attention to detail are key skills. They help ensure issues are solved at the source and don’t repeat.

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Sreenath Edakkudi (301419939) Root Cause Analysis in the Biotech Lab: The Case of the Invisible Bands

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Sreenath Edakkudi (301419939) Root Cause Analysis in the Biotech Lab: The Case of the Invisible Bands

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During a biotechnology lab, we were running gel electrophoresis to visualize PCR products, but when I checked my gel, there were no visible bands—just a faint smear. I retraced my steps and realized I had accidentally used an expired loading dye that wasn’t properly labeled. This simple mistake led me to conduct a mini Root Cause Analysis, which revealed that poor labeling and not double-checking reagents were the main issues. It taught me how important attention to detail, communication, and proper lab practices are in preventing errors. Identifying the correct root cause saved time and helped ensure others didn’t make the same mistake.

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Thilakshan S. ( 301377623 )School Project Chaos -“The Broken Presentation File”

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Thilakshan S. ( 301377623 )School Project Chaos -“The Broken Presentation File”

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Hey folks,

Here’s one that happened during a group project in college. We were using Google Slides to put together a presentation, and the night before it was due, the entire file glitched out—slides were missing, formatting was gone, and animations were out of control. It was a mess.

We all freaked out, thinking someone must have deleted stuff by accident. There was a bit of arguing, honestly. But then we checked the version history and saw that one of the group members had opened the file in PowerPoint to “make it look better,” then reuploaded it to Google Slides.

Turns out, some of the formatting and animations from PowerPoint didn’t translate properly back into Google Slides, and that was what caused the issue. We didn’t know the platforms weren’t fully compatible.

So we set a rule after that: only edit the file in Google Slides, and no one uses outside software. It was a tough situation, but we learned to focus on fixing the system instead of blaming people.

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 Anjali Bharadwaj (301380229)Home Life Detective — “The Disappearing Laundry”

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 Anjali Bharadwaj (301380229)Home Life Detective — “The Disappearing Laundry”

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Hi everyone,

This might sound funny, but one time I had to do a full-blown investigation at home. My clothes kept going missing from the laundry room—like, shirts just gone. I live with family, so at first I figured someone was just grabbing the wrong stuff by accident. But it kept happening.

So, I started asking questions and checking laundry days. I even wrote down when I did each load. Eventually, I realized that the dryer vent wasn’t attached properly, and lighter clothes were literally getting sucked into the space behind the machine. I found three socks, two shirts, and a towel back there.

That was the real root cause—not a careless family member, but a maintenance issue. If I hadn’t looked into it, we would’ve kept blaming each other and losing clothes.

It made me realize that in RCA, jumping to conclusions usually leads you in the wrong direction. You have to stay objective and gather facts.

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Jay Patel ( 301429020 )Workplace Mix-Up - “The Printer Panic”

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Jay Patel ( 301429020 )Workplace Mix-Up - “The Printer Panic”

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Hey everyone,

I want to share a quick story from my part-time office job. A few months ago, there was this big panic because a batch of invoices went out with incorrect totals. People were confused, customers were calling, and management thought the billing software had glitched.

They asked a few of us to help figure out what happened. I went through the files and noticed that the issue was only in the ones processed on one specific afternoon. Turns out, someone had updated the formula in an Excel sheet but forgot to lock the cells, so every time someone edited something, the totals would get messed up.

So, the real root cause wasn’t the software—it was human error and a lack of proper file management. We fixed it by locking the cells, and now we have a checklist for file formatting before anything goes out.

That experience taught me how important it is to look past assumptions and dig into the details. If we had just blamed the software and moved on, the same mistake could have happened again.

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During a lab-based project in my biotechnology program, I was involved in a Root Cause Analysis (RCA) after a repeated issue with bacterial contamination in one of our media preparation exercises. The same contamination appeared in multiple groups’ culture plates, even though all procedures were followed according to the lab manual.

At first, our instructor suspected a problem with the autoclave cycle not reaching the correct sterilization temperature. However, our RCA process encouraged us to consider all possible contributing factors instead of jumping to conclusions. We formed small investigation teams and used tools like the "Fishbone Diagram" and "5 Whys" to examine all aspects—equipment, materials, methods, environment, and people.

After analyzing the situation carefully, we traced the problem back to a shared bottle of distilled water used to prepare media. Someone had unknowingly touched the inside of the bottle cap with their glove, and the contaminated cap led to the spread of microbes across multiple batches of media. The issue wasn’t due to faulty equipment, but rather a small lapse in aseptic technique.

As a result, we updated our lab practices to include more rigorous handling procedures for shared reagents and added a visual reminder near the media prep station about avoiding contact with bottle openings. This experience showed me how easily the real cause can be missed if assumptions are made too early.

It also emphasized how valuable transferable skills like critical thinking, attention to detail, communication, and teamwork are during RCA. Without a structured approach and group collaboration, we might have misidentified the root cause and continued facing the same issue.

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RCA experience - Sloka Desai (301342763)

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RCA experience - Sloka Desai (301342763)

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As a lab technician, I encountered recurring contamination in our agar plates. I joined the RCA team to investigate. After checking sterilization logs and aseptic practices, we discovered a small crack in the Petri dish storage container. This allowed air exposure post-autoclaving. Replacing the container and improving storage checks solved the issue. It taught me how small errors can lead to big problems in lab environments.

2. Impact of Wrong Root Cause:
Identifying the wrong root cause can harm both productivity and safety. For example:

Blaming the autoclave instead might lead to media damage and wasted resources.

In a clinical setting, unresolved contamination could delay patient results or drug testing, risking compliance and health outcomes.

3. Key Skills for RCA:

Attention to detail – spotting small but critical issues.

Analytical thinking – connecting symptoms to root problems.

Team communication – working with cross-functional teams to find accurate solutions.

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RCA Experience - Israel Oyebanji (310280929)

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RCA Experience - Israel Oyebanji (310280929)

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During a lab project, we tested disinfectants' effectiveness against Pseudomonas aeruginosa by varying exposure times. Contrary to our expectations, shorter exposure times led to better bacterial kill results, while longer exposures resulted in unexpected bacterial growth. This prompted us to conduct a Root Cause Analysis (RCA) to rule out contamination in our materials and processes. We meticulously checked and remade reagents and components to identify potential sources of error. This experience highlighted the importance of thorough investigation when results contradict expectations and the significant impact of contamination on experimental outcomes.

Identifying the wrong root cause in an investigation can have serious consequences, such as ongoing issues if the actual problem isn’t resolved. For instance, misattributing contamination to a supplier issue could lead to wasted resources while the underlying problem persists. Additionally, incorrect root cause identification can harm a company's reputation, resulting in customer distrust and financial losses.

In my opinion, the most important transferable skills for individuals who regularly conduct RCAs are attention to detail and critical thinking. RCA requires people to look beyond the obvious and consider all possible factors that could contribute to a problem. Patience is also important because the process often involves going back through multiple steps and testing different possibilities before finding the true cause. Finally, good communication skills are essential because the findings need to be shared clearly with the team or management to prevent future issues and ensure everyone understands what went wrong and how to fix it.

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While working on my thesis in Life Science, I encountered a situation where one of our key experiments consistently failed to yield reproducible results. The experiment involved protein expression in bacterial cultures, and despite following the protocol carefully, the protein yield was significantly lower than expected in several trials.

To identify the issue, I conducted a Root Cause Analysis. I started by collecting data from each trial: recording conditions such as temperature, pH, culture time, reagent batches, and equipment used. I created a fishbone diagram to map out possible causes, which helped us visualize the different contributing factors (e.g., human error, equipment malfunction, materials, and environment).

After systematically testing each possibility, I discovered that a recent change in the buffer preparation process introduced a pH variation, which in turn affected the efficiency of protein folding. Once the buffer preparation method was standardized and recalibrated, the protein yield returned to expected levels. This experience emphasized the importance of thorough data analysis and collaboration in identifying the true root cause.

Impact of Identifying the Wrong Root Cause

Identifying the wrong root cause in an RCA investigation can have serious consequences for a company. Here are two examples:

Increased Costs and Wasted Resources: If a company misidentifies the root cause of a production issue and invests in fixing the wrong part of the process (e.g., replacing machinery when the real issue is in raw material quality), it can lead to significant financial losses, delays, and wasted effort.

Reputation and Compliance Risks: In regulated industries like pharmaceuticals or food production, failing to identify the correct root cause of a quality defect can result in continued product failures, leading to regulatory penalties, product recalls, or loss of consumer trust.

Transferable Skills Important for RCA Investigators

Individuals who regularly conduct Root Cause Analyses need a variety of transferable skills, including:

Critical Thinking and Problem-Solving: The ability to objectively evaluate evidence and consider multiple hypotheses is essential to accurately pinpoint root causes.

Attention to Detail: Small oversights in data or procedure can lead to incorrect conclusions. Precision and thoroughness are crucial.

Communication and Team Collaboration: RCA often involves cross-functional teams. Clear communication helps ensure that all perspectives are considered and that findings are well-documented and actionable.

Analytical and Data Interpretation Skills: Being able to analyze trends, correlate variables, and understand technical data plays a huge role in successful investigations.

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During my second year, I participated in a group presentation that did not meet our expectations. Although we had strong content, our delivery was hindered by disorganization, repetitive points, and the absence of one team member.

Initially, we attributed our shortcomings to the missing teammate. However, following the class, we convened to discuss the situation and recognized that the primary issue was a lack of planning. We had not clearly defined roles, established deadlines, or conducted proper check-ins. Consequently, the absent member was unaware of the final presentation date, which was our responsibility.

The fundamental issue was not the absence of one individual, but rather inadequate communication and absence of structure. Following this experience, we implemented the use of shared documents, group communication channels, and assigned specific tasks early in the process. As a result, our subsequent project proceeded much more smoothly.

This experience highlighted for me that misidentifying the root cause can lead to blame rather than solutions. I learned that effective teamwork, honest reflection, and clear communication are essential skills in any collaborative effort.

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During my time as a Production Supervisor and Quality Control lead in a plant tissue culture lab, I participated in an RCA after a spike in contamination across batches. Initially blamed on human error, I led a structured investigation using the 5 Whys and Fishbone Diagram. We discovered the real issue—a faulty autoclave sensor causing incomplete sterilization. Revising SOPs and validating equipment resolved the problem and avoided unnecessary staff retraining.

Identifying the wrong root cause can waste time and resources, like replacing machines or retraining staff without solving the real issue. It can also damage morale and trust if individuals are wrongly blamed.

Key skills for RCA include critical thinking, communication, data analysis, and understanding processes—helping ensure problems are solved effectively and don’t reoccur.

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🔍 My Experience with Root Cause Analysis

Hi everyone,

I’d like to share a small but memorable RCA experience from when I lived with roommates during university.

One day, I noticed half my leftover pizza was missing from the fridge. Instead of jumping to conclusions, I asked around and checked things carefully. Eventually, I found it in the freezer—someone had accidentally moved it while reorganizing the fridge. The issue wasn’t theft—it was a misunderstanding. This taught me how useful RCA can be, even in daily life, when we ask the right questions and stay objective.

⚠️ Why Identifying the Wrong Root Cause Matters

In a professional setting, finding the wrong root cause can lead to:

1. Wasted time and money—fixing the wrong thing won’t solve the real issue.

2. Low team morale—blaming the wrong person or department creates frustration and mistrust.

💡 Key Skills for RCA

The most important skills for RCA are:

Critical thinking

Good communication

Attention to detail

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Root Cause Analysis – My Experience

I once participated in an RCA during a quality investigation in a lab setting. We noticed inconsistent results from a piece of equipment, and the initial assumption was that the machine was malfunctioning. However, after applying tools like the 5 Whys and reviewing procedures, we found the real issue: an incorrect setting used during sample preparation by the technician. As a result, we revised the SOPs and provided proper retraining to prevent it from happening again.

Why finding the right root cause is important:
If the wrong cause is identified, it can lead to wasted time and resources—like repairing or replacing equipment that wasn’t the issue. Even worse, the actual problem might go unaddressed, leading to repeated errors and possibly affecting product quality or safety.

Key skills for effective RCA:
I believe strong attention to detail, critical thinking, and the ability to communicate clearly across teams are essential for anyone regularly conducting RCAs. These skills help ensure that problems are accurately identified and permanently resolved.

RCA is not just about fixing a problem—it's about understanding it deeply and preventing it from happening again.

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once participated in a Root Cause Analysis (RCA) investigation to resolve a recurring equipment malfunction in a production setting. Initially, the issue was blamed on operator error, but through a structured RCA using the "5 Whys" method and reviewing maintenance logs, we discovered the real cause was a faulty sensor giving inconsistent readings. Replacing the sensor resolved the issue completely.

Identifying the wrong root cause can lead to wasted resources—for example, unnecessary retraining—or worse, repeated failures that damage a company’s reputation or lead to safety risks. To conduct effective RCAs, key transferable skills include critical thinking, attention to detail, strong communication, and teamwork, all of which help uncover the true root cause and implement lasting solutions.

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Experience with a Root Cause Analysis (RCA) Investigation

During my time in the microbiology lab, I participated in a Root Cause Analysis after we consistently observed contamination in a batch of culture plates used for bacterial sensitivity testing. Our goal was to identify the underlying issue causing the contamination. The RCA team used a fishbone diagram and the “5 Whys” method to systematically analyze potential factors such as equipment, environment, personnel practices, and materials.

After reviewing SOPs, environmental logs, and speaking with the lab staff, we found that one of the water baths used in media preparation hadn’t been calibrated in several months. The temperature was lower than required, resulting in incomplete sterilization. Once recalibrated and validated, contamination levels returned to normal.

2. Impact of Incorrect Root Cause Identification

a. Recurring Issues and Increased Costs:
If the wrong root cause is identified, the actual problem remains unresolved. For example, if we had incorrectly blamed human error instead of equipment failure in our case, unnecessary retraining might have been enforced while contamination continued, leading to repeated test failures, wasted resources, and higher costs.

b. Regulatory and Quality Consequences:
In industries like pharmaceuticals or food production, incorrect RCA can result in non-compliance with quality standards. This may lead to product recalls, regulatory penalties, or loss of customer trust. A misdiagnosed contamination issue, for instance, could cause unsafe products to reach the market, endangering public health.

3. Most Important Transferable Skills for Conducting RCAs

a. Analytical Thinking:
Professionals must be able to critically evaluate data, connect patterns, and distinguish symptoms from true causes.

b. Communication and Collaboration:
Effective RCAs require input from multiple departments. Clear communication ensures all perspectives are considered, and findings are understood and acted upon.

c. Attention to Detail:
Subtle oversights can derail investigations. Observing minor deviations and thoroughly checking documentation is key to accuracy.

d. Problem-Solving:
RCA is solution-oriented. The ability to propose and assess corrective/preventive actions is crucial to long-term success.

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During my time as a Production Supervisor and Quality Control lead in a plant tissue culture laboratory, I was involved in a Root Cause Analysis (RCA) investigation following a sudden spike in contamination across multiple culture batches. Despite strict aseptic practices, the issue was widespread and initially attributed to human error, with plans to retrain the entire team. However, I initiated a structured RCA using tools like the Fishbone Diagram and 5 Whys, analyzing potential causes across Environment, Methods, Materials, Machines, and People. This led to the discovery that autoclave validation logs had not been reviewed for weeks, and further inspection revealed a faulty temperature sensor causing incomplete sterilization. Had we accepted the initial assumption of personnel error, we would have wasted valuable time and resources while the real issue persisted, potentially compromising large volumes of product and damaging team morale. How the wrong Root Cause can impact a company (2 examples):

1. Wasted Resources and Time: Acting on incorrect assumptions can lead to misdirected corrective actions. In our case, retraining staff would not have solved the real issue. Valuable time would have been lost, and contamination would continue—affecting production schedules and deliveries.

2. Loss of Trust and Morale: Incorrectly blaming individuals without evidence can hurt team morale. In environments like plant tissue culture labs, where precision and teamwork are essential, trust is key. Repeated failures due to misdiagnosed issues also erode confidence in leadership and the QA process. Transferable Skills Essential for RCA:

1. Critical Thinking and Attention to Detail – Not accepting the first visible cause as the final answer and questioning deeper.

2. Communication Skills – Facilitating discussions with teams across production, QC, and maintenance without placing blame, focusing instead on collaboration.

3. Documentation and Data Analysis – Accurately reviewing logs, SOPs, and equipment records to find hidden patterns.

4. Decision-Making Under Pressure – Root cause investigations often happen under tight deadlines; staying calm and objective is vital.

5. Understanding of Systems and Processes – A good RCA investigator must understand the technical flow and dependencies within the lab or facility.

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Learning the Value of Identifying the Correct Root Cause: A Lab-Based Experience

One Monday morning, our laboratory received a customer complaint regarding a recurring issue with one of our products. The defect was subtle yet impactful—it seemed to cause an unexpected decline in product quality over time. Recognizing the potential regulatory risks, we promptly initiated a Root Cause Analysis (RCA) to investigate the problem.

Our cross-functional team, composed of quality engineers, manufacturing experts, and scientists, gathered to tackle the issue. Using the 5 Whys method, we methodically traced the issue backward to identify its source. Initially, contamination appeared to be the most likely culprit, possibly linked to a compromised batch of raw materials. However, after a full traceability review, we found no anomalies.

Next, we turned our attention to equipment functionality. By examining calibration logs, maintenance records, and operator reports, we confirmed that all systems were operating within their specifications, and no process parameters had been altered. With no clear answers, frustration grew, and the urgency from upper management to find a resolution intensified.

Eventually, a team member suggested investigating storage conditions—a less obvious factor. Reviewing historical data on temperature and humidity during transportation revealed occasional fluctuations that exceeded the ideal conditions for the product. Subsequent testing confirmed that these variations were enough to accelerate product degradation.

Had we stopped at our initial hypothesis of contamination, the company might have taken unnecessary corrective measures, such as rejecting a perfectly good batch of raw materials. This misstep could have resulted in wasted resources and production delays. Even worse, if the true issue remained unresolved, customer trust might have been eroded, and regulatory complications could have arisen.

This experience underscored the importance of thorough investigation in RCAs. Rushing to conclusions without critical thinking, collaboration, and perseverance can lead to treating symptoms rather than addressing the root cause itself.

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Got it! Here's the revised version without mentioning PCR:

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During a lab project focused on detecting Listeria monocytogenes in romaine and iceberg lettuce, we encountered inconsistent results during the detection process. We conducted a Root Cause Analysis using the 5 Whys method and discovered the issue was due to uneven sample homogenization, not contamination as we initially thought. By standardizing our blending process, we improved consistency across samples. Identifying the wrong root cause would have led to wasted resources and delayed progress. This experience emphasized the importance of critical thinking, clear communication, and attention to detail—key skills for anyone conducting RCA investigations.

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For the Root Cause Analysis experience, I would like to recall my project on phage characterization against Pseudomonas aeruginosa during my master's. I encountered an issue during the pH sensitivity assessment where the phage failed to lyse the bacterial host even under standard temperature and pH conditions. No plaques were formed, and I noticed an unusual change in the bacterial lawn: the typical green pigmentation of P. aeruginosa turned whitish, raising concerns about possible contamination.

To troubleshoot, I repeated the experiment using fresh media, adjusted the incubation condition, and ensured I used a log phase host and proper concentration of phage stocks. Despite this, lysis still did not occur. I then performed a spot assay using freshly streaked bacteria from my lyophilized stock cultures. This time, clear plaques were formed, confirming successful lysis. The root cause was identified as contamination or degradation of the original bacterial stock. This might have happened due to improper aseptic handling or repeated use of stock culture making it non-viable or incompatible with the phage.

Misidentifying the root cause can lead to wasted resources and delays. In our case, if I had blamed pH or temperature instead of contaminated bacterial stock, I might have discarded a good phage and lost valuable time as I had to repeat the whole project. This type of error might have impacted my project quality and also my project deadline.

Key skills for effective RCA include critical thinking, attention to detail, problem solving capability and clear communication skills. These characteristics help to identify the real issue, and prevent similar problems in the future.

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Priyanshu Sharma (301349112)  My RCA experience

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Priyanshu Sharma (301349112)  My RCA experience

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In a previous lab setting, I participated in a Root Cause Analysis (RCA) after we observed inconsistent results during a routine quality control test. Initially, we suspected user error, but through a structured RCA process—including reviewing documentation, equipment logs, and interviewing staff—we discovered the actual root cause was improper storage conditions that affected reagent stability. Identifying the wrong root cause in such investigations can significantly impact a company; for example, it can lead to repeated failures and wasted resources if the real issue remains unresolved, or result in regulatory non-compliance, especially in highly regulated industries, potentially leading to fines or product recalls. To conduct RCAs effectively, transferable skills such as critical thinking, strong communication, attention to detail, and the ability to work collaboratively are essential, as they help ensure thorough investigations and the implementation of sustainable corrective actions.

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While working at a vaccination center, our team often struggled with staying on schedule. Although we had enough staff and supplies, long wait times were common, and it affected both visitor satisfaction and staff performance.

To understand the issue, we used a Root Cause Analysis approach by repeatedly asking “why” to uncover the real problem.

First, why were there delays? We noticed backups were happening after registration.

Why was that? The vaccination team was receiving too many people at once.

Why were they being sent all at once? Because the registration staff had no way of knowing how busy the vaccination area was.

Why was there no coordination? There was no communication system between the two teams.

This led us to the root cause: a lack of a structured communication protocol between the registration and vaccination stations. It wasn’t just a people problem—it was a system issue.

As a solution, we introduced a simple real-time coordination system using a tracking sheet and appointed one staff member to oversee patient flow. This helped balance the workload between stations and significantly reduced wait times.

This experience helped me understand how RCA goes beyond identifying symptoms—it helps reveal the underlying cause. By working step by step, we found a sustainable solution instead of just reacting to surface-level issues.

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At work, I participated in a Root Cause Analysis (RCA) after a piece of equipment repeatedly breaking down, leading to delays. We initially believed that the power supply was the problem, but after conducting additional research and applying techniques such as the Five Whys, we found that the true cause was a lack of routine maintenance. Parts of the equipment were wearing out too soon because it wasn't getting enough maintenance.

We would have wasted money changing things that weren't the problem if we had misinterpreted the issue, for example, by concentrating on the power supply. The issue would have persisted, resulting in time wastage and frustration. I learned from this experience how crucial it is to determine the accurate underlying reason.

Additionally, it emphasized the importance of critical thinking, effective communication, and patience as RCA abilities. Finding a rapid cure isn't the only goal of root cause analysis (RCA); it also aims to fully comprehend the issue and address its root cause.

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Event: A researcher was stuck with a needle containing a potentially pathogenic organism, requiring antibiotics.

RCA Steps:

1. Q: Why did the researcher get stuck with a needle?
A: The researcher wasn’t familiar with using the device.

2. Q: Why wasn’t the researcher familiar with it?
A: The researcher normally used a pipette, but it wasn’t available.

3. Q: Why wasn’t the pipette available?
A: It was broken and not replaced.

4. Q: Why wasn’t it replaced?
A: The lab manager didn’t know it was broken.

5. Q: Why didn’t the manager know?
A: The lab had no system to track equipment.

Root Cause: The lab lacked an equipment tracking system, which led to the broken pipette not being replaced.

Reflection: This analysis shows how a simple event can reveal deeper issues. By identifying and addressing the root cause lack of equipment tracking future incidents can be prevented.

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Root Cause Analysis (RCA) Reflection – Walk-in Retail Pharmacy Store (Philippines)

Event:
While working in a walk-in retail pharmacy store in the Philippines, a customer complained that her maintenance medication, which she claimed to have reserved over the phone earlier that day, was not set aside. The stock had run low by the time she arrived.

RCA Investigation:

Q1: Why wasn’t the medicine reserved?
A1: Because there was no record of the reservation in the logbook or on the shelf.

Q2: Why was there no record?
A2: The staff who received the call forgot to log the reservation.

Q3: Why did the staff forget to log it?
A3: Because there was no formal system in place to track phone reservations.

Q4: Why was there no system?
A4: Because phone reservations were not consistently managed or monitored.

Root Cause:
Lack of a proper system to track and confirm phone reservations led to missed or forgotten orders.

Resolution:
We introduced a simple reservation tracking system using a logbook with reservation slip numbers, and attached labels to reserved medicines to ensure visibility and accountability.

Outcome:
The new system prevented missed reservations, improved customer satisfaction, and helped build trust. This experience taught me that even small process gaps can have a big impact, and that solving the root cause helps prevent repeat issues in a busy retail setting.

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Root Cause Analysis (RCA) Reflection as a Lab Assistant

Event:
As a Lab Assistant, we faced repeated failures in DNA extraction experiments, despite using high-quality reagents. I was asked to investigate the issue.

RCA Investigation:

Q1: Why were the experiments failing?
A1: Because the results were inconsistent.

Q2: Why were the results inconsistent?
A2: Because a crucial step in the protocol was skipped, leading to incorrect buffer preparation.

Q3: Why was the step skipped?
A3: The team was rushing and didn’t double-check the procedure.

Q4: Why were they rushing?
A4: Due to poor time management and lack of attention to detail.

Root Cause:
The root cause was not following the protocol due to poor time management and rushing through the process.

Resolution:
We corrected the buffer preparation, emphasized protocol adherence, and improved time management.

Outcome:
The experiments were successful after these changes, and the experience taught me the importance of addressing root causes and thoroughly investigating issues to prevent future problems.

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Root Cause Analysis (RCA) Reflection as a Lab Assistant

Event:
As a Lab Assistant, I was tasked with investigating repeated failures in DNA extraction experiments, despite using high-quality reagents.

RCA Investigation:

Why were the experiments failing?
The results were inconsistent.

Why were the results inconsistent?
A crucial step in the protocol was skipped, leading to incorrect buffer preparation.

Why was the step skipped?
The team was rushing and didn’t double-check the procedure.

Why were they rushing?
Due to poor time management and lack of attention to detail.

Root Cause:
The root cause was not following the protocol properly, caused by poor time management and rushing through the process.

Resolution:
We corrected the buffer preparation, emphasized strict adherence to the protocol, and focused on better time management.

Outcome:
The experiments were successful after these changes. This experience taught me the importance of addressing root causes and thoroughly investigating issues to prevent future problems.

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Tanvi Panchal (301380569)

During my time working in a lab, I was asked to help with an investigation into why our cultures were frequently showing signs of microbial contamination, even though we followed all standard sterile procedures. At first, it seemed like a small issue, but as it persisted, the team became more concerned, as the contamination was affecting our results.

We decided to perform a Root Cause Analysis (RCA) to identify the source of the contamination. We started by collecting data on the conditions under which the contamination occurred. I reviewed the procedures we followed, the equipment we used, and even the environment where we stored our cultures. We also interviewed lab personnel to see if there had been any deviations from protocols.

The first thing we noticed was that contamination was most common with samples that were left out for extended periods during the day. This led us to suspect that it might be an issue with the environment or equipment. We checked the autoclave and sterilization techniques, but everything seemed in order. However, when we examined the air filtration system, we found that it wasn’t functioning properly, and the lab wasn’t as sterile as it should have been.

Upon further investigation, we realized that the root cause of the contamination was actually the malfunctioning air filtration system. It had been allowing airborne microbes to enter the lab during open work periods, which explained the persistent contamination in certain cultures.

Once we identified this root cause, we immediately had the air filtration system repaired. After that, the contamination issue was resolved, and our cultures remained sterile, allowing us to continue our work without any issues.

Looking back, I learned that RCA isn’t just about finding problems, but about questioning everything,even the things you think are already in place and functioning well. The wrong root cause could have led to wasted time on other potential issues, like the sterilization process or contamination during sample handling. This experience taught me the value of thorough investigation and the importance of looking at every part of the process to find the real cause.

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Back when I was working as a cashier, I had a situation where my manager asked me to help figure out why our cash register was short by a significant amount at the end of multiple shifts. At first, I thought it was just a miscount or a simple mistake, but after reviewing the records, the issue kept happening over and over again.

To investigate, I started by double-checking my own cash handling to make sure I wasn’t making mistakes. Then, I noticed that a few other cashiers also had shortages. We reviewed the security footage and found that one of the self-checkout registers had a glitch where it wasn’t registering some transactions properly, particularly when customers used gift cards. Instead of stealing or human error, the actual problem was a technical issue in the system.

The fix? The management team reported the issue to IT, and in the meantime, we manually cross-checked gift card transactions to prevent further losses.

From this experience, I realized that people who conduct RCA regularly need:

Problem-Solving Skills – It’s important to approach an issue logically and not jump to conclusions too quickly.

Observation Skills – Paying attention to patterns and details can help uncover the real issue.

Teamwork and Communication – Since I had to talk with managers, IT staff, and other cashiers, it showed me how crucial it is to work together to solve problems.

This experience made me realize that investigations don’t always mean something suspicious—sometimes, they’re just about finding small technical issues before they turn into big problems!

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My RCA experience in a chemistry experiment in middle school

It happened when I was in middle school, my groupmate and I were conducting a standard heat reaction with potassium permanganate (KMnO4) to observe its decomposition in a chemistry lab. The goal was to heat the KMnO4 in a big, tilted test tube, which would decompose and release oxygen and bring the embers in the attached tube back to life. However, during the experiment, something unusual occurred: when we applied heat, the KMnO4 powder in the test tube suddenly ignited with a visible flame. Luckily, by swiftly removing the heat source, the flame was extinguished quickly, and no injuries occurred.

After reported to the instructor and some closer investigation, I found that the cause of the problem was not the reaction itself, but a storage error: The glass bottle containing the KMnO4 powder still had a label named "carbon powder", which means this container used to store carbon powder. Carbon, when heated in an oxygen-rich environment, can undergo an exothermic reaction, igniting and producing flames. The oxygen released during the decomposition of KMnO4 likely accelerated the oxidation of the carbon powder, causing the combustion. Once the mistake was discovered, it became clear that the residual carbon powder had led to a highly reactive situation, turning a routine experiment into an unanticipated hazard.

The root cause of the incident was traced back to the improper storage of different chemicals in the same container without cleaning. Following the incident, the lab instituted stricter procedures for chemical labeling and verification to prevent similar mishaps, ensuring that safety protocols were always followed and reducing the risk of future accidents.

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My Experience with a Root Cause Analysis (RCA) at Home

Hi classmates,

I want to share a personal story about a Root Cause Analysis (RCA) I did in my everyday life — nothing too formal, but it definitely taught me how RCA works even outside of a professional setting.

The Case of the Disappearing Cheesecake

A few months ago, I was living with three roommates. One Friday night, I bought myself a slice of cheesecake from my favorite bakery and put it in the fridge with my name clearly written on the container. I was saving it for Saturday after work you know, as a reward for surviving the week.

But when I came home the next evening… it was gone.

At first, I was just annoyed. But then I thought — okay, let’s treat this like a little investigation. I decided to dig into it like a Root Cause Analysis (RCA).

How I Investigated It (Like an RCA)

I asked each of my roommates if they’d seen the cheesecake. All of them denied touching it. But I noticed one of them (I'll call him R) seemed really nervous and avoided eye contact.

So I started asking questions like:

"Did anyone move it to make space in the fridge?"

"Did anyone throw something out yesterday?"

I even checked the sink and found a spoon with cheesecake residue.

Eventually, R admitted that he ate it, thinking it was his — even though my name was on it! He said he didn’t even look at the label.

Root Cause Identified: Lack of Communication and Clear Shared Rules

We realized we never really discussed rules about labeling or respecting each other's food. So the real issue wasn’t just R being careless — it was that we had no system in place. That’s the root cause.

We fixed it by creating a simple house rule:
1) If it’s not yours and it has a name on it, don’t touch it.

2)If you’re not sure, ask before eating.

Why the Right Root Cause Matters

If I had just blamed R and left it at that, the same issue might’ve happened again —maybe with someone else’s food. By finding the real reason (no house rules), we were able to prevent it from happening again. That’s the power of identifying the correct root cause, it leads to real, lasting solutions.

Transferable Skills I Used:

1. Critical Thinking – Asking questions, observing behavior, connecting clues.

2. Communication – Talking with others calmly, without starting a fight.

3. Problem-solving – Finding a solution everyone could agree to.

These are all skills that can be used not just at home, but in any job where RCA is required.

This may have started as a "cheesecake mystery," but it taught me that investigations — big or small — follow the same logic. Ask the right questions, observe carefully, and solve the real issue, not just the surface one.

Thanks for reading!

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One day, I participated in root cause analysis. I am cashier and I observed that many customers were not satisfying with prices and they were returning items. So, I was worried about what was the reasons behind this. I also talked with my supervisor about this issues. I spoke with customers and I got information that there was different price tag and in system there was different prices. So, I thought that why and what was the reasons. For getting root , I visited the each spot and I took items and scanned ,and I found some different prices. For getting solution , I spoke with workers who were doing facing items and managing price tags. After speaking with them I got information that in my company there is rule to change price of all products every year. while applying this rule, they forgot to change some price tags and removed old tags. I told them removed old tags and placed new tags. After doing this , now customers are satisfying with prices.

If I did not involve in this situation, so customers are returning items continuously. As a result, company is facing loss in selling items and it affects company's profit and reputations.

I think that it is good experience and I believe that RCA is playing most importance part in any failed situation.

Thank you.

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During one of my shifts at the lab, I was involved in a Root Cause Analysis (RCA) investigation when we noticed that our testing equipment was producing inconsistent results. The lab team and I gathered data, reviewed equipment logs, and conducted interviews with technicians who used the machine. After careful analysis, we identified that the issue wasn't with the software, as we initially suspected, but rather with a faulty calibration mechanism that had gone unnoticed during regular maintenance. Had we focused on the software glitch, we could have wasted time troubleshooting code, leading to delays and missed deadlines. The real issue might have continued to cause inaccurate results, affecting our overall research accuracy. I believe that attention to detail, problem-solving, and clear communication are essential skills when conducting RCAs. These skills ensure that the problem is understood correctly, the team stays aligned, and corrective actions are effectively implemented.

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During our Project 2 experiment, we were attempting to cultivate Lactobacillus plantarum for growth and metabolic activity experiments. However, after several attempts, the bacteria consistently did not grow at all or at the minimum required density even in our controls. This was a critical setback, as our experiments relied on it as our organism of interest. My partner and I then systematically investigated what might have caused this. We started by meticulously reviewing the growth requirements, including media preparation, incubation parameters, and inoculation techniques. We then examined the equipment used, such as the incubator and spectrophotometer to rule out any malfunctions. Through the right questions, careful observation, and data analysis, we discovered that the MSG we added in the media interfered with the bacteria's growth. The MSG was originally added as a substrate for GABA utilization measurement in preparation for the metabolic activity experiment and ensure that the project would finish in time. This was confirmed when a batch of media without the MSG was incubated and growth was observed. The root cause was identified as a media preparation error, leading to less than optimal growth conditions, and consequently failed bacterial growth.

If we had misidentified the root cause, the consequences could have been significant. For instance, if we incorrectly assumed incubation conditions, we might have wasted time and resources adjusting to different incubation environments without getting substantial information on what went wrong and failed to address the media problem. If we suspected a faulty bacterial strain, we might have discarded a viable culture and delayed our experiments. This highlights the importance of rigorous process review, meticulous equipment checks, and a systematic approach to troubleshooting in a lab setting, especially when dealing with sensitive biological processes.

When dealing with these situations, it is important that the individual possesses transferable skills such as critical thinking and problem solving as well as communication and collaboration. The ability to understand the process and analytically identify the root cause through the process of deduction and critical evaluation is essential to provide an appropriate solution to the problem at hand. Moreover, it is crucial that the individual also possesses communication and collaboration skills so that they are able to efficiently and effectively gather information, facilitate discussions and brainstorming sessions, and convey findings clearly so that the issue can be resolved appropriately.

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When I was working in a hospital laboratory, I encountered an issue with one of the machines while running quality control. The control results were consistently out of range despite multiple re-runs. Initially, I suspected a reagent issue, but after further investigation and consulting with the technician, we discovered that the system had an incorrect reference range input. The root cause was a discrepancy in the configured range, which required updating to match the correct values. Once corrected, the control results fell within the expected range, ensuring accurate patient testing.

Their are impacts for wrong RCA, First, Continued Operational Issues: If the wrong root cause is identified, the actual problem remains unresolved, leading to repeated errors. For example, in a laboratory setting, misidentifying the cause of out-of-range quality control results could result in continued reporting of incorrect patient results, compromising patient safety. Second, Unnecessary Costs and Wasted Resources: Addressing an incorrect root cause can lead to wasted time, effort, and financial resources. For instance, replacing an entire instrument when the real issue is a calibration error would result in unnecessary expenses without resolving the underlying problem.

The transferable skills that most important are: Analytical Thinking: The ability to systematically assess a problem, identify potential causes, and evaluate evidence is crucial for accurate root cause identification. Attention to Detail: Small discrepancies, such as incorrect reference ranges or minor calibration errors, can have significant impacts. A keen eye for detail ensures that such issues are caught early. Communication and Collaboration: RCA often involves consulting with different stakeholders, such as technicians, engineers, or quality assurance teams. Clear communication ensures that information is accurately conveyed and solutions are effectively implemented. Problem-Solving Skills: The ability to think critically and develop corrective actions prevents recurrence of the issue and improves overall system reliability.

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The Importance of Identifying the Right Root Cause: A Lesson from the Lab - Harsimran Kaur 301293939

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The Importance of Identifying the Right Root Cause: A Lesson from the Lab - Harsimran Kaur 301293939

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It was a typical Monday morning when our lab received a customer complaint about a recurring issue in one of our products. The defect was subtle but significant—something was causing an unexpected degradation in product quality over time. Given the potential regulatory implications, we immediately launched a Root Cause Analysis (RCA) to determine what went wrong.

Our cross-functional team, consisting of quality engineers, manufacturing specialists, and scientists, gathered in a conference room. We applied the 5 Whys method, systematically working backward from the defect to uncover its origin. Initially, it seemed like a contamination issue—perhaps a raw material batch was compromised. We conducted a full material traceability review and found nothing unusual.

Then, we considered equipment failure. We checked calibration logs, maintenance records, and operator notes—everything was in spec. The process parameters hadn’t changed. Frustration was growing, and pressure from upper management mounted to resolve the issue quickly.

Finally, one of my colleagues suggested looking into storage conditions. That wasn’t the most obvious cause, but as we reviewed historical temperature and humidity data, we found subtle fluctuations that exceeded ideal conditions for short periods during transportation. Further testing confirmed that these fluctuations were enough to accelerate product degradation.

Had we stopped at the first assumption (contamination), the company could have taken incorrect corrective actions, such as rejecting a perfectly good batch of raw materials, leading to unnecessary costs and production delays. Worse, if the problem persisted, it could have damaged customer trust and even led to regulatory scrutiny.

This experience reinforced a key lesson: Rushing to identify a root cause without thorough investigation can have serious consequences. A proper RCA requires critical thinking, teamwork, and persistence—without these, companies risk treating symptoms instead of solving the actual problem.

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Problem:

Patient A's medications were encoded in patient B's record.

RCA Investigation:

We investigated and found out that their names were switched, and it was his brother's (patient B) name instead of patient A's name.

How did it happen?

One of the key factors that led to this incident was poor communication. The encoder might have been confused since the patients were twins and had almost identical and rhyming names. This highlights the need for improved communication protocols to prevent such errors in the future.

Environmental Factor: Since it was a busy day, many patients entered the pharmacy, which added to the encoder's confusion.

Solution:

Verify the identity of the patient by asking for a valid ID.

sort and fix the records so as not to mix the medications

Confirm the patient's date of birth and name before submitting the encoded medications.

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In my previous job role in the QC department, I have participated in several Root Cause Analysis (RCA) investigations, particularly related to HPLC analysis. One example involved inconsistencies in peak retention times for impurities during a routine HPLC test of a drug product. After conducting a thorough investigation, we identified that the mobile phase solvent preparation was incorrect, causing variations in the results. By correcting the solvent preparation process, we were able to resolve the issue and ensure accurate and reliable analysis in subsequent tests.

Identifying the wrong root cause in an RCA can have significant consequences. For example, if we had mistakenly blamed the sample preparation process instead of the mobile phase, the problem would have persisted, leading to unreliable HPLC results and potentially affecting product quality. Additionally, incorrect identification of the root cause can waste time and resources, such as unnecessary equipment replacements or labor on issues that do not resolve the actual problem. This not only increases costs but also prolongs the problem, impacting production timelines.

Key transferable skills for those conducting RCAs, especially in a QC environment, include strong analytical thinking, attention to detail, and effective collaboration. In HPLC analysis, understanding data patterns and pinpointing discrepancies in chromatograms are crucial for identifying the root cause. Communication skills are essential when working with cross-functional teams to gather all relevant information. Problem-solving abilities are necessary to develop appropriate corrective actions once the root cause is identified, and time management ensures that RCA investigations are completed efficiently without compromising quality.

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I participated in a Root Cause Analysis (RCA) investigation in a laboratory setting after repeated calibration failures. Using the 5 Why technique, we traced the issue back to inconsistent cleaning of calibration tools—something initially overlooked in favor of equipment malfunction. This led to updated SOPs and retraining, ultimately improving the reliability of the process and preventing future issues.

Identifying the wrong root cause can seriously impact a company. For example, if recurring delays are wrongly blamed on staff error instead of aging equipment, the problem will persist. Similarly, implementing the wrong corrective action—like retraining staff instead of fixing a process flaw—can waste resources and lower employee morale.

To conduct RCAs effectively, key transferable skills include critical thinking to dig beyond surface issues, strong communication to gather accurate information across teams, and attention to detail to catch small but important clues. These skills help ensure the root cause is accurately identified and addressed.

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Athul Sakthi( 301346945)

At one point, our pizzeria started receiving multiple customer complaints about pizzas being undercooked in the center. Initially, the team assumed it was a problem with the dough recipe, and we tried adjusting the hydration levels. However, the issue persisted.

Using RCA, I broke down the process and checked each factor:
.Oven temperature and cooking time
.Dough preparation and thickness
.Placement of pizzas in the oven

After testing, we discovered that a faulty oven heating element was causing uneven heat distribution. The center of the pizza wasn’t getting enough direct heat, leading to undercooked dough. Once we repaired the heating element, the problem was resolved, and pizzas were consistently baked to perfection.

If we had identified the wrong root cause, it could have negatively impacted the business in two ways:

Increased Waste & Costs – If we had continued tweaking the dough recipe unnecessarily, we would have wasted ingredients and time, without actually fixing the problem.

Loss of Customer Trust – Customers expect high-quality pizza every time. If the issue persisted, repeat customers might stop ordering, and bad reviews could hurt the restaurant’s reputation.

People who perform RCA regularly need:

Attention to Detail – Identifying small changes, like slight temperature variations in an oven, can make a big difference.
Critical Thinking – Evaluating multiple potential causes before jumping to conclusions.
Communication Skills – RCA often involves discussing issues with coworkers to gather insights and prevent future mistakes.

For example, another time, I had to investigate why pizza dough was rising inconsistently. By going step by step, I found that one batch of yeast had expired, causing weak fermentation. This showed me how important it is to check ingredient freshness regularly.

RCA isn’t just for high-tech industries—it’s useful in any job, even as a pizza chef! By finding the real cause of a problem, businesses can improve efficiency, maintain quality, and keep customers happy

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RCA experience:

I participated in a Root Cause Analysis (RCA) while I was a trainee at Bosonic Nutraceutical Company in response to consumer concerns regarding the strength of our vitamin supplements. We initially thought that the manufacturing machinery was broken, but after more research, we found that the potency problems were caused by lower-than-expected purity in the raw materials that were provided to us. A careful examination of supplier communications and batch data allowed for the identification of this main cause.

If we had mistaken the underlying cause, we might have kept wasting time and money trying to fix equipment that wasn't the problem. Additional customer unhappiness and possible financial losses could have resulted from this. We were able to collaborate with the supplier to enhance the quality of the raw material by determining the true cause, which helped avert further complaints and guaranteed product consistency.

I learned the value of thorough data analysis and efficient team communication from this experience. It also reaffirmed the importance of an organized method of problem-solving, which is crucial for anyone who frequently performs RCAs. Critical thinking, teamwork, and attention to detail are all essential for RCA inquiry success.

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Unexpected Machine Failure: A Root Cause Analysis Experience

It was a busy morning in the lab, and I was in the middle of running a batch of critical patient samples through the hematology analyzer. Everything seemed routine, until suddenly, the machine stopped mid-run, flashing an error code I had never seen before.

Step 1: Identifying the Problem

At first, I assumed it was a minor issue—a simple jam or a temporary sensor glitch. But after restarting the machine, the same error reappeared. My supervisor, noticing my frustration, came over, and we both realized this wasn’t a quick fix. The analyzer was one of the only functional units that day, meaning any delay could impact patient diagnoses.

Step 2: Investigating Possible Causes

Since I had worked with this analyzer for a while, I knew the usual suspects:
✅ Reagents & Consumables: I checked reagent levels and replaced the sample probe, but the error persisted.
✅ Mechanical Issues: I ran a manual cleaning cycle to rule out clogs—still no luck.
✅ Software or Calibration Problems: A quick check of the system logs showed no failed calibrations or overdue maintenance.

At this point, my supervisor suggested we escalate the issue to technical support while continuing our investigation.

Step 3: Finding the Root Cause

After speaking with the manufacturer’s support team, we discovered that the issue was due to a faulty internal temperature sensor. The machine had misread the internal temperature as too high, causing an automatic safety shutdown. This was something I wouldn’t have thought of on my own!

Step 4: Preventing Future Issues

The solution involved replacing the sensor, but we also made preventative changes:
🔹 Added a daily sensor check to our maintenance routine
🔹 Implemented a troubleshooting guide for similar errors
🔹 Ensured we had a backup analyzer available at all times

Lessons Learned & Transferable Skills

This experience showed me how important problem-solving and teamwork are in RCA.
🔹 Critical Thinking – I had to systematically eliminate possible causes.
🔹 Attention to Detail – Small details, like an internal sensor, can have big impacts.
🔹 Communication – Working with my supervisor and the manufacturer’s team helped us resolve the issue quickly.

The Impact of Identifying the Wrong Root Cause

Had we assumed the issue was just a clogged sample probe, we might have wasted time replacing parts unnecessarily or delaying urgent samples. In a medical setting, a misdiagnosed machine failure could lead to:
1️⃣ Delayed Patient Care – Doctors relying on test results might not get them in time.
2️⃣ Increased Costs – Ordering unnecessary repairs or even replacing the entire machine when only a small part needed fixing.

This experience reinforced that a structured approach to RCA is crucial in any industry, not just healthcare. Whether investigating a machine failure or a missing snack from the fridge, the key is to ask the right questions and not jump to conclusions!

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My RCA Reflection

While working as a pharmacist at a pharmacy in India, I noticed that our physical inventory wasn’t matching the digital stock records. This was a serious concern because it could affect both inventory control and patient service. I reported the issue to my supervisor, and together we began a Root Cause Analysis. After checking stock logs and contacting the software company, we discovered the issue: a newly hired pharmacy assistant had been entering new stock without updating the quantity field in the system. As a result, only one item was logged instead of two, creating ongoing discrepancies. The situation was resolved through retraining and closer supervision of data entry.

If the wrong root cause had been identified, such as blaming a software glitch or even suspecting theft, it could have led to poor decisions. For example, unnecessary software updates or disciplinary actions might have wasted resources and damaged team morale. Misidentifying the cause could also leave the real issue unresolved, allowing inventory errors to continue and potentially affect medication availability for patients.

For those conducting RCA investigations regularly, I think some of the most important transferable skills include attention to detail, since even small errors can have big impacts, and strong communication, as gathering accurate information and collaborating with others is key to finding the real root cause. Patience and critical thinking also play a big role in making sure no step is overlooked.

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RCA Experience:

During my Quality Assurance Technician Co-Op work term in a food company, I experienced an issue related to the flavor and quality of the product being made. For one of the products being processed daily at the company, the sauce used to coat this product showed an unusual bitter taste and darker colour than regular, which led to a change in the final product's taste and visual appearance that did not meet with the quality standards set for this specific product. Thereby, a Root Cause Analysis (RCA) investigation took place, with the QA team from the company, we checked how the processing employees were handling the sauce, if there was any deviation in the regular process during the mixing of the sauce for the batches of product, or if there was any difference in the sauce containers. After asking multiple employees and individually checking the taste, colour and viscosity of the sauce we were able to narrow down the quality issue of the sauce into one specific lot. This lot was separated and new SOPs were implemented for the employees to do a quick quality check of every new lot of sauce used to avoid any further similar issue. Also, the sauce presenting these defects was returned to the supplier and they were  advised to inform our company why this lot presented this quality issue. The suppliers did their part and sent out a new lot of sauce presenting the usual quality along with proper explanations of the root of the issue and with the corrective actions they implemented in their facility to detect this deviation effectively.

Effects of wrong RCA being identified in a company:

1. Wrong implementation of resources in solving an issue that would not completely fix the original issue and would most likely work temporarily but not for the long run. Wasting time, money and labour.

2. Reputation of the company - the customers of the company would most likely gain distrust with the company practices if there is a recurring issue that is not being addressed well. Leading to the company’s reputation being hindered along with a loss in business opportunities and relationships.

Transferable skills essential for individuals conducting RCA’s:

I consider that skills such as critical thinking and problem solving are mainly useful for any employee, manager, supervisor, among others, to conduct a proper RCA. Being able to analyze in depth all the factors involved in the cause of an issue by asking adequate questions with the help of the 5 Whys or by making a Fishbone diagram is fundamental to identify patterns of the issue and know how and where to start addressing it. However, skills such as: attention to detail, decision-making and communication skills are also key to conduct effective RCAs in any industry.