How do you make sure that a problem is fixed?
Throughout your certification system there are many points where non-conformities may be found these include:
- Certificate holders or applicants can have a non-conformity raised by an auditor or they could find an error through their internal procedures.
- Certification bodies can have a non-conformity raised by their accreditation body, or can find a error through their own internal audit process or as a result of a complaint.
Logo license holders may be found to be out of conformity with the terms of licensing rules.
- And yes, even the scheme owner may find through an internal audit or complaint process that it has made an error.
Finding an error or having a non-conformity raised is not the end of the world. The most important factor is what is done about it.
Correction and Prevention
In the world of standards we talk about 'corrective' and 'preventive' actions. These are the things that are done by the organization that has been found to have a non-conformity or has identified an error that it has made.
'Corrective' actions are the things that are done to correct the error. For example if a certificate holder did not track the sales of certified product then it may 'correct' the non-conformity by going back into its records and making sure that sales that have been made are properly recorded.
'Preventive' actions are the things that are done to make sure that the non-conformity does not reoccur. This is where a challenge presents itself - How do you know what caused the problem in the first place? In the case of the sales records you could say the cause was the clerk that entered the data, the software used to record the information, the sales staff not specifying all the required the sale information, the office procedures or a whole bunch of other possibilities. If the action chosen does not fix the root cause then the problem may reoccur. Retraining the sales staff, for example will not fix a software problem.
Root Cause Analysis or Things may not be what they seem
Root Cause Analysis is a way to identify the real cause so that the fix can be directed to the source and ensure that the non-conformiety does not reoccur or so that a new problem does not occur from the same root cause.
There are number of methods available for identifying root causes, these are called root cause analysis methods. The one that fits best with you and your organization can be a subjective choice so I will not recommend that you choose a particular method. Some basic information can be found on Wikipedia or through a web search. There are also load workshops on root cause analysis on offer that your web search will pull up.
The most generic method that I have found is the '5 Whys'. In this method the question 'why' is asked first of the identified error, then the question is asked again of each answer at least 5 times.
On the sales records example:
Question 1: Why were the sales records wrong?
Answer 1: The clerk did not enter all the required information.
Question 2: Why did the clerk not enter all the required information?
Answer 2: The clerk was never trained on how to record sales information.
Question 3: Why was the clerk never trained?
Answer 3: The clerk has been on the job for 6 months and no training has been scheduled.
Question 4: Why has no training been scheduled?
Answer 4: Training is only offered once each year.
Question 5: Why is training only offered once each year?
Answer 5: The training budget has been cut each year for the last 5 years.
As a result of this Root Cause Analysis the proper preventive action would be to fix the training deficit one way would be to make sure that the budget allows for timely training of staff.
If your first thought was to fire the clerk then this action would not solve the problem and it is likely that it would would occur with the next clerk. It is also likely that other seemingly unrelated problems would occur in other parts of the organization because of lack of proper and timely training.
The root cause can sometimes be simple, but it is never a good idea to simply jump on the first idea you have and assume that the problem will be fixed. Often our first idea is more a reflection of our own bias (clerks are lazy) and not a considered analysis of the real cause (management is cheap).