INTRODUCTION

Reliability engineering and predictive maintenance have two major objectives: preventing catastrophic failures of critical plant production systems and avoiding deviations from acceptable performance levels that result in personal injury, environmental impact, capacity loss, or poor product quality. Unfortunately, these events will occur no matter how effective the reliability program. Therefore, a viable program also must include a process for fully understanding and correcting the root causes that lead to events having an impact on plant performance. This book provides a logical approach to problem resolution. The method can be used to accurately define deviations from acceptable performance levels, isolate the root causes of equipment failures, and develop cost-effective corrective actions that prevent recurrence. This three-part set is a practical, step-by-step guide for evaluating most recumng and serious incidents that may occur in a chemical plant. Part One, Introduction to Root Cause Failure Analysis, presents analysis techniques used to investigate and resolve reliability-related problems. It provides the basic methodology for conducting a root cause failure analysis (RCFA). The procedures defined in this section should be followed for all investigations. Part Two provides specific design, installation, and operating parameters for particular types of plant equipment. This information is mandatory for all equipment-related problems, and it is extremely useful for other events as well. Since many of the chronic problems that occur in process plants are directly or indirectly influenced by the operating dynamics of machinery and systems, this part provides invaluable guidelines for each type of analysis. Part Three is a troubleshooting guide for most of the machine types found in a chemical plant. This part includes quick-reference tables that define the common failure or

Root Cause Failure Analysis

deviation modes. These tables list the common symptoms of machine and processrelated problems and identify the probable cause(s).

PURPOSE OF THE ANALYSIS

The purpose of RCFA is to resolve problems that affect plant performance. It should not be an attempt to& blame for the incident. This must be clearly understood by the investigating team and those involved in the process. Understanding that the investigation is not an attempt to fix blame is important for two reasons. First, the investigating team must understand that the real benefit of this analytical methodology is plant improvement. Second, those involved in the incident generally will adopt a self-preservation attitude and assume that the investigation is intended to find and punish the person or persons responsible for the incident. Therefore, it is important for the investigators to allay this fear and replace it with the positive team effort required to resolve the problem.

EFFECTIVE USE OF THE ANALYSIS

Effective use of RCFA requires discipline and consistency. Each investigation must be thorough and each of the steps defined in this manual must be followed. Perhaps the most difficult part of the analysis is separating fact from fiction. Human nature dictates that everyone involved in an event or incident that requires a RCFA is conditioned by his or her experience. The natural tendency of those involved is to filter input data based on this conditioning. This includes the investigator. However, often such preconceived ideas and perceptions destroy the effectiveness of RCFA. It is important for the investigator or investigating team to put aside its perceptions, base the analysis on pure fact, and not assume anything. Any assumptions that enter the analysis process through interviews and other data-gathering processes should be clearly stated. Assumptions that cannot be confirmed or proven must be discarded.

PERSONNEL REQUIREMENTS
The personnel required to properly evaluate an event using RCFA can be quite substantial. Therefore, this analysis should be limited to cases that truly justify the expenditure. Many of the costs of performing an investigation and acting on its recommendations are hidden but nonetheless are real. Even a simple analysis requires an investigator assigned to the project until it is resolved. In addition, the analysis requires the involvement of all plant personnel directly or indirectly involved in the incident. The investigator generally must conduct numerous interviews. In addition, many documents must be gathered and reviewed to extract the relevant information.

Introduction

In more complex investigations, a team of investigators is needed. As the scope and complexity increase, so do the costs. As a result of the extensive personnel requirements, general use of this technique should be avoided. Its use should be limited to those incidents or events that have a measurable negative impact on plant performance, personnel safety, or regulatory compliance.

WHEN TO USE THE

METHOD

The use of RCFA should be carefully scrutinized before undertaking a full investigation because of the high cost associated with performing such an in-depth analysis. The method involves performing an initial investigation to classify and define the problem. Once this is completed, a full analysis should be considered only if the event can be fully classified and defined, and it appears that a cost-effective solution can be found. Analysis generally is not performed on problems that are found to be random, nonrecurring events. Problems that often justify the use of the method include equipment, machinery, or systems failures; operating performance deviations; economic performance issues; safety; and regulatory compliance issues.