Three Flags, No Fix: The RCA That Missed a Second Failure
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Three Flags, No Fix: The RCA That Missed a Second Failure
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A 785C A-frame bearing failed. Two days of unscheduled downtime, a line bore, a proper RCA.
The RCA was genuinely good. The site found the bearing hadbeen installed wrong six months earlier, rewrote the install procedure, added QA checkpoints. Textbook root cause work.
Pete and Drew walk through what that RCA missed: an existing 1000-hour PM check had already flagged that same bearing out of spec, three times, and none of those flags ever made it into the CMMS. Once the site dug further, the same gap held across the whole mobile work group, not just the one bearing.
This is the Failure Response Model in action, four questionsto walk through after any failure, and why stopping at "we know the cause" isn't the same as being done.
Break Tip: Don't just check whether your PMs are getting done. Check whether the defects they flag get closed out. Pick one asset, pull its last few completed PM sheets, find a flagged comment, and trace it into your CMMS. Did it become a work order? If it didn't, check a handful of other assets the same way. If it's not just the one, you've got a work management gap, not a “bearing” problem.