Audit, Non-Conformity, Root Cause Analysis & CAPA in Aviation

Course Overview

Learning Outcomes

Course Content & Topics Covered

Module 1 — RCA: What It Is & When It Is Required

1. What is Root Cause Analysis? — Definition, purpose and the core principle: if the fix doesn’t stop it happening again, you have not found the root cause
2. Reactive vs. Proactive — How RCA fits within a broader safety management approach
3. Root Cause · Contributing Factor · Symptom — The critical distinction, the ‘Why Ladder’, and a worked aviation maintenance example
4. The 5 EASA Trigger Situations — When regulation mandates RCA: authority findings (145.A.95 / CAMO.A.150), internal compliance monitoring findings, MORs, voluntary safety reports, and negative SMS trends
5. The Management Control Test — Three criteria every true root cause must satisfy, with pass/fail examples
6. Common RCA Failures — Why organisations stop too early, blame the individual, or fix the wrong thing
7. Regulatory Framework & Documentation — Key articles under Part-145 and Part-CAMO; documentation in MOE Chapter 3.8 / CAME Chapter 2.8

Module 2 — RCA Tools & Techniques

1. Why the Right Tool Matters — Selection criteria: problem complexity, team size, data availability, and regulatory expectation
2. The RCA Toolbox — A Landscape View — Four categories: Simple Causal, Structured Causal, Statistical/Data-Driven, and Systemic/Framework
3. Tool Selection & Regulatory Context — Matching tool to situation and the proportionality principle; MOE/CAME documentation requirements
4. MEDA in Depth
   • Boeing’s Maintenance Error Decision Aid: origins, philosophy, the 3 core beliefs, and the MEDA Error Model
   • The 5-step MEDA process and the 8-category Contributing Factors Checklist
   • Full worked case study: NLG hydraulic line incident
5. The 5 Whys in Depth
   • Method, the 5 Golden Rules, and the 5 traps that invalidate analysis
   • Three worked aviation maintenance scenarios
   • Knowing the limits: when the 5 Whys is not enough
6. Ishikawa (Fishbone) Diagram in Depth
   • The 6M framework: Man, Machine, Method, Material, Environment, Management
   • Step-by-step construction and two detailed case studies
   • Fishbone vs 5 Whys — when to use which
7. Ishikawa + 5 Whys Combined Method
   • The 4-phase approach: Diverge, Prioritise, Converge, Synthesise
   • Two worked scenarios and guidance on when to use the combined method

Module 3 — The Investigation Process in Practice

1. Investigation vs. Inspection — The fundamental distinction and why it matters for recurring findings
2. Investigation Planning & Preparation — Securing evidence, defining scope, selecting the team, and managing regulatory deadlines
3. Interviewing Techniques — Individual interviews, question sequencing (open, probing, closed), and Just Culture protection
4. Psychological Bias & Just Culture — Recognising hindsight, outcome, and availability biases; behaviour classification and proportionate interventions within a Just Culture framework
5. The Event Review Group (ERG) — Role, composition, and independence requirements
6. The Complete Investigation Workflow — Event → Planning → Data Collection → Interviewing → Analysis → Report → ERG → CAPA & Closure

Module 4 — Corrective & Preventive Action (CAPA)

1. CA vs. PA — The Fundamental Distinction — Corrective Action (reactive, targets root cause) vs Preventive Action (proactive, targets potential cause); ISO 9001:2015 alignment
2. Containment · Corrective Action · Preventive Action — The three-level distinction and why containment alone is never sufficient
3. Regulatory Basis — What EASA requires under 145.A.95, 145.A.200(f), CAMO.A.150, and corresponding AMC; documentation in MOE/CAME
4. What Does NOT Qualify as Corrective Action — Common non-answers that authority inspectors will reject: retraining, monitoring, repair-as-CA, and undocumented procedure changes
5. The Root Cause Linkage Rule — Every CA must be traceable to a specific root cause statement; the three tests an authority inspector will apply

Module 5 — Full Practical Workshop

Learning Format