{"id":22357,"date":"2024-11-21T12:09:53","date_gmt":"2024-11-21T04:09:53","guid":{"rendered":"https:\/\/www.yunshan.net\/blog\/?p=22357"},"modified":"2024-11-21T12:09:53","modified_gmt":"2024-11-21T04:09:53","slug":"%e4%ba%86%e8%a7%a3%e6%95%85%e9%9a%9c%e6%a0%b9%e5%9b%a0%e5%88%86%e6%9e%90%ef%bc%8c%e6%8f%90%e5%8d%87%e8%ae%be%e5%a4%87%e6%95%85%e9%9a%9c%e5%ba%94%e5%af%b9%e8%83%bd%e5%8a%9b","status":"publish","type":"post","link":"https:\/\/www.yunshan.net\/blog\/archives\/22357.html","title":{"rendered":"\u4e86\u89e3\u6545\u969c\u6839\u56e0\u5206\u6790\uff0c\u63d0\u5347\u8bbe\u5907\u6545\u969c\u5e94\u5bf9\u80fd\u529b"},"content":{"rendered":"<p>\t\t\t\t<![CDATA[\n\n<p>\u5728\u73b0\u4ee3\u5de5\u4e1a\u751f\u4ea7\u4e2d\uff0c\u8bbe\u5907\u7684\u7a33\u5b9a\u8fd0\u884c\u662f\u4f01\u4e1a\u751f\u4ea7\u6548\u7387\u548c\u8d28\u91cf\u4fdd\u969c\u7684\u5173\u952e\u56e0\u7d20\u4e4b\u4e00\u3002\u7136\u800c\uff0c\u8bbe\u5907\u6545\u969c\u662f\u4e0d\u53ef\u907f\u514d\u7684\uff0c\u5982\u4f55\u5feb\u901f\u3001\u51c6\u786e\u5730\u627e\u5230\u6545\u969c\u7684\u6839\u6e90\uff0c\u5e76\u91c7\u53d6\u6709\u6548\u63aa\u65bd\u8fdb\u884c\u5e94\u5bf9\uff0c\u6210\u4e3a\u4e86\u4f01\u4e1a\u8bbe\u5907\u7ba1\u7406\u7684\u91cd\u8981\u8bfe\u9898\u3002\u672c\u6587\u5c06\u4ece<a href=\"https:\/\/www.yunshan.net\" target=\"_blank\" style=\"color:blue\" rel=\"noopener noreferrer\">\u6545\u969c<a href=\"https:\/\/www.yunshan.net\" target=\"_blank\" style=\"color:blue\" rel=\"noopener noreferrer\">\u6839\u56e0\u5206\u6790<\/a><\/a>\u7684\u539f\u7406\u3001\u65b9\u6cd5\u3001\u6b65\u9aa4\u4ee5\u53ca\u5982\u4f55\u63d0\u5347\u8bbe\u5907\u6545\u969c\u5e94\u5bf9\u80fd\u529b\u7b49\u65b9\u9762\u8fdb\u884c\u8be6\u7ec6\u63a2\u8ba8\u3002<\/p>\n\n\n\n\n<h3>\u4e00\u3001<a href=\"https:\/\/www.yunshan.net\" target=\"_blank\" style=\"color:blue\" rel=\"noopener noreferrer\">\u6545\u969c<a href=\"https:\/\/www.yunshan.net\" target=\"_blank\" style=\"color:blue\" rel=\"noopener noreferrer\">\u6839\u56e0\u5206\u6790<\/a><\/a>\u7684\u57fa\u672c\u6982\u5ff5<\/h3>\n\n\n\n\n<p><strong>1.1 \u6545\u969c\u6839\u56e0\u7684\u5b9a\u4e49<\/strong><\/p>\n\n\n\n\n\n\n\n\n<p align=center><img decoding=\"async\" src=\"https:\/\/www.yunshan.net\/blog\/wp-content\/uploads\/2024\/11\/E0i0q8.jpg\" width=1000><\/p>\n\n\n\n\n\n\n\n\n\n<p>\u6545\u969c\u6839\u56e0\uff08Root Cause\uff09\u662f\u6307\u5bfc\u81f4\u8bbe\u5907\u6545\u969c\u53d1\u751f\u7684\u6700\u6839\u672c\u539f\u56e0\u3002\u5b83\u4e0d\u4ec5\u4ec5\u662f\u8868\u9762\u73b0\u8c61\u7684\u76f4\u63a5\u539f\u56e0\uff0c\u800c\u662f\u9690\u85cf\u5728\u73b0\u8c61\u80cc\u540e\u7684\u6df1\u5c42\u6b21\u539f\u56e0\u3002\u53ea\u6709\u627e\u5230\u6839\u56e0\uff0c\u624d\u80fd\u4ece\u6839\u672c\u4e0a\u89e3\u51b3\u95ee\u9898\uff0c\u9632\u6b62\u6545\u969c\u518d\u6b21\u53d1\u751f\u3002<\/p>\n\n\n\n\n<p><strong>1.2 \u6545\u969c\u6839\u56e0\u5206\u6790\u7684\u610f\u4e49<\/strong><\/p>\n\n\n\n\n<p>\u6545\u969c\u6839\u56e0\u5206\u6790\uff08Root Cause Analysis, RCA\uff09\u662f\u4e00\u79cd\u7cfb\u7edf\u6027\u7684\u95ee\u9898\u89e3\u51b3\u65b9\u6cd5\uff0c\u65e8\u5728\u901a\u8fc7\u79d1\u5b66\u7684\u65b9\u6cd5\u548c\u5de5\u5177\uff0c\u627e\u51fa\u6545\u969c\u7684\u6839\u672c\u539f\u56e0\uff0c\u4ece\u800c\u5236\u5b9a\u6709\u6548\u7684\u6539\u8fdb\u63aa\u65bd\u3002\u5176\u610f\u4e49\u5728\u4e8e\uff1a<\/p>\n\n\n\n\n<ul>\n\n\n<li><strong>\u51cf\u5c11\u6545\u969c\u91cd\u590d\u53d1\u751f<\/strong>\uff1a\u901a\u8fc7\u627e\u5230\u6839\u56e0\uff0c\u91c7\u53d6\u9488\u5bf9\u6027\u63aa\u65bd\uff0c\u907f\u514d\u540c\u7c7b\u6545\u969c\u518d\u6b21\u53d1\u751f\u3002<\/li>\n\n\n\n\n<li><strong>\u63d0\u9ad8\u8bbe\u5907\u53ef\u9760\u6027<\/strong>\uff1a\u901a\u8fc7\u7cfb\u7edf\u5206\u6790\uff0c\u63d0\u5347\u8bbe\u5907\u7684\u6574\u4f53\u53ef\u9760\u6027\uff0c\u5ef6\u957f\u8bbe\u5907\u4f7f\u7528\u5bff\u547d\u3002<\/li>\n\n\n\n\n<li><strong>\u964d\u4f4e\u7ef4\u4fee\u6210\u672c<\/strong>\uff1a\u51cf\u5c11\u56e0\u91cd\u590d\u6545\u969c\u5bfc\u81f4\u7684\u7ef4\u4fee\u8d39\u7528\u548c\u65f6\u95f4\u6210\u672c\u3002<\/li>\n\n\n\n\n<li><strong>\u63d0\u5347\u751f\u4ea7\u6548\u7387<\/strong>\uff1a\u51cf\u5c11\u8bbe\u5907\u505c\u673a\u65f6\u95f4\uff0c\u4fdd\u969c\u751f\u4ea7\u8fde\u7eed\u6027\u3002<\/li>\n\n\n<\/ul>\n\n\n\n\n<h3>\u4e8c\u3001\u6545\u969c\u6839\u56e0\u5206\u6790\u7684\u5e38\u7528\u65b9\u6cd5<\/h3>\n\n\n\n\n<p><strong>2.1 \u4e94\u95ee\u6cd5\uff085-Why Analysis\uff09<\/strong><\/p>\n\n\n\n\n<p>\u4e94\u95ee\u6cd5\u662f\u4e00\u79cd\u7b80\u5355\u800c\u6709\u6548\u7684\u6839\u56e0\u5206\u6790\u65b9\u6cd5\uff0c\u901a\u8fc7\u8fde\u7eed\u8ffd\u95ee\u201c\u4e3a\u4ec0\u4e48\u201d\uff0c\u9010\u6b65\u6df1\u5165\u95ee\u9898\u7684\u672c\u8d28\u3002\u5177\u4f53\u6b65\u9aa4\u5982\u4e0b\uff1a<\/p>\n\n\n\n\n<ol>\n\n\n<li><strong>\u660e\u786e\u95ee\u9898<\/strong>\uff1a\u63cf\u8ff0\u5177\u4f53\u7684\u6545\u969c\u73b0\u8c61\u3002<\/li>\n\n\n\n\n<li><strong>\u7b2c\u4e00\u6b21\u63d0\u95ee<\/strong>\uff1a\u4e3a\u4ec0\u4e48\u4f1a\u51fa\u73b0\u8fd9\u4e2a\u73b0\u8c61\uff1f<\/li>\n\n\n\n\n<li><strong>\u7b2c\u4e8c\u6b21\u63d0\u95ee<\/strong>\uff1a\u4e3a\u4ec0\u4e48\u4f1a\u6709\u8fd9\u4e2a\u539f\u56e0\uff1f<\/li>\n\n\n\n\n<li><strong>\u4f9d\u6b21\u7c7b\u63a8<\/strong>\uff1a\u8fde\u7eed\u8ffd\u95ee\uff0c\u76f4\u5230\u627e\u5230\u6839\u672c\u539f\u56e0\u3002<\/li>\n\n\n<\/ol>\n\n\n\n\n<p><strong>2.2 \u9c7c\u9aa8\u56fe\uff08Fishbone Diagram\uff09<\/strong><\/p>\n\n\n\n\n<p>\u9c7c\u9aa8\u56fe\u53c8\u79f0\u4e3a\u56e0\u679c\u56fe\uff0c\u662f\u4e00\u79cd\u53ef\u89c6\u5316\u7684\u95ee\u9898\u5206\u6790\u65b9\u6cd5\u3002\u901a\u8fc7\u5c06\u95ee\u9898\u4f5c\u4e3a\u201c\u9c7c\u5934\u201d\uff0c\u5c06\u5404\u79cd\u53ef\u80fd\u7684\u539f\u56e0\u5206\u7c7b\u5e76\u7ed8\u5236\u6210\u201c\u9c7c\u9aa8\u201d\uff0c\u5e2e\u52a9\u5206\u6790\u8005\u7cfb\u7edf\u5730\u601d\u8003\u95ee\u9898\u3002\u4e3b\u8981\u6b65\u9aa4\u5305\u62ec\uff1a<\/p>\n\n\n\n\n<ol>\n\n\n<li><strong>\u786e\u5b9a\u95ee\u9898<\/strong>\uff1a\u660e\u786e\u8981\u5206\u6790\u7684\u6545\u969c\u73b0\u8c61\u3002<\/li>\n\n\n\n\n<li><strong>\u5206\u7c7b\u539f\u56e0<\/strong>\uff1a\u5c06\u53ef\u80fd\u7684\u539f\u56e0\u5206\u4e3a\u4eba\u5458\u3001\u8bbe\u5907\u3001\u6750\u6599\u3001\u65b9\u6cd5\u3001\u73af\u5883\u7b49\u7c7b\u522b\u3002<\/li>\n\n\n\n\n<li><strong>\u7ed8\u5236\u9c7c\u9aa8\u56fe<\/strong>\uff1a\u5c06\u5404\u7c7b\u539f\u56e0\u53ca\u5176\u5b50\u539f\u56e0\u7ed8\u5236\u5728\u56fe\u4e0a\u3002<\/li>\n\n\n\n\n<li><strong>\u5206\u6790\u8ba8\u8bba<\/strong>\uff1a\u901a\u8fc7\u56e2\u961f\u8ba8\u8bba\uff0c\u786e\u5b9a\u6700\u53ef\u80fd\u7684\u6839\u56e0\u3002<\/li>\n\n\n<\/ol>\n\n\n\n\n<p><strong>2.3 \u6545\u969c\u6811\u5206\u6790\uff08Fault Tree Analysis, FTA\uff09<\/strong><\/p>\n\n\n\n\n<p>\u6545\u969c\u6811\u5206\u6790\u662f\u4e00\u79cd\u81ea\u4e0a\u800c\u4e0b\u7684\u5206\u6790\u65b9\u6cd5\uff0c\u901a\u8fc7\u6784\u5efa\u6545\u969c\u6811\uff0c\u7cfb\u7edf\u5730\u5206\u6790\u6545\u969c\u7684\u5404\u79cd\u53ef\u80fd\u539f\u56e0\u53ca\u5176\u903b\u8f91\u5173\u7cfb\u3002\u4e3b\u8981\u6b65\u9aa4\u5305\u62ec\uff1a<\/p>\n\n\n\n\n<ol>\n\n\n<li><strong>\u5b9a\u4e49\u9876\u4e8b\u4ef6<\/strong>\uff1a\u660e\u786e\u8981\u5206\u6790\u7684\u6545\u969c\u73b0\u8c61\u3002<\/li>\n\n\n\n\n<li><strong>\u6784\u5efa\u6545\u969c\u6811<\/strong>\uff1a\u4ece\u9876\u4e8b\u4ef6\u51fa\u53d1\uff0c\u9010\u6b65\u5206\u89e3\u4e3a\u4e2d\u95f4\u4e8b\u4ef6\u548c\u5e95\u4e8b\u4ef6\uff0c\u4f7f\u7528\u903b\u8f91\u95e8\u8868\u793a\u4e8b\u4ef6\u4e4b\u95f4\u7684\u5173\u7cfb\u3002<\/li>\n\n\n\n\n<li><strong>\u5b9a\u6027\u5206\u6790<\/strong>\uff1a\u901a\u8fc7\u6545\u969c\u6811\u7ed3\u6784\uff0c\u627e\u51fa\u6240\u6709\u53ef\u80fd\u7684\u6545\u969c\u8def\u5f84\u3002<\/li>\n\n\n\n\n<li><strong>\u5b9a\u91cf\u5206\u6790<\/strong>\uff1a\u8ba1\u7b97\u5404\u4e8b\u4ef6\u7684\u6982\u7387\uff0c\u8bc4\u4f30\u7cfb\u7edf\u7684\u53ef\u9760\u6027\u3002<\/li>\n\n\n<\/ol>\n\n\n\n\n<h3>\u4e09\u3001\u6545\u969c\u6839\u56e0\u5206\u6790\u7684\u6b65\u9aa4<\/h3>\n\n\n\n\n<p><strong>3.1 \u6570\u636e\u6536\u96c6<\/strong><\/p>\n\n\n\n\n<p>\u5728\u8fdb\u884c\u6839\u56e0\u5206\u6790\u4e4b\u524d\uff0c\u9700\u8981\u6536\u96c6\u4e0e\u6545\u969c\u76f8\u5173\u7684\u6240\u6709\u6570\u636e\uff0c\u5305\u62ec\u8bbe\u5907\u8fd0\u884c\u8bb0\u5f55\u3001\u7ef4\u4fee\u8bb0\u5f55\u3001\u6545\u969c\u73b0\u8c61\u63cf\u8ff0\u3001\u64cd\u4f5c\u4eba\u5458\u53cd\u9988\u7b49\u3002\u6570\u636e\u8d8a\u5168\u9762\uff0c\u5206\u6790\u7ed3\u679c\u8d8a\u51c6\u786e\u3002<\/p>\n\n\n\n\n<p><strong>3.2 \u95ee\u9898\u5b9a\u4e49<\/strong><\/p>\n\n\n\n\n<p>\u660e\u786e\u8981\u5206\u6790\u7684\u6545\u969c\u73b0\u8c61\uff0c\u907f\u514d\u6a21\u7cca\u4e0d\u6e05\u7684\u63cf\u8ff0\u3002\u95ee\u9898\u63cf\u8ff0\u5e94\u5177\u4f53\u3001\u51c6\u786e\uff0c\u4fbf\u4e8e\u540e\u7eed\u5206\u6790\u3002<\/p>\n\n\n\n\n<p><strong>3.3 \u521d\u6b65\u5206\u6790<\/strong><\/p>\n\n\n\n\n<p>\u5229\u7528\u4e94\u95ee\u6cd5\u3001\u9c7c\u9aa8\u56fe\u7b49\u5de5\u5177\uff0c\u8fdb\u884c\u521d\u6b65\u5206\u6790\uff0c\u627e\u51fa\u53ef\u80fd\u7684\u6545\u969c\u539f\u56e0\u3002<\/p>\n\n\n\n\n<p><strong>3.4 \u6df1\u5165\u5206\u6790<\/strong><\/p>\n\n\n\n\n<p>\u901a\u8fc7\u6545\u969c\u6811\u5206\u6790\u7b49\u65b9\u6cd5\uff0c\u6df1\u5165\u6316\u6398\u5404\u539f\u56e0\u4e4b\u95f4\u7684\u903b\u8f91\u5173\u7cfb\uff0c\u786e\u5b9a\u6700\u53ef\u80fd\u7684\u6839\u56e0\u3002<\/p>\n\n\n\n\n<p><strong>3.5 \u9a8c\u8bc1\u6839\u56e0<\/strong><\/p>\n\n\n\n\n<p>\u901a\u8fc7\u5b9e\u9a8c\u3001\u6a21\u62df\u6216\u5176\u4ed6\u9a8c\u8bc1\u624b\u6bb5\uff0c\u786e\u8ba4\u6240\u627e\u51fa\u7684\u6839\u56e0\u662f\u5426\u6b63\u786e\u3002<\/p>\n\n\n\n\n<p><strong>3.6 \u5236\u5b9a\u6539\u8fdb\u63aa\u65bd<\/strong><\/p>\n\n\n\n\n<p>\u6839\u636e\u6839\u56e0\uff0c\u5236\u5b9a\u9488\u5bf9\u6027\u7684\u6539\u8fdb\u63aa\u65bd\uff0c\u9632\u6b62\u540c\u7c7b\u6545\u969c\u518d\u6b21\u53d1\u751f\u3002<\/p>\n\n\n\n\n<p><strong>3.7 \u5b9e\u65bd\u4e0e\u8ddf\u8e2a<\/strong><\/p>\n\n\n\n\n<p>\u5b9e\u65bd\u6539\u8fdb\u63aa\u65bd\uff0c\u5e76\u6301\u7eed\u8ddf\u8e2a\u6548\u679c\uff0c\u786e\u4fdd\u95ee\u9898\u5f97\u5230\u5f7b\u5e95\u89e3\u51b3\u3002<\/p>\n\n\n\n\n<h3>\u56db\u3001\u63d0\u5347\u8bbe\u5907\u6545\u969c\u5e94\u5bf9\u80fd\u529b\u7684\u7b56\u7565<\/h3>\n\n\n\n\n<p><strong>4.1 \u5efa\u7acb\u5b8c\u5584\u7684\u8bbe\u5907\u7ba1\u7406\u4f53\u7cfb<\/strong><\/p>\n\n\n\n\n<ul>\n\n\n<li><strong>\u8bbe\u5907\u6863\u6848\u7ba1\u7406<\/strong>\uff1a\u5efa\u7acb\u8be6\u7ec6\u7684\u8bbe\u5907\u6863\u6848\uff0c\u8bb0\u5f55\u8bbe\u5907\u7684\u8d2d\u7f6e\u3001\u4f7f\u7528\u3001\u7ef4\u4fee\u3001\u4fdd\u517b\u7b49\u4fe1\u606f\u3002<\/li>\n\n\n\n\n<li><strong>\u9884\u9632\u6027\u7ef4\u62a4<\/strong>\uff1a\u5236\u5b9a\u79d1\u5b66\u7684\u9884\u9632\u6027\u7ef4\u62a4\u8ba1\u5212\uff0c\u5b9a\u671f\u5bf9\u8bbe\u5907\u8fdb\u884c\u68c0\u67e5\u548c\u7ef4\u62a4\uff0c\u51cf\u5c11\u6545\u969c\u53d1\u751f\u7684\u6982\u7387\u3002<\/li>\n\n\n\n\n<li><strong>\u5907\u4ef6\u7ba1\u7406<\/strong>\uff1a\u5efa\u7acb\u5408\u7406\u7684\u5907\u4ef6\u5e93\u5b58\uff0c\u786e\u4fdd\u6545\u969c\u53d1\u751f\u65f6\u80fd\u591f\u53ca\u65f6\u66f4\u6362\u3002<\/li>\n\n\n<\/ul>\n\n\n\n\n<p><strong>4.2 \u63d0\u5347\u4eba\u5458\u7d20\u8d28<\/strong><\/p>\n\n\n\n\n<ul>\n\n\n<li><strong>\u57f9\u8bad\u4e0e\u6559\u80b2<\/strong>\uff1a\u5b9a\u671f\u5bf9\u8bbe\u5907\u64cd\u4f5c\u4eba\u5458\u548c\u7ef4\u4fee\u4eba\u5458\u8fdb\u884c\u57f9\u8bad\uff0c\u63d0\u5347\u5176\u4e13\u4e1a\u6280\u80fd\u548c\u6545\u969c\u5904\u7406\u80fd\u529b\u3002<\/li>\n\n\n\n\n<li><strong>\u7ecf\u9a8c\u5206\u4eab<\/strong>\uff1a\u5efa\u7acb\u6545\u969c\u6848\u4f8b\u5e93\uff0c\u9f13\u52b1\u5458\u5de5\u5206\u4eab\u6545\u969c\u5904\u7406\u7ecf\u9a8c\uff0c\u5f62\u6210\u77e5\u8bc6\u79ef\u7d2f\u3002<\/li>\n\n\n<\/ul>\n\n\n\n\n<p><strong>4.3 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