使用此模板作为从问题中吸取教训并将问题转化为进展的框架。讨论事件的细节:为什么会发生,产生的影响,采取了哪些措施,以及应该做些什么来防止它再次发生。
这是一个分享反馈的安全空间:
以开放的心态倾听
请记住,每个人的体验都是有效的
专注于寻找根本原因,而不是指责
Include what happened why the severity of the incident and how long the impact lasted.
Stick to the facts. Avoid individual behavior or naming names. You can use sticky notes below to fill in the blanks.
Add any notable lead-up events any starts of activity the first known impact and escalations. Note any decisions or changes made and when the incident ended along with any post-impact events of note.
Add this before the session to save time.
Begin with a description of the impact and ask why it occurred. Note the impact that it had. Ask why this happened and why it had the resulting impact. Then continue asking why until you arrive at a root cause.
Add sticky notes to question why and answer because as many times as need be.
Reflect as a group on actions, related incidents, and opportunities.