Postmortem

# /em:postmortem — Honest Analysis of What Went Wrong

**Command:** `/em:postmortem <event>`

Not blame. Understanding. The failed deal, the missed quarter, the feature that flopped, the hire that didn't work out. What actually happened, why, and what changes as a result.

---

## Why Most Post-Mortems Fail

They become one of two things:

**The blame session** — someone gets scapegoated, defensive walls go up, actual causes don't get examined, and the same problem happens again in a different form.

**The whitewash** — "We learned a lot, we're going to do better, here are 12 vague action items." Nothing changes. Same problem, different quarter.

A real post-mortem is neither. It's a rigorous investigation into a system failure. Not "whose fault was it" but "what conditions made this outcome predictable in hindsight?"

**The purpose:** extract the maximum learning value from a failure so you can prevent recurrence and improve the system.

---

## The Framework

### Step 1: Define the Event Precisely

Before analysis: describe exactly what happened.

- What was the expected outcome?
- What was the actual outcome?
- When was the gap first visible?
- What was the impact (financial, operational, reputational)?

Precision matters. "We missed Q3 revenue" is not precise enough. "We closed $420K in new ARR vs $680K target — a $260K miss driven primarily by three deals that slipped to Q4 and one deal that was lost to a competitor" is precise.

### Step 2: The 5 Whys — Done Properly

The goal: get from **what happened** (the symptom) to **why it happened** (the root cause).

Standard bad 5 Whys:
- Why did we miss revenue? Because deals slipped.
- Why did deals slip? Because the sales cycle was longer than expected.
- Why? Because the customer buying process is complex.
- Why? Because we're selling to enterprise.
- Why? That's just how enterprise sales works.

→ Conclusion: Nothing to do. It's just enterprise.

Real 5 Whys:
- Why did we miss revenue? Three deals slipped out of quarter.
- Why did those deals slip? None of them had identified a champion with budget authority.
- Why did we progress deals without a champion? Our qualification criteria didn't require it.
- Why didn't our qualification criteria require it? When we built the criteria 8 months ago, we were in SMB, not enterprise.
- Why haven't we updated qualification criteria as ICP shifted? No owner, no process for criteria review.

→ Root cause: Qualification criteria outdated, no owner, no review process.
→ Fix: Update criteria, assign owner, add quarterly review.

**The test for a good root cause:** Could you prevent recurrence with a specific, concrete change? If yes, you've found something real.

### Step 3: Distinguish Contributing Factors from Root Cause

Most events have multiple contributing factors. Not all are root causes.

**Contributing factor:** Made it worse, but isn't the core reason. If removed, the outcome might have been different — but the same class of problem would recur.

**Root cause:** The fundamental condition that made the outcome probable. Fix this, and this class of problem doesn't recur.

Example — failed hire:
- Contributing factors: rushed process, reference checks skipped, team under pressure to staff up
- Root cause: No defined competency framework, so interview process varied by who happened to conduct interviews

**The distinction matters.** If you address only contributing factors, you'll have a different-looking but structurally identical failure next time.

### Step 4: Identify the Warning Signs That Were Ignored

Every failure has precursors. In hindsight, they're obvious. The value of this step is making them obvious prospectively.

Ask:
- At what point was the negative outcome predictable?
- What signals were visible at that point?
- Who saw them? What happened when they raised them?
- Why weren't they acted on?

**Common patterns:**
- Signa