"Nibbled to death by ducks" used to be the saying of how all the parameters leading to an accident happened and eventually all the cogs lined up. The lining up of these cogs was usually an unfortunate combination of simple steps, any one of which had it been removed would have prevented tragedy.
Well said Baston. And I've mentioned one such step/cog/duck or even hole in a slice of cheese that led to them having to fly a Mk2 instead of a Mk1. There may indeed have been others, like a pilot error, but you are absolutely right to say all the cogs should be studied. That is why the regs required Organisational Fault, and other contributory factors, to be considered. One day, perhaps that particular regulation will be implemented properly.