A team at Alcoa Power and Propulsion developed and implemented a structured process management approach across their business unit to improve product quality, reduce waste and costs, and cut costs. By defining and standardizing key processes, the unit minimized variation, shared best practices, and sustained improvements, reducing scrap, saving millions of dollars, and improving customer satisfaction. The project was named a finalist in an international team excellence award competition for its success in implementing process management approaches.
Making the Case for QualityOptimizing Purchasing Processes.docxinfantsuk
Making the Case for Quality
Optimizing Purchasing Processes
Saves $1 Million
• UsingtheDMAIC
method,aSixSigma
improvementteamat
MWMINTERNATIONAL
MotoresinBrazilimproved
thecompany’ssupplier
selectionprocess.
• KnownastheMoving
Forwardteam,thisgroup
appliedawidevariety
ofqualitytoolstoreduce
theprice/weightratiofor
bolts,akeycomponent
forthecompany’sdiesel
engineproducts.
• Bystreamliningprocesses,
reducingvariability,and
increasingefficiency,
theyearlongproject
helpedreduceengine
boltcostsby$1million.
• Theteamsharedits
successstorywitha
worldwideaudiencewhen
itparticipatedinthefinal
roundofcompetitioninthe
2009InternationalTeam
ExcellenceAwardProcess.
AtaGlance...
Often the simple things create the biggest impact. But could a change in purchasing processes for the
most basic manufacturing components, like bolts, actually lead to $1 million in savings, increased effi-
ciency, and reduced process variation? When a multidisciplinary Six Sigma improvement team tackles
the issue, the answer is a resounding yes!
About MWM INTERNATIONAL
MWM INTERNATIONAL Motores is a wholly-owned subsidiary of Navistar, a major worldwide
diesel engine manufacturer and current leader in diesel engine technology and development in Latin
America. Operations include a technology and business center in São Paulo, Brazil, as well as three
South American manufacturing sites—São Paulo; Canoas, Brazil; and Jesus Maria, Argentina.
The company’s engine products range from 2.5 to 9.3 liters and from 50 to 375 cv and serve a
wide range of markets in the vehicular, agricultural, industrial, and marine sectors. Among MWM
INTERNATIONAL’s customers are Ford, GM, Volvo, Volkswagen, New Holland, Troller, and Valtra.
Focusing on Purchasing Activities to Reduce Waste
As an engine maker, MWM INTERNATIONAL uses more than 400 different bolts in its manufactur-
ing operations, which led to inefficient purchasing strategies for this commodity. Because bolts are
a standardized product, both the material and production processes are similar for the entire range of
existing bolts. Therefore, MWM INTERNATIONAL officials believed it was reasonable to expect a
linear relationship between the price of bolts and steel—the raw material from which they are made.
The relationship is expressed in a formula called linear price performance or LPP. This comparative
method evaluates price and measurement correlation in kilograms, linear meters, square meters, or
liters. LPP is calculated by dividing price per a measurement unit, as shown in the examples below.
price price
weight
= LPP or
length
= LPP
Company leaders surmised that finding a way to optimize the organization’s purchasing processes for
engine bolts would reduce the LPP, thus lowering costs and reducing waste.
This Six Sigma improvement project was identified as a result of the company’s culture of continu-
ous improvement, whereby MWM INTERNATIONAL officials consistently pursue opportunities to
develop n ...
Foods Case Study
What to cover
Executive summary
Define Phase
Measure Phase
Analyze phase
Improve phase
Control Phase
Conclusion
1. Executive Summary
In December 2008, the company began to receive heavy surcharge from local authorities because of their poor water quality, mainly due to an excess of biological waste entering the sewer system.
Biological Oxygen Demand (BOD) The amount of oxygen needed by bacteria to decompose all the solid wastes in wastewater. Accounted for 74% of the resulting fees. The total bill for poor water quality reached $204,000 in 2009.
A six-sigma team was tasked to extremely reduce the BOD, after 6 months they reached 70% with a goal of 95%.
2. Define Phase
Project Charter
Project NameBOD Reduction at Kahiki FoodsCommencement DateSep, 2009Project SponsorKahiki FoodsCompletion DateDec, 2010Expected Hard Cost Reduction$195,000Expected % Reduction95%
Project Mission
The main objectives are:
Intense reduction in solid waste entering floor drains.
Increase output at different plant processes.
Green initiative for the organization.
$195,000 hard cost reduction.
Problem Statement
Per local authorities BOD levels shouldn’t exceed 250mg/L
Kahiki had BOD waste levels of 3864mg/L, 1546% higher than upper spec limit
The source of the waste was obviously originating from inefficient floor drain management
6
Goal Statement
At least a 50% BOD reduction in 6 months and establishing a sustainable system able of reaching the goal of 95% reduction.
Process map
SIPOC map
8
3. Measure Phase
The waste removal system doesn't meet the spec.
Process Capability Charts
Measurement Plan
Demand Analysis
Metrics Used To Determine Water Quality
Biological Oxygen Demand (BOD)
Total Suspended Solids (TSS)
Total Kjeldahl Nitrogen (TKN)
BOD Process Capability Charts
TSS Process Capability Charts
Measurement Plan
N/B In any area of concern, should there be a negative response on any unit, the unit is rendered incomplete and therefore a defect.
13
Data Collection Challenges
System changed in 2007.
Standard sampling schedule 3 site visits/year moved to monthly.
Data collection visibility most critical points came from cleanup shift.
The above assessment was done by five individuals who were, one hired external expert, two quality assurance officers at the state government, while two are community professionals. MSA is an experimental process and require more views from different quotas of different levels of understanding to make independent judgments on quality (McCarty, 2005).
14
4. Analyze Phase
5 Why Analysis.
FMEA.
Gap analysis.
Fishbone diagram.
Hotspot heat map.
Regression Analysis.
Benchmarking.
5 Why Analysis
Plant Floor Drain Hotspot Heat Map
5. Improve phase
Improved Solid/Liquid Separation.
Reducing Waste Creation.
Employee Training.
Best Practice Identification.
WAP Committee: A "Waste Awareness Program“.
Error Proofing: Adding visual S ...
Ford motor improvement by using tqm tools presented by group 5 047, 068, 074...TalhaAli81
Presentation by the final year students of University of Lahore (Department of Mechanical Engineering).
Presentation purpose is to understand the implementation of TQM Tool for the improvement of a company.
Talha Ali created these slides.
Slides include TQM Tools used by Ford Motor. TQM Tools include Six Sigma, Kaizen cycle, Paynter chart and 8D Problem solving.
Making the Case for QualityOptimizing Purchasing Processes.docxinfantsuk
Making the Case for Quality
Optimizing Purchasing Processes
Saves $1 Million
• UsingtheDMAIC
method,aSixSigma
improvementteamat
MWMINTERNATIONAL
MotoresinBrazilimproved
thecompany’ssupplier
selectionprocess.
• KnownastheMoving
Forwardteam,thisgroup
appliedawidevariety
ofqualitytoolstoreduce
theprice/weightratiofor
bolts,akeycomponent
forthecompany’sdiesel
engineproducts.
• Bystreamliningprocesses,
reducingvariability,and
increasingefficiency,
theyearlongproject
helpedreduceengine
boltcostsby$1million.
• Theteamsharedits
successstorywitha
worldwideaudiencewhen
itparticipatedinthefinal
roundofcompetitioninthe
2009InternationalTeam
ExcellenceAwardProcess.
AtaGlance...
Often the simple things create the biggest impact. But could a change in purchasing processes for the
most basic manufacturing components, like bolts, actually lead to $1 million in savings, increased effi-
ciency, and reduced process variation? When a multidisciplinary Six Sigma improvement team tackles
the issue, the answer is a resounding yes!
About MWM INTERNATIONAL
MWM INTERNATIONAL Motores is a wholly-owned subsidiary of Navistar, a major worldwide
diesel engine manufacturer and current leader in diesel engine technology and development in Latin
America. Operations include a technology and business center in São Paulo, Brazil, as well as three
South American manufacturing sites—São Paulo; Canoas, Brazil; and Jesus Maria, Argentina.
The company’s engine products range from 2.5 to 9.3 liters and from 50 to 375 cv and serve a
wide range of markets in the vehicular, agricultural, industrial, and marine sectors. Among MWM
INTERNATIONAL’s customers are Ford, GM, Volvo, Volkswagen, New Holland, Troller, and Valtra.
Focusing on Purchasing Activities to Reduce Waste
As an engine maker, MWM INTERNATIONAL uses more than 400 different bolts in its manufactur-
ing operations, which led to inefficient purchasing strategies for this commodity. Because bolts are
a standardized product, both the material and production processes are similar for the entire range of
existing bolts. Therefore, MWM INTERNATIONAL officials believed it was reasonable to expect a
linear relationship between the price of bolts and steel—the raw material from which they are made.
The relationship is expressed in a formula called linear price performance or LPP. This comparative
method evaluates price and measurement correlation in kilograms, linear meters, square meters, or
liters. LPP is calculated by dividing price per a measurement unit, as shown in the examples below.
price price
weight
= LPP or
length
= LPP
Company leaders surmised that finding a way to optimize the organization’s purchasing processes for
engine bolts would reduce the LPP, thus lowering costs and reducing waste.
This Six Sigma improvement project was identified as a result of the company’s culture of continu-
ous improvement, whereby MWM INTERNATIONAL officials consistently pursue opportunities to
develop n ...
Foods Case Study
What to cover
Executive summary
Define Phase
Measure Phase
Analyze phase
Improve phase
Control Phase
Conclusion
1. Executive Summary
In December 2008, the company began to receive heavy surcharge from local authorities because of their poor water quality, mainly due to an excess of biological waste entering the sewer system.
Biological Oxygen Demand (BOD) The amount of oxygen needed by bacteria to decompose all the solid wastes in wastewater. Accounted for 74% of the resulting fees. The total bill for poor water quality reached $204,000 in 2009.
A six-sigma team was tasked to extremely reduce the BOD, after 6 months they reached 70% with a goal of 95%.
2. Define Phase
Project Charter
Project NameBOD Reduction at Kahiki FoodsCommencement DateSep, 2009Project SponsorKahiki FoodsCompletion DateDec, 2010Expected Hard Cost Reduction$195,000Expected % Reduction95%
Project Mission
The main objectives are:
Intense reduction in solid waste entering floor drains.
Increase output at different plant processes.
Green initiative for the organization.
$195,000 hard cost reduction.
Problem Statement
Per local authorities BOD levels shouldn’t exceed 250mg/L
Kahiki had BOD waste levels of 3864mg/L, 1546% higher than upper spec limit
The source of the waste was obviously originating from inefficient floor drain management
6
Goal Statement
At least a 50% BOD reduction in 6 months and establishing a sustainable system able of reaching the goal of 95% reduction.
Process map
SIPOC map
8
3. Measure Phase
The waste removal system doesn't meet the spec.
Process Capability Charts
Measurement Plan
Demand Analysis
Metrics Used To Determine Water Quality
Biological Oxygen Demand (BOD)
Total Suspended Solids (TSS)
Total Kjeldahl Nitrogen (TKN)
BOD Process Capability Charts
TSS Process Capability Charts
Measurement Plan
N/B In any area of concern, should there be a negative response on any unit, the unit is rendered incomplete and therefore a defect.
13
Data Collection Challenges
System changed in 2007.
Standard sampling schedule 3 site visits/year moved to monthly.
Data collection visibility most critical points came from cleanup shift.
The above assessment was done by five individuals who were, one hired external expert, two quality assurance officers at the state government, while two are community professionals. MSA is an experimental process and require more views from different quotas of different levels of understanding to make independent judgments on quality (McCarty, 2005).
14
4. Analyze Phase
5 Why Analysis.
FMEA.
Gap analysis.
Fishbone diagram.
Hotspot heat map.
Regression Analysis.
Benchmarking.
5 Why Analysis
Plant Floor Drain Hotspot Heat Map
5. Improve phase
Improved Solid/Liquid Separation.
Reducing Waste Creation.
Employee Training.
Best Practice Identification.
WAP Committee: A "Waste Awareness Program“.
Error Proofing: Adding visual S ...
Ford motor improvement by using tqm tools presented by group 5 047, 068, 074...TalhaAli81
Presentation by the final year students of University of Lahore (Department of Mechanical Engineering).
Presentation purpose is to understand the implementation of TQM Tool for the improvement of a company.
Talha Ali created these slides.
Slides include TQM Tools used by Ford Motor. TQM Tools include Six Sigma, Kaizen cycle, Paynter chart and 8D Problem solving.
Operational turnaround at auto components manufacturerAnirban Mazumdar
A project for an auto-ancillary client whose largest plant was running in losses even though demand from OEM customers were rising.We could help the team turnaround operations within a period of 4 months. Not only did they close the year profitably, they also delivered significantly higher volumes.
Dire situations call for smart solutions. In this case, a good diagnosis of the situation, identification of the right initiatives, meticuluous execution and ensuring sustenance delivered the results.
Running head Improving Efficiency in the Organization1Improvin.docxcowinhelen
Running head: Improving Efficiency in the Organization 1
Improving Efficiency in the Organization 7
Justification Report – Final Version
Date: 11/06/2016
Student’s Name: Amir Mousavi
Institute: Strayer University
Course name: Professional Communications
Instructor: Sarawathi Lakshmanan
Transmittal letter
P.O Box 6452,
State.
11/6/2016
XYZ Company,
P.O Box,
45278,
City
Dear Sir/ Madam,
Re: Improving Efficiency in Operations
Due to increased delay in order delivery from the company, the following research was conducted to evaluate possible alternatives for handling the challenge. Of the two alternatives, Lean process is highly recommended to eliminate waste and increase efficiency of the operations. Find all details on evaluation criteria in the report.
Thanks.
Table of Contents
Executive Summary 4
Introduction 5
Problem Statement 5
Terminology 5
Major Parts of the report 5
Overview of Alternatives 5
Criteria 6
Research Methods 6
Evaluation of Alternatives 6
Efficiency 6
Desirability 6
Findings and Analysis 6
Recommendation 7
References 8
Executive Summary
Inefficiency in operations leads to delayed in processing clients' orders and in entire production as seen from XYZ firm. There are many practices in the market to solve this challenge. However, this study evaluates the ERP and Lean approaches. From the findings, the research recommends implementation of the lean process in improving overall efficiency.
Improving Efficiency in XYZ EnterpriseIntroduction
Every organization is established for a shared purpose and objective. An organization can either develop a service-based or product-based business. In addition to that, it is the aim of organization to maximize its profits through provision of quality service or produdct to clients or consumers without delays. In this regard, improving efficiency and delivering the product or service without hassle is key priority to any organization. That being said, the purpose of this report is to help improve the operational efficiency of XYZ Enterprise through provision of various alternatives. The report will present a brief background of the problem and will highlight why there have been inefficiencies in production and information flow. The important terminologies regard improvement of efficiency of XYZ Enterprise will also be explained, i.e. enterprise resource planning (ERP) and lean process. Similarly, the major part of this report will be about overview of the alternatives, in which research methods and criteria will be explained. This section will also present an evaluation of the proposed alternatives in which efficiency and desirability of the ERP and lean process ...
Elimination of rework in V Cap by Using Six Sigma MethodologyIJERD Editor
The purpose of this project was to gain a strong understanding of Six Sigma management philosophy, concepts, and practices and to apply this knowledge to creating a Six Sigma academic course or training program. This was done through three main methods: preliminary research and data collection, the creation of a design model for Six Sigma academic course program establishment, and the creation of a Six Sigma academic course program syllabus. The preliminary research consisted of conducting a Six Sigma knowledge survey with the students of Worcester Polytechnic Institute, interviewing a Six Sigma expert, and examining current Six Sigma educational programs in other universities, businesses, and organizations. As a result of our observations, we determined that Six Sigma has become a large part of many companies and should be implemented into more engineering programs at universities nation-wide, including Worcester Polytechnic Institute. This can be done through a project based course, as well as more Six Sigma based Interactive and Major Qualifying Projects.
APM Center of Excellence Drives Improved Business Results at Itau UnibancoCA Technologies
Improving the quality of applications and the overall customer experience is a key focus for Itau. This presentation will discuss the APM Center of Excellence
process and how this approach lead to better response times using fewer resources and improved business results while delighting both clients and applications support teams.
For more information on DevOps solutions from CA Technologies, please visit: http://bit.ly/1wbjjqX
1. Discuss the organization and the family role in every one of the.docxcroysierkathey
1. Discuss the organization and the family role in every one of the heritages mentioned about and how they affect (positively or negatively) the delivery of health care.
2. Identify sociocultural variables within the Irish, Italian and Puerto Rican heritage and mention some examples.
References must be no older than 5 years. A minimum of 700 words is required.
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1. Compare and contrast D'Emilio's
Capitalism and Gay Identity
with the
From Mary to Modern Woman
reading. What patterns do you see that are similar to the modern American society? What can be said about global notions of gender in the modern age? Feel free to invoke Foucault.
2. How is the writer's experience important in the story being told in
Middlesex
? Describe your reaction to the reading and invoke some of the concepts discussed in the
Queer Theory
reading to try to make sense of sexuality when it does not match your own conventions. Compare both readings, but go deeper to explore your own stereotypes and socialization.
**PLEASE READ THE READINGS IN ODER TO DO THIS ASSIGNMENT.
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Operational turnaround at auto components manufacturerAnirban Mazumdar
A project for an auto-ancillary client whose largest plant was running in losses even though demand from OEM customers were rising.We could help the team turnaround operations within a period of 4 months. Not only did they close the year profitably, they also delivered significantly higher volumes.
Dire situations call for smart solutions. In this case, a good diagnosis of the situation, identification of the right initiatives, meticuluous execution and ensuring sustenance delivered the results.
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Justification Report – Final Version
Date: 11/06/2016
Student’s Name: Amir Mousavi
Institute: Strayer University
Course name: Professional Communications
Instructor: Sarawathi Lakshmanan
Transmittal letter
P.O Box 6452,
State.
11/6/2016
XYZ Company,
P.O Box,
45278,
City
Dear Sir/ Madam,
Re: Improving Efficiency in Operations
Due to increased delay in order delivery from the company, the following research was conducted to evaluate possible alternatives for handling the challenge. Of the two alternatives, Lean process is highly recommended to eliminate waste and increase efficiency of the operations. Find all details on evaluation criteria in the report.
Thanks.
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Executive Summary 4
Introduction 5
Problem Statement 5
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Major Parts of the report 5
Overview of Alternatives 5
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References 8
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Inefficiency in operations leads to delayed in processing clients' orders and in entire production as seen from XYZ firm. There are many practices in the market to solve this challenge. However, this study evaluates the ERP and Lean approaches. From the findings, the research recommends implementation of the lean process in improving overall efficiency.
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Every organization is established for a shared purpose and objective. An organization can either develop a service-based or product-based business. In addition to that, it is the aim of organization to maximize its profits through provision of quality service or produdct to clients or consumers without delays. In this regard, improving efficiency and delivering the product or service without hassle is key priority to any organization. That being said, the purpose of this report is to help improve the operational efficiency of XYZ Enterprise through provision of various alternatives. The report will present a brief background of the problem and will highlight why there have been inefficiencies in production and information flow. The important terminologies regard improvement of efficiency of XYZ Enterprise will also be explained, i.e. enterprise resource planning (ERP) and lean process. Similarly, the major part of this report will be about overview of the alternatives, in which research methods and criteria will be explained. This section will also present an evaluation of the proposed alternatives in which efficiency and desirability of the ERP and lean process ...
Elimination of rework in V Cap by Using Six Sigma MethodologyIJERD Editor
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Audience: Anyone that uses stereotypical jokes or saying around people that are different than them even without realizing that they are making a stereotypical joke or statement.
3.
Genre: the genre that I will be trying to reach out to in this essay will be informational, reason being is that I mainly look at informational online documentaries and stories.
4.
Stance and tone: I’m just a young man who grew up around a lot of people from different places and have different cultures and never paid attention in my younger years to what was happening from stereotyping others that they are different till recently.
5.
Graphic design
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1.Writing Practice in Reading a PhotographAttached Files.docxcroysierkathey
1.
Writing: Practice in Reading a Photograph
Attached Files:
Bachman, Ieshia Evans, Baton Rouge (2016).jpg
(277.283 KB)
For this assignment, you will practice analyzing how various rhetorical elements contribute to the overall meaning of a visual image--in this case, a photograph. To begin, click on the attached image.
By way of some context, this photo was taken in 2016 at a protest rally in Baton Rouge, Louisiana. The woman in the photo is named Ieshia Evans. The photographer is named Jonathan Bachman. Bachman's photo, which was first published by Reuters, was a finalist for a Pulitzer Prize in 2017. You can use this information to do more research on the image, if you like.
Now, review once again the Elements and Methods of Visual Rhetoric document and select from it
three
elements that you wish to discuss in relation to this photo. Please note that this is not a formal essay assignment, so do not treat it as such. For example, you do not need to create a formal introduction.
Begin by simply providing an
interpretive claim
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one
sentence (tho you can write two if necessary). After that, your document simply needs to contain
three paragraphs
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Note: Your assignment must be submitted as an attached .doc or .docx file. Name your file correctly, using your last name and brief description of assignment (e.g., Martinez, Photograph.docx).
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DB: Interpreting Political Ads
In this discussion board, you will be discussing and interpreting a recent political ad entitled "Mourning in America," which was produced by The Lincoln Project, a political action committee (PAC). If you are not familiar with the group, take a moment to research it, as that context will add to your understanding and interpretation. You can
click here
to view the ad.
As you watch "Mourning in America", think carefully about how this political advertisement compares and contrasts with Ronald Reagan's "Morning in America" ad, in terms of its rhetorical methods as well as its overall message. You will be asked to comment on
three
specific rhetorical elements, so decide which ones stand out most to you and take careful notes on those to prepare for the discussion.
When you are ready, click the link above to enter the Discussion Board, and then follow the instructions in the first thread posted in this forum for responding to this material.
Questions:-
Mourning in America
COLLAPSE
Your task here is to share with your peers your ideas on how
three
specific rhetorical elements or your choosing are used in this ad to make its appeal to an audience and to convey a message.
1. Identity the three rhetorical elements that you have selected and then
explain
how each .
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to alleviate these symptoms? What motivates his drinking behaviour given that he no longer enjoys this
activity (most of the time)?
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attempts to do so? Why are these processes important for our understanding of addiction and
substance use disorders.
1 Page
at least 3 sources
APA
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.
1. Discuss the cultural development of the Japanese and the Jewis.docxcroysierkathey
1. Discuss the cultural development of the Japanese and the Jewish heritage.
2. What are the cultural beliefs of the Japanese and Jewish heritage related to health care and how they influence the delivery of evidence-based healthcare?
A minimum of 2 evidence-based references
no older than 5 years is required.
A minimum of 600 words
(excluding the first and references page) is required.
.
1. Discuss at least 2 contextual factors(family, peers, school,.docxcroysierkathey
1.
Discuss at least 2 contextual factors(family, peers, school, community, work, etc.) that might make young people more or less likely to experience adolescence as a period of storm and stress.
2. How might the dramatic physical changes that adolescents undergo—and the accompanying reactions from others—influence other aspects of development, such as social or emotional development?
3. Describe some ways in which adolescent decision making is a product of interactions among puberty, brain development, cognitive growth, and contextual influences such as parents, peers, and community.
.
1.Write at least 500 words in APA format discussing how to use senti.docxcroysierkathey
1.Write at least 500 words in APA format discussing how to use sentiment analysis how political speech affects voters. Use at least 3 references in APA format.
2.Read the below article(link below) on statistics for categorical variables. Write at least 500 words in APA format discussing how to use these statistics to help understand big data.
Link: https://uc-r.github.io/descriptives_categorical
.
1.The following clause was added to the Food and Drug Actthe S.docxcroysierkathey
1.The following clause was added to the Food and Drug Act:
“the Secretary [of the Food and Drug Administration] shall not approve for use in food any chemical additive found to induce cancer in man, or, after tests, found to induce cancer in animals.”
After this clause was adopted, no new additives could be approved for use in food if they caused cancer in people or animals.
The public loved this and industry hated it.
What do you think of this clause? Do you support it or do you oppose it?
At the top of your post, please indicate SUPPORT or OPPOSE and then give your rationale. Then after you can view your classmates' posts, make your case to your fellow students.
2.There was a law that individuals who were indigent and who wished to litigate could apply to the courts for a total waiver of the normal filing fee. In the legislative session, however, a statute was enacted which limits the courts' authority to waive filing fees in lawsuits brought by prisoners against the state government.
Under this new law, a court has to require the prisoner to pay a filing fee "equal to 20 percent ... of the average monthly deposits made to the prisoner's [prison] account ... or the average balance in that account", whichever is greater (unless this calculation yields a figure larger than the normal filing fee).
A prisoner (who was indigent) wanted to appeal his case and was to be charged this fee. He filed suit claiming it was unconstitutional to charge this fee to prisoners.
Choose the side of the prisoner or the side of the state and tell why you would rule for the side you chose.
At the top of your post, please indicate SUPPORT PRISONER or OPPOSE PRISONER and then give your rationale. After you can view your classmates' posts, make your case to your fellow students.
3.A defendant pleaded guilty to receiving and possessing child pornography and was sentenced to 108 months in prison. The sentencing judge raised the defendant’s base offense level….by two levels because "a computer was used for the transmission" of the illegal material.
The appeal filed challenged the punishment enhancement (not his guilt of the base punishment.)
The defendant argued the law did not apply to him because he did not use a computer to transmit the material. (ie He was the receiver, not the sender, of the child pornography.)
Do you believe that the sentence enhancement should be upheld? Give an economic analysis and rational for your choice.
At the top of your post, please indicate SENTENCE UPHELD or SENTENCE REVERSED and then give your economic analysis/rationale. After you can view your classmates' posts, make your case to your fellow students.
4.The ordinance was enacted that gives tenants more legal rights including:
the payment of interest on security deposits;
requires that those deposits be held in Illinois banks;
allows (with some limitations) a tenant to withhold rent in an amount reflecting the cost to him of the landlord's v.
1.What are social determinants of health Explain how social determ.docxcroysierkathey
1.What are social determinants of health? Explain how social determinants of health contribute to the development of disease. Describe the fundamental idea that the communicable disease chain model is designed to represent. Give an example of the steps a nurse can take to break the link within the communicable disease chain.
Resources within your text covering international/global health, and the websites in the topic materials, will assist you in answering this discussion question.
2. Select a global health issue affecting the international health community. Briefly describe the global health issue and its impact on the larger public health care systems (i.e., continents, regions, countries, states, and health departments). Discuss how health care delivery systems work collaboratively to address global health concerns and some of the stakeholders that work on these issues.
Resources within your text covering international/global health, and the websites in the topic materials, will assist you in answering this discussion question.
.
1.This week, we’ve been introduced to the humanities and have ta.docxcroysierkathey
1.
This week, we’ve been introduced to the humanities and have taken some time to consider the role of the humanities in establishing socio-cultural values, including how the humanities differ from the sciences in terms of offering unique lenses on the world and our reality. Since one of the greatest rewards of being a human is engaging with different forms of art, we’ve taken some time this week to learn about what it means to identify and respond to a work of art. We’ve learned about the difference between abstract ideas and concrete images and concepts like structure and artistic form. To help you deepen your understanding of these foundational ideas, your Unit 1 assignment will consist of writing an essay addressing using the following criteria:
Essay Requirements:
• 1,000 words or roughly four double-spaced pages.
• Make use of at least three scholarly sources to support and develop your ideas. Our course text may serve as one of these three sources.
• Your essay should demonstrate a thorough understanding of the READ and ATTEND sections.
• Be sure to cite your sources using proper APA format (7th edition).
Essay Prompt:
• In this essay, you will consider the meaning of art and artistic form by responding to these questions:
o To what extent does Kevin Carter’s Pulitzer Prize-winning photograph (figure 2-5) have artistic form?
o Using what you’ve learned in Chapters 1, 2 and 14 explain if you consider Carter’s photograph a work of art? Be sure to point to specific qualities of the photograph to support/develop your response.
o How do you measure the intensity of your experience in response to Carter’s photograph? What does it make you see/feel/imagine and how does your response/reaction support Carter’s image as a work of art?
.
1.What are barriers to listening2.Communicators identif.docxcroysierkathey
1.
What are barriers to listening?
2.
Communicators identified the following as major listening poor habits. Search what each poor habit means and try to set an example using your own experience.
Poor listening habit:
Pseudo-listening, Stage hogging, Filling in gaps, Selective listening, Ambushing (
Definition & Example)
.
1.Timeline description and details There are multiple way.docxcroysierkathey
1.
Timeline description and details
: There are multiple ways to construct a timeline. Find one that fits you and your information.
Include 10-15 events, each including the following descriptors:
- titles of books or writings or some sort of identifier
- your age or some time reference
- and whether it was a positive or negative experience
.
1.The PresidentArticle II of the Constitution establishe.docxcroysierkathey
1.
The President
Article II of the Constitution established the institution of the presidency. Select any TWO Presidents prior to 1933 and any TWO Presidents since 1933 and for EACH one:
a.
Discuss
any
expressed
power used by each president and the
impact
that decision had on American society at the time of its use
b.
Explain
whether you
agree/disagree
with the presidential action taken and
WHY
c.
Describe
one
legislative initiative
promoted by each president and the
impact
on America at the
time of its passage
as well as what the impact of that legislation is
TODAY
d.
Discuss
one
executive order
issued by each president and whether you
agree/disagree
with the order and
WHY
1.
Select any FOUR United States Supreme court decisions related to Civil Rights/Civil Liberties and for
each one
:
a.
Describe
the facts of the case
b.
Discuss
the arguments of each side as it pertains to the
Constitutional issue
being addressed
c.
Explain
the decision citing
Constitutional rationale
of the court including any dissenting opinion if not a unanimous verdict
d.
Explain
whether you
agree/disagree
with the court’s decision and
WHY
.
1.What other potential root causes might influence patient fal.docxcroysierkathey
1.
What other potential root causes might influence patient falls?
2.
Equipped with the data, what would you do about the hypotheses that proved to be unsupported?
3.
Based on the correctly identified hypothesis in the case scenario, what would be your course of action if you were the CEO/president of St. Xavier Memorial Hospital?
4.
What do you think of the CNO’s (Sara Mullins) position of “waiting and seeing what the data tells us” instead of immediately jumping to conclusions?
.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
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Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
Making the Case for QualityProcess Management Approach R.docx
1. Making the Case for Quality
Process Management Approach
Reduces Scrap, Saves Alcoa Millions
• A team at Alcoa Power
and Propulsion sought
to improve product
quality, reduce waste and
inefficiency, and cut costs.
• To achieve these goals,
the team developed
and implemented a
structured process
management approach
across the business unit.
• By defining and then
standardizing key
processes, the unit
minimized variation,
shared best practices, and
sustained improvements.
• The project improved
customer satisfaction,
reduced costs of poor
quality, and saved
millions of dollars.
• The team was named
2. a finalist in ASQ’s
2015 International
Team Excellence
Awards competition.
At a Glance . . .
As Alcoa Power and Propulsion sought to minimize
manufacturing process waste,
inefficiency, and related expenses, two key findings caught the
attention of the
business unit’s executive leadership team. Customer satisfaction
surveys revealed
60 percent of respondents held an unfavorable or neutral
opinion of the unit, while
at the same time, internal quality measures revealed the
business unit recorded the
highest levels of scrap in the organization for the year. The
findings represented
a significant opportunity, but improvement would require rapid
deployment in a
methodical, deliberate, and sustainable manner.
About Alcoa Power and Propulsion
Alcoa Power and Propulsion (APP), a unit of New York City-
based Alcoa Inc., is divided into three
segments: structural castings and special products, industrial
gas turbine airfoils, and aerospace airfoils.
3. This business unit serves the defense, energy, aerospace, and
industrial markets, where its products
are used in military and commercial aircraft engines as well as
power-generation turbines. Additional
products and services include molds, hot isostatic pressings,
specialty coatings and tools, as well as
machinery. APP operates 25 production facilities around the
world, employing more than 9,000 people.
Working to Improve Processes
The APP leadership team discovered scrap and rework issues
were resulting in high customer claims
and delivery issues, therefore they sought solutions for
significant reductions to scrap levels to improve
delivery, rework, and customer satisfaction. In the past,
substantial scrap level decreases were thought
to be unattainable because casting is a particularly complex
process (see the sidebar, The Investment
Casting Process, for more details) with many sources of
variation.
In late 2011, APP’s quality focus shifted toward sustainable and
continuous process improvement,
particularly at nine of the unit’s super alloy foundries (five in
the United States, three in Western
Europe, and one in Japan). While these foundries were the
starting point for the initiative because
they recorded the highest levels of scrap, the ultimate goal for
APP was to create a sustainable solu-
tion for deployment at the plant level by mid-2012. The right
solution would need to capture and
by Janet Jacobsen
May 2016
4. ASQ www.asq.org Page 1 of 5
ASQ www.asq.org Page 2 of 5
communicate tribal knowledge as well as monitor capable
processes. Creating
a new approach could directly impact financial performance by
reducing scrap,
rework, and returns.
Identifying Stakeholders and Building the Team
One of the first steps in forming a project improvement team
was to identify
stakeholder groups from which team members would be
selected. The following
stakeholders were included:
• Internal groups:
engineering
process owners,
business unit and
site managers,
operations
personnel, and
members of the
quality staff.
• External groups:
Alcoa and the
business unit’s
customers.
5. Once these groups
were determined and
the required knowledge
and skills for each group identified, skill and knowledge gaps
were identified. For
example, the engineering process owners needed training on the
DMAIC method,
while the quality group required additional training on the audit
process. Corporate
quality staff provided introductory training on the
organization’s process manage-
ment methodology, and APP created a Six Sigma training class
for its engineers.
It made sense to build upon already-existing team structures and
working relation-
ships at APP where there are business unit process owners and
corresponding plant
process owners. The improvement project’s deployment team
included members
from these process owner groups.
The project goal was to develop a sustainable methodology to
reduce the APP scrap
rate by 10 percent year over year by June 2012, as depicted in
Figure 1. The team
was to develop manufacturing process models for key areas,
validate the methodol-
ogy at pilot locations, and then prepare a full implementation
plan.
Analyzing the Opportunity
When analyzing the improvement opportunity at hand, the team
quickly realized the
part-focused scrap reduction methodology, which had been used
6. for years, reached
the point of diminishing returns. To achieve the additional scrap
reductions required
to meet the stated goal, process stability became the new focus.
Since the investment casting process includes several complex
steps, the team cre-
ated process maps to identify, understand, and analyze each step
for its savings
potential. Pareto charts helped illustrate the contribution of
each step to the overall
scrap rate. Brainstorming, scrap rates, and defect data were used
to identify potential
The majority of APP’s business is related to
its investment casting process, which includes
the following steps:
• APP receives a design from one
of its customers, and through a
collaborative process, the proper
shape of the casting is determined.
• A die is constructed, usually in
wax, to produce the pattern.
• This wax die is then assembled
into a cluster to produce multiple
castings economically through a
single pour of molten alloy.
• The wax cluster process continues as
a ceramic slurry is applied, followed
by ceramic sand, and then into
the controlled drying step until the
desired shell thickness is achieved.
7. • The wax is then melted out and the
resulting shell is fired to create a hard
ceramic ready for casting. Selective
insulation that eliminates casting
defects, such as micro-shrinking, may
be applied at this point before the
shell proceeds to the casting stage.
• During the casting step, metal is melted
under vacuum to maintain purity.
Once melted, the mold is loaded
through a vacuum-lock system.
• After the mold is cast, the gating
is removed and the castings move
through the post-cast operations
and quality inspection.
• Once approved, the certified casting
is shipped to the customer.
THE INVESTMENT
CASTING PROCESS
This is the casting portion of
the investment casting process.
Pe
rc
en
t
Year
2011 2012 2013
8. Figure 1: Desired Scrap Trend Across APP
ASQ www.asq.org Page 3 of 5
improvement opportunities within the
process. In addition, the team utilized
scrap rates at each APP location to
search for potential savings.
Scrap by point-of-cause data was analyzed
within each process area to determine
which processes held the greatest savings
potential. In addition to pinpointing spe-
cific processes for improvement, quality
tools such as Pareto analysis were also
useful in determining which plants to tar-
get for early implementation.
At the outset, the project scope was
quite broad—global business unit scrap
reduction—a hefty challenge. After
reviewing the data and securing buy-in
from leadership, the improvement team
narrowed the scope to focus on the great-
est opportunities—the wax, shell, and
cast manufacturing operations of nine
selected locations. Although the scope
was now more narrowly focused, the
challenge was still immense, requiring
the engagement of the entire operation.
At this point, team membership grew
to include additional process owners,
9. engineers, quality staff, operations,
and leadership personnel from plants
involved in the project.
Developing
Solution
s
Because the nine APP locations for this
improvement initiative were located
around the world, it was imperative to
create a cohesive language that could tie
all the foundry processes together. This
common language was necessary for not
only deploying the methods and tools,
but also identifying the key operations
and sub-processes at various plants for
comparative and benchmarking purposes.
Process-mapping exercises, shop-floor
interviews, brainstorming sessions, and
benchmarking studies generated data
to help develop potential solutions.
The data was first used for comparing
10. Alcoa plants with similar processes and
improvement requirements. The com-
pany saved $20 million at seven Alcoa
plants that had implemented process
management initiatives. These results
inspired the improvement team to pursue
a similar approach within APP.
The left portion of Figure 2 depicts a
typical plant-based approach to process
improvement where efforts are confined.
In contrast, the right side of Figure
2 shows how an integrated approach
involving plants throughout the BU
enables the sharing of approaches with
common templates and coordinated
plant projects. The new approach would
Figure 2: Potential Implementation Approaches for Process
Management Directive
Plant 3
Plant 2
11. Plant 1
Coordinated pilot plant projects
Pilot efforts well-supported
Ef
cient local leveraging
Common process map template
Integrated BU-wide approach
Plant 3
Plant 2
Plant 1
Independent plant projects
Wasteful duplicated efforts
Poor leveraging
Independent process maps
12. Traditional plant-based approach
ASQ www.asq.org Page 4 of 5
leverage one plant’s independent ideas by sharing its
solutions across the entire business unit to spur global
improvement. This business-unit approach also enabled
process owners to transfer technical details through a
common language that was lacking in the past, and to
build a collaborative culture.
The team developed a three-stage plan to implement
its process management approach. The first stage
involved pilot plants; the second fast-follower plants;
before finally, implementation to a broad business-unit
approach. This three-stage rollout provided data that team
members used to validate the efficiency and speed of the
shared and integrated approaches.
The key to incorporating solutions throughout the busi-
ness unit was a structured, common process model, which
incorporates the tools recognized as the best-suited means
to get processes in control, and to identify key operations
13. and sub-processes at multiple plant locations. Utilizing
this process management approach, as illustrated in
Figure 3, would increase sustainability through manage-
ment review, quality audits, rigorous control plans, and a
focus on the correct variables.
The process management solution was validated through
the pilot and fast-follower stages. For example, one of
the pilot-stage plants deployed a new casting/mold wrap
process and demonstrated a 30 percent reduction in
related scrap in just three months. Then a fast-follower
plant used the same new process as the pilot plant and
achieved similar scrap reduction results, but this time
within just 30 days. This demonstrated that lessons
learned at one plant advance the process management
efforts at other locations when similar process improve-
ments are implemented.
Initial
assessment
Identi�cation of
key processes and
process managers
15. resistance, including:
• Concerns regarding the availability of resources, particularly
the ability for employees to handle the new initiative while still
meeting production goals.
• Stakeholders at various levels lacked a sense of urgency and
showed some hesitancy about making changes.
• Because the process management approach was a
nontraditional
method for reducing scrap, a change in culture would be
essential
to inspire employees to embrace the new process-focused
method.
The team understood providing information and education was
vital to
achieve positive change, so the process management model
includes
routine communication such as holding team-building meetings
and shar-
ing monthly process audit databases. Resistance was also
mitigated by
engaging the entire workforce in the new process management
16. approach.
Examples included employees who helped by defining
improvement
opportunities, planning and prioritization activities,
participating in kai-
zen events, as well as establishing and executing control plans.
Exceeding Goals and Realizing Additional Benefits
Once the pilot and fast-follower stages were completed, APP
imple-
mented the process management model throughout the business
unit.
While the initial project goal was to reduce scrap by 10 percent
year
over year, those expectations were exceeded by more than $20
mil-
lion in improvements from the three key areas: wax, shell, and
cast.
Tyrus Hansen, APP team lead, said reductions in scrap and
other
costs of poor quality continue year over year, as highlighted in
APP’s
Quality Index, shown in Figure 4.
17. Specific examples of dramatic cost savings include:
• A 77 percent improvement in wax expenses in one department
at
one plant, which resulted in a $38,000 annual savings.
• A sub-process involving shell weight control to reduce
material
costs at one production facility resulted in a 21 percent
improvement and an annual savings of $400,000.
• A sub-process of the cast/wrap step reduced scrap and rework
expenses by more than 30 percent, approximately $750,000, at
one location.
Not only did the new approach lower scrap rates, but it also
reduced
rework activities and customer returns, leading to more on-time
deliv-
ery and higher levels of customer satisfaction. At the outset of
this
project, all nine plants involved in the pilot were rated in the
poor
performance category, but since that time, all of the
manufacturing
18. locations have fully integrated the process management
approach.
An unexpected benefit of the work was an improved workforce
devel-
opment. Many team members completed training and then
gained
ASQ www.asq.org Page 5 of 5
valuable experience with basic problem-solving tools—new
skills that enabled employ-
ees to operate in a more proactive, process-focused manner.
Members of the improvement team learned valuable lessons
throughout the project, but
Hansen said the biggest lesson centered on discipline as team
members realized, “If we
maintain the discipline, quality will improve,” he said. “The
proactive work minimizes
the time spent managing problems and fighting fires.”
Sustaining the Momentum
19. The APP process management models for the wax, shell, and
cast operations were
revised to reflect the new approach. These models were
deployed through the process
owner group at each APP location. Results are measured and
reported at the process
and sub-process levels with metrics directly linked to each
location’s business case.
Reports and feedback soon became more proactive and process-
focused rather than
reactive and problem-focused as was the case before this
improvement initiative.
To ensure the new process management approach remains
sustainable and continues to
perform to expectations, APP implemented a number of
controls, including:
• The business case must drive all activities associated with this
approach and the
activities are measured for impact.
• A reporting structure was created to communicate specific
details on a regular basis.
20. • All efforts are recorded and included in the business unit
manuals and audit tools.
As APP continued to implement the process management
approach, the business unit
realized further benefits, such as:
• By emphasizing control of the entire process, additional
operators and supervisors
are engaged in more proactive roles.
• The workforce is more satisfied and engaged due to greater
stability, education,
and structure.
• With fewer daily “firefighting” activities, time to focus on key
process metrics for
employees increases, triggering reactions before issues become
scrap problems.
GOAL
reduction
from 2013
6.59%
23. time in sharing its success story with
others. Within Alcoa, the model used in
this project now serves as the corporate
standard and is being applied at various
locations and business units around the
globe with similar results. The team’s
effort was also highlighted at the 2014
Alcoa Corporate Process Management
Network Conference and was a can-
didate in the 2013 Alcoa Corporate
Impact Award Competition.
At the prompting of Alcoa’s cor-
porate quality department, the team
entered its project into the ASQ 2015
International Team Excellence Award
(ITEA) competition. The project was
named a finalist, and this recognition
enabled members of the team to share
APP’s proven process management
approach during the World Conference
on Quality and Improvement.
For More Information
24. • For additional information on
Alcoa Power and Propulsion,
visit the organization’s website at
www.alcoa.com.
• To learn more about this project
from a team interview, watch this
video http://videos.asq.org/alcoa-
six-sigma-and-teams.
• To view more examples of
successful improvement projects in
quality, visit the ASQ Knowledge
Center at asq.org/knowledge-center/
case-studies.
• Learn more about the International
Team Excellence Award Process
by visiting the official website at
asq.org/wcqi/team-award/index.aspx.
About the Author
Janet Jacobsen is a freelance writer
specializing in quality and compliance
25. topics. A graduate of Drake University,
she resides in Cedar Rapids, IA.
www.alcoa.com
http://videos.asq.org/alcoa-six-sigma-and-teams
http://videos.asq.org/alcoa-six-sigma-and-teams
http://asq.org/knowledge-center/case-studies
http://asq.org/knowledge-center/case-studies
http://asq.org/wcqi/team-award/index.aspx
Making the Case for Quality
Systematically Improving
Operating Room Patient Flow
Through Value Stream Mapping and Kaizen Events
• Value stream maps (VSMs)
are effective tools for
facilitating incremental
improvements to complex
healthcare processes.
• Thomas Jefferson University
26. Hospitals utilized the VSM
approach to identify and
execute seven lean projects
within the perioperative
department over four years.
• Results include
preadmission testing
reduction in length of
visit from 110 to 92
minutes, 36 percent
reduction in preoperative
patient waiting, and an
improvement of on-time
first-case starts from
56 to 67 percent.
At a Glance …
The focus of hospital senior leaders on operations expense
reduction and management has been spurred
by increases in costs of pharmaceutical and medical supplies,
revenue movement from inpatient to
27. outpatient settings, and malpractice insurance.1 Key to
addressing these issues is successfully utiliz-
ing performance improvement methodologies to improve quality
and decrease variation, which saves
money.2 At Thomas Jefferson University Hospitals, inpatient
and outpatient operating room (OR)
activity accounts for a large percentage of total patient revenue.
The majority of OR cases occur at the
academic medical center known as the Center City campus.
As part of the perioperative (the department responsible for all
surgical procedure activities) strategic
plan overview, a team of certified lean practitioners was
assigned to analyze and improve the OR
patient flow process. Given the existing high volume of
procedures and strategic vision to increase
case loads, it was critical to ensure consistent flow throughout
the system. From preadmission test-
28. ing through the post-anesthesia unit, the entire process was
wrought with inefficiencies (i.e., delays
in preoperative patient processing, cases not starting on time,
and slow OR turnover case to case) and
bottlenecks that had compounding effects on the overall
department.
Representatives from all related disciplines and departments
converged to tackle the complex problem.
Facilitated by the lean team, a value stream mapping (VSM)
event was held in August 2010 to deter-
mine how to strategically solve key issues.
About Thomas Jefferson
University Hospitals
Thomas Jefferson University Hospitals
(Jefferson) is a 969-acute-care-bed healthcare
29. facility located in Philadelphia, PA. Jefferson
provides a full range of patient care in all
specialties and subspecialties. The southeast-
ern Pennsylvania, New Jersey, and northern
Delaware region includes more than 11 million
people. Annually, Jefferson clinical operations
include nearly 50,000 admissions, more than
120,000 emergency department visits, and almost
a half-million hospital-based outpatient visits.
by Dennis Delisle
October 2013
ASQ www.asq.org Page 1 of 7
Dennis Delisle, operations support director for Jefferson
University Hospitals, discussing a pay-off priority matrix
with team members.
30. Why Quality?
Committed to lean thinking since 2008, in 2010 Jefferson
hired a certified lean master to develop a robust education and
process improvement program. As part of this program, more
than 50 certified lean practitioners who are imbedded in vari-
ous clinical and nonclinical departments volunteer their time for
improvement projects. In addition to the formal university-
based
lean thinking and certification program, Jefferson offers staff
department-level training that emphasizes application of simple,
yet effective tools (i.e., 5S, visual management, process map-
ping) and leads to project execution on a smaller scale.
31. Jefferson
is dedicated to providing world-class care, and approaches like
lean thinking enable staff to contribute value-adding services
while reducing wasteful efforts.
The consumer-driven healthcare market demands a high degree
of
customer service and responsiveness. As such, Jefferson leaders
identified a need to streamline the perioperative department’s
pro-
cesses. The perioperative department engaged a team of
certified
lean practitioners to strategically evaluate opportunities and
facili-
tate change. Operating room patient flow is a complex process
that
32. involves multiple areas, including:
• Physician offices
• OR scheduling
• Preadmission testing
• Registration
• Pre-procedure preparation
• Patient transportation
• Holding area unit
• Operating room
• Environmental services
• Post-anesthesia care unit
Given the numerous levels,
functions, and responsibilities
involved, leaders determined that
the best approach to initiate the
project would be a VSM event. The full-day facilitated effort
included the lean team working with a group of process experts
throughout the entire OR patient flow process.
Jefferson’s Quality Journey
Prior to initiation of the VSM event, the lean team conducted
33. voice of customer interviews with representatives from manage-
ment and frontline staff. The interviews focused on qualitative
analysis of key issues and barriers to patient flow. Throughout
the discussions, several themes became apparent: constant
changes to the OR schedule the day before or day of surgery,
poor communication among perioperative units, excessive
processes and patient travel due to poor layout, inadequate tech-
nology for decision making and monitoring flow, and workflow
variation across all disciplines.
Following the interviews, the lean team began observations. A
critical element of lean thinking is gemba walks. Gemba is a
Japanese term that stands for the place of action, or where the
work takes place.3 The approach is simple: Go to where work is
being done, observe the processes and workflow, and talk with
staff to understand their challenges.4 Gemba walks also enable
ASQ www.asq.org Page 2 of 7
OR Kaizen 5 Team – Improving On-Time, First-Case Starts
OR Kaizen 6 Team – Improving OR Patient Flow From SPU to
Holding Area
34. ASQ www.asq.org Page 3 of 7
the team to document process steps in the current state, a key
input in the VSM event. Additionally, observations were supple-
mented by the OR information system database providing key
performance indicators such as on-time, first-case starts, OR
turnover times, and cycle times across the patient flow process.
Together, these data helped shape the current state.
The lean team developed a comprehensive agenda that included
current state validation, brainstorming and prioritizing issues
and
barriers, future state design, and creating an improvement plan
for incremental progress over time. Managers and perioperative
department leaders participated. Inclusion of the right
stakehold-
ers (i.e., process expert, influential leader, creative problem
solver,
etc.) is a critical element of successful improvement efforts.
The
OR vice president and management team helped choose a group
of individuals to represent the broader department.
Figure 1 depicts the validated current state at the time of the
35. event. Participants went through a facilitated brainstorming ses-
sion to determine the key drivers of quality and efficiency
issues.
The problem-solving process used by the lean practitioners can
be seen in Table A.
The group then began the solution development process. The
pro-
posed solutions were prioritized based on impact (high/low) and
ease of implementation (easy/difficult). Figure 2 shows the
current
state, with proposed solutions represented as kaizen bursts.
This led to final recommendations of where the team should
focus (Figure 3: Proposed Action Plan). At the conclusion of the
event, the entire team presented the findings and recommenda-
tions to leadership, along with the timeline for implementation.
Lean thinking emphasizes incremental improvement over time.
These improvement efforts are typically known as kaizen
events.
Kaizen, a Japanese term, represents “change for good.” Lean
teams facilitate kaizen events with process experts in order to
rapidly develop and implement solutions. Jefferson lean teams
utilize the define, measure, analyze, improve, and control
36. (DMAIC) project structure to execute initiatives. The main
deliv-
erables for each phase can be seen in Table B.
The VSM team identified two areas as the priority focus based
on the majority of opportunities and solutions identified through
the VSM event. The first piece was patient arrival. Next, the
Table A — Problem-Solving Process
Step Description Deliverable
Brainstorm issues and barriers Through various brainstorming
activities, participants discuss and
document all issues and barriers related to the problem being
addressed.
Documented list of all issues and barriers that contribute to
inefficiencies and poor quality.
Prioritize issues and barriers The team determines which issues
and barriers are within their control.
These filtered issues are subsequently prioritized through
voting.
37. The highest priority issues/barriers (usually two to four in total)
are
selected for solution development.
Brainstorm potential solutions Through brainstorming activities,
the team discusses and develops
potential solutions to address the prioritized issues and barriers
from
the prior step.
Documented list of all potential solutions to address the
prioritized
issues.
Prioritize solutions The team prioritizes solutions based on
impact on the problem (high or
low) and ease of implementation (easy or difficult).
All solutions are prioritized, highlighting the high-impact and
easy-
to-do ideas.
Develop action plan A detailed action plan is developed for all
solutions that fall within the
high-impact, easy-to-do or low-impact, easy-to-do categories.
38. The action plan consists of what, who, when, required
resources, and
expected outcome. Plans are executed within a six-week
timeframe,
often with pilots occurring during the actual kaizen event.
Patient Surgeon
OR
schedule
nalized
OR
schedule
nalized
Delivered
to central
scheduling
Patient
arrives
42. recommendation was to look at the holding area process where
patients have an IV line placed and are then interviewed by the
surgical and anesthesia teams (interventions and outcomes of all
efforts can be found in the results).
After execution of the first and second kaizen events, the lean
team re-evaluated the VSM with perioperative department lead-
ership to identify additional opportunities for improvement.
Over
the course of four years, the lean team systematically addressed
issues and challenges through seven formal kaizen events. The
scope of the subsequent improvement efforts spanned
scheduling
through post-procedure processes and can be seen in Table C.
Patient Surgeon
OR
schedule
nalized
OR
schedule
49. 10th St. open
4:30 a.m.
JIT patient
arrival
Update
scripts
Move
interviewers
FAR closed
on schedule
Larger OR
labels
Physician
of
ce education
Low/easy ORSOS = OR information system JIT = just-in-time
FAR =
rst available room Pixis = medication carousels on nursing units