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1 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
Welcome to
8D Problem Solving Process - An Overview
Clinic #2
ASQ Orange Empire Monthly Dinner Meeting
February 12, 2013
Frank G. Adler, Ph.D.
Principal & Managing Partner
Operational Excellence Consulting LLC
info@operational-excellence-consulting.com
www.operational-excellence-consulting.com
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8D Problem Solving Process - An Overview
Presenter: Frank G. Adler
Operational Excellence Consulting
“People and their managers are working so
hard to be sure things are done right, that they
hardly have time to decide if they are doing the
right things.”
Stephen R. Covey
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Learning Outcomes:
 understand the purpose and objectives of each phase of the
8D Problem Solving Process
 learn how to utilize key problem solving tools in each phase
of the 8D Problem Solving Process
 use assessing questions effectively at the end of each phase
of the 8D Problem Solving Process
 be able to apply some of the problem solving tools and
key learning points on a simple case study
Case Study: We will have a case study throughout the presentation
so that you can apply and practice some of the key learning points.
Purpose  Key Learning Points
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Problem Solving Process - The Terminology
 Symptom – A quantifiable event or effect, experienced by a Customer
(internal  external), that may indicate the existence of one or more problems.
 Problem – A deviation from an expectation, standard, or status quo; a
perceived gap between the existing state and a desired state. In the context of
the 8D Problem Solving Process the cause(s) of the problem is not known.
 Possible Cause – Any cause, identified through Process Mapping and C  E
Matrix, Why-Why Diagram or Fishbone Diagram, that describes how an effect
may occur.
 Most Likely Cause – A theory, based on available or collected data, that
best explains the problem description.
 Root Cause – A verified cause that convincingly supports and explains
ALL facts available and thus accounts for the problem; verified passively and
actively, by making the problem come and go. Root causes are the
fundamental, underlying reasons for a problem, e.g. management policies,
product design, system design, process capabilities, technology constraints,
standard operating procedures and human errors.
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Problem Solving Process - The Tool Box
If you only have a hammer, everything looks like a nail.
→ You need the right tools for the right tasks.
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The 8D Problem Solving Process
1
• Establish the Team
2
• Describe the Problem
3
• Develop Interim Containment Actions
4
• Define and Verify Root Causes and Escape Points
5
• Choose and Verify Permanent Corrective Actions
6
• Implement and Validate Permanent Corrective Actions
7
• Prevent Recurrence
8
• Recognize Team and Individual Contributions
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Purpose: Establish a small group of people with the process and/or product
knowledge, allocated time, authority, and skills in the required technical
disciplines to solve the problem and implement corrective actions. Review
and scope the problem or improvement opportunity.
 Review priorities, scope and complexity
 Identify if a team is needed
 Identify team members and establish the team
 Nominate a team leader, project champion and facilitator
 Establish roles and responsibilities
 Establish basic team guidelines
 Consider team building exercises
“Establish the Team” Key Activities
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The Problem Solving Team:
 Are the people affected by the problem represented?
 Does each person have a reason for being on the team?
 Do the team members agree on membership?
 Is the team large enough to include all necessary input, but small
enough to act effectively?
 The Team Leader has been identified?
 The Champion of the team has been identified?
 Need for a Facilitator to coach the process has been
considered?
 Have the roles and responsibilities been reviewed?
“Phase 1” Checklist Questionnaire
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The 8D Problem Solving Process
1
• Establish the Team
2
• Describe the Problem
3
• Develop Interim Containment Actions
4
• Define and Verify Root Causes and Escape Points
5
• Choose and Verify Permanent Corrective Actions
6
• Implement and Validate Permanent Corrective Actions
7
• Prevent Recurrence
8
• Recognize Team and Individual Contributions
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Purpose: Describe the internal or external problem by identifying “what is wrong
with what” and detailing the problem in quantifiable terms.
 Develop a Problem Statement
 Develop a Problem Description using the “IS – IS NOT Matrix”
 Develop a flowchart of the process and identify critical process steps with
respect to the Problem Description and Escape Point(s)
 Determine whether the problem describes a “something changed” or a
“never been there” situation
 Develop a Cause  Effect Matrix, Why-Why Diagram or Fishbone Diagram
to identify “all” possible causes?
 Establish a high-level project plan, including milestones,
project goals and objectives
“Describe the Problem” Key Activities
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There are two steps to develop a good Problem Statement.
The first step is used to identify the object and the defect and develop the
initial Problem Statement.
The object and the defect are defined by asking “What is wrong with what?”
 “What is wrong?” is the defect
 The defect is an unwanted characteristic present in a product or
process – broken, missing, wrong, too short, …
 “… with what?” is the object
 The object is the name given to a specific product or process that
exhibits the defect
The Problem Statement (Step 1)
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The 5 Why’s
Description: The 5 Why’s Analysis helps to identify the final problem
statement or in some cases even the root cause.
Step 1: Develop an initial problem statement of the specific problem to be
solved. Write it in the upper left corner of a piece of paper, flip chart or white
board.
Step 2: Ask “Why?” this problem does or could occur. Write the cause (object 
defect) underneath the initial problem statement.
Step 3: The cause identified in Step 2 now becomes a new problem statement.
Repeat Step 2 and ask “Why?”, e.g. “Why would this situation occur?, again.
Step 4: Continue Step 2 and Step 3 until you cannot for certain answer the
question or reach an answer that is fundamental and actionable.
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Once the initial problem statement (object  defect) is established, the second step
is to use the “5 Why’s” and ask “Why would this situation occur?” or “Why is
that happening to that object?”
The objective of this step is to refine the initial problem statement to
 determine the problem, rather than the symptom of the problem
 focus efforts on a single problem with a single root cause
 get as near as possible to the root cause using existing knowledge 
information
 check if the root cause of the problem is really unknown
If you are certain that you have found the root cause, then you can immediately go
to Phase 4 “Define and Verify Root Cause” and test your root cause theory.
However, if the cause is unknown and there is a need to find the root cause, then
the last object and defect with an unknown cause is the final Problem Statement.
The Problem Statement (Step 2)
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Problem Statement - Example
What is the Problem Statement (Object  Defect)?
WHY? → The tool was not in inventory.
WHY? → The Supplier did not deliver the replacement tools.
WHY? → The Supplier did not receive our Purchase Order on-time.
WHY? → We did not submit the Purchase Order on time.
WHY? → We did not have the “right” rework tool.
WHY? → We don’t know.
Initial Problem
Statement
Final Problem
Statement
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Case Study Group Work 1
The Task:
 Read the introduction to the “Felt Tip Marker” Case Study
 Develop the Problem Statement for the Case Study
5 Minutes
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Process Flowchart
Most problem solving projects will require a process flowchart as the problem is
associated with a process that is failing. The team needs to understand how
that process works or at least is intended to work.
A Process Flowchart is a graphical process description of the work flow or
activities using standard symbols for each of the activities.
Different types of activities are described with standard symbols. The problem
areas in the process are often relatively easy to discover when assessing the
flowchart.
An ellipse shows the start and the end point of the process.
A box describes an activity or process step.
A diamond shows a decision making step.
An arrow shows the direction from one activity to another.
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“Change-Induced” vs. “Day-One-Deviation”
Change
Performance SHOULD
Past Present
DEVIATION
When the process performance once met
the SHOULD and no longer does, then
you have a “Change-Induced” problem.
Performance ACTUAL
Performance SHOULD
Present
DEVIATION
Day One
When a condition required for achieving the
SHOULD never existed, then you have a
“Day-One-Deviation” problem.
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The Problem Description
The Problem Description defines the boundaries of the problem, in terms of what it is
and what it is not but could be.
Scientific description of any event can be made by providing information on
 What the problem is and what it is not but could be?
 IS - The long brackets are missing
 IS NOT - The short brackets are not missing (but could be)
 Where the problem is and where it is not but could be?
 IS - The order entry defects are in direct ship orders
 IS NOT - The order entry defects are not in stock orders (but could be)
 When the problem occurs and when it does not but could?
 IS - The clips started breaking in early 2010
 IS NOT – The clips did not break before early 2010 (but could have)
 How big the problem is and how big it is not but could be?
 IS - About 50% of the paychecks are incorrect
 IS NOT – Not all paychecks are incorrect (but could be)
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The “IS – IS NOT” Matrix
PROBLEM SOLVING PROCESS WORKSHEET
Problem Statement
(What is wrong with what?):
Red Felt Tip Marker Leaks
IS IS NOT DISTINCTIONS CHANGES
TEST FOR MOST LIKELY CAUSES
(+) (-) (?)
Describe what does occur
Describe what does not occur, but
could occur
What could explain the IS-IS NOT?
(People, Methods, Material,
Machines, Environment)
What has changed in, on, around or
about this distinction? When
did it change?
Define Possible Root Cause
Theory
What?
Object:
Defect:
Where?
Where is the object when the
defect is observed? Where is the
defect on the object? Are there
any pattern or trends identifiable?
When?
When was the defect observed
first? Can or was the defect be
observed before, during or after
other events? When since has the
defect occurred? Are there any
pattern or trends identifiable?
How Big?
How many objects have the
defect? What is the size of a single
defect? How many defects are on
each object? Are there any
pattern or trends identifiable?
1
2
3
4
5
2
3
4
5
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Case Study Group Work 2
The Task:
 Study the “Felt Tip Marker” Case Study (Part 1) thoroughly
 Develop the Problem Description for the Case Study
30 Minutes
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Case Study - Problem Description
PROBLEM SOLVING PROCESS WORKSHEET
Problem Statement
(What is wrong with what?):
Red Felt Tip Marker Leaks
IS IS NOT DISTINCTIONS CHANGES
TEST FOR MOST LIKELY CAUSES
(+) (-) (?)
Describe what does occur
Describe what does not occur, but
could occur
What could explain the IS-IS NOT?
(People, Methods, Material,
Machines, Environment)
What has changed in, on, around or
about this distinction? When
did it change?
Define Possible Root Cause
Theory
What?
Object: Red felt tip marker Blue, black or green marker
Defect: Leaks Totally dry
Where? Tip Barrel (side or base)
Where is the object when the
defect is observed? Where is the
defect on the object? Are there
any pattern or trends identifiable?
Both our place and next door Just us or just next door
All other places/customers No other places/customers
When? First seen two weeks ago Before two weeks ago
When was the defect observed
first? Can or was the defect be
observed before, during or after
other events? When since has the
defect occurred? Are there any
pattern or trends identifiable?
Daily Just some days
Continuing Stopped
Last ten days shipments Just some daily shipments
Upon arrival
Develops later (on shelf) in supply
room
How Big? All red felt tip markers (100%)
Just some red felt tip markers (less
than 100%)
How many objects have the
defect? What is the size of a single
defect? How many defects are on
each object? Are there any
pattern or trends identifiable?
All shipments Just some shipments
All ten per day Less than 10 per days
Slow drip Steady or pressurized stream
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Identifying Possible Causes
To learn more about a specific problem and identify “all” possible
causes, the following tools are often very helpful and widely used.
 Process Flowchart and  Cause  Effect Matrix or
 Why – Why Diagram or
 Fishbone Diagram
These tools work really great in a team environment to ensure that
everyone has a voice and every voice is being heard.
Select the Cause  Effect Matrix, the Why-Why Diagram or the
Fishbone Diagram based on the problem you try to solve and/or your
personal or team’s preference.
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Cause-and-Effect or Ishikawa Diagram is another way of looking at the possible
causes of a problem. It organizes large numbers of possible causes into pre-
defined categories, e.g. 4Ms  1 E or 4 Ps, or team-defined categories.
Fishbone Diagram - Phase 1
4M’s = MEN
METHODS
MATERIALS
MACHINES
+ ENVIRONMENT
4P’s = PEOPLE
PRODUCT
PRICE
PROMOTION
Machines
Materials Methods
Environment
Trunk
Primary Possible Cause Category
Main Branch
Minor Branch
Second-Level
Possible Causes
Men/People
Problem
Statement
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Problem Statement:
 The initial question “What’s wrong with what?” has been answered?
 The “5 Why’s” were used to asking questions “Do we know for certain
why this is occurring?”
 A final problem statement (or specific root cause) has been defined
(object and defect) and documented?
Problem Description:
 A thorough “IS – IS NOT” Analysis has been performed (what, where,
when, how big) and documented?
 The problem description has been confirmed as to what
the Customer and/or affected party(s) are experiencing?
 Physical evidence of the problem has been obtained?
“Phase 2” Checklist Questionnaire
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“Phase 2” Checklist Questionnaire
Problem Description (cont.):
 Determination has been made as to whether this problem describes
a “Change-Induced” or a “Day-One-Deviation” situation?
 The current process flow has been identified and documented (if
applicable)?
 Process detail has been reviewed to determine where this problem
first appears?
 Problem pattern(s) has been considered / evaluated?
 Similar components and/or parts have been reviewed for the same
problem?
 All required data has been collected and analyzed?
 A Cause  Effect Matrix, Why-Why Diagram or Fishbone
Diagram has been developed to identify possible causes?
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1
• Establish the Team
2
• Describe the Problem
3
• Develop Interim Containment Actions
4
• Define and Verify Root Causes and Escape Points
5
• Choose and Verify Permanent Corrective Actions
6
• Implement and Validate Permanent Corrective Actions
7
• Prevent Recurrence
8
• Recognize Team and Individual Contributions
The 8D Problem Solving Process
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“Develop Interim Containment Actions” Key Activities
Purpose: Define, verify and implement Interim Containment Action to isolate
the effects of the problem from any internal and/or external Customer until
Permanent Corrective (Preventive) Action are implemented.
 Define potential Interim Containment Action
 Verify effectiveness of potential Interim Containment Action
 Select and implement Interim Containment Action
 Validate effectiveness of implemented Interim Containment Action with
the Customer
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“Phase 3” Checklist Questionnaire
Planning:
 Appropriate departments have been involved in the planning of the
Interim Containment Action
 Plans, including action steps, have been developed considering who
needs to do what by when?
 The Customer’s viewpoint has been considered for the Interim
Containment Action
 The Customer’s approval has been obtained?
 A validation method for the Interim Containment Action has been
determined?
Post Implementation:
 The validation data indicates that the Customer is being
protected from the symptom of the problem?
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1
• Establish the Team
2
• Describe the Problem
3
• Develop Interim Containment Actions
4
• Define and Verify Root Causes and Escape Points
5
• Choose and Verify Permanent Corrective Actions
6
• Implement and Validate Permanent Corrective Actions
7
• Prevent Recurrence
8
• Recognize Team and Individual Contributions
The 8D Problem Solving Process
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“Define and Verify Root Causes” Key Activities
Purpose: Isolate and verify the root cause by testing each root cause theory
against the Problem Description and supporting data. Isolate and verify the
place in the process where the effect of the root cause could have been
detected and contained but was not (escape point).
 Establish any additional data collection plans needed to learn more about
the problem and/or possible causes.
 Utilize the Cause  Effect Matrix, Why-Why Diagram or Fishbone Diagram
created earlier to identify the most likely cause(s).
 Isolate and verify the most likely cause(s) by testing each Root Cause
Theory against the Problem Description and the
collected data.
 Isolate and verify the place in the process where the
effect of the root cause could have been detected
and contained but was not (escape point).
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Comparative Analysis
 The Comparative Analysis is the third part of the 8D Problem Solving
Process Worksheet.
 The Comparative Analysis connects the facts from the Problem Description
(“IS – IS NOT” Matrix) with the analysis of possible causes using the Process
Flowchart and the CE Matrix or Why-Why Diagram or Fishbone Diagram.
 Step 1: Compare each “IS” with its corresponding/contrasting “IS NOT”. List
any known distinctions and uncommon factors that could explain the “IS”
and “IS NOT”.
 Ask: What is unique, odd, different, distinctive, unusual about the “IS”?
 Consider the possible causes identified so far.
 Step 2: List all known changes in distinctions and uncommon factors.
 Ask: What has changed in, on, around or about this distinction and
uncommon factors?
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Comparative Analysis - Example
 Problem Description:
 “WHAT” IS – The Red Makers leak
 “WHAT” IS NOT – The Blue Markers could leak, but are not
 Comparative Analysis:
 Distinctions
 1. Different Color Plastic
 2. Different Color Ink
 3. Strawberry Scent in Red Marker
 Changes
 1. New Plastic Supplier (5 weeks ago)
 2. Added Powder to Red Marker (2.5 weeks ago)
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Comparative Analysis
PROBLEM SOLVING PROCESS WORKSHEET
Problem Statement
(What is wrong with what?):
Red Felt Tip Marker Leaks
IS IS NOT DISTINCTIONS CHANGES
TEST FOR MOST LIKELY CAUSES
(+) (-) (?)
Describe what does occur
Describe what does not occur, but
could occur
What could explain the IS-IS NOT?
(People, Methods, Material,
Machines, Environment)
What has changed in, on, around
or about this distinction?
When did it change?
Define Possible Root Cause
Theory
What?
Object: Red felt tip marker Blue, black or green marker
Defect: Leaks Totally dry
Where? Tip Barrel (side or base)
Where is the object when the
defect is observed? Where is the
defect on the object? Are there
any pattern or trends
identifiable?
… …
When? First seen two weeks ago Before two weeks ago
When was the defect observed
first? Can or was the defect be
observed before, during or after
other events? When since has
the defect occurred? Are there
any pattern or trends
identifiable?
… …
How Big?
All red felt tip markers
(100%)
Just some red felt tip markers (less
than 100%)
How many objects have the
defect? What is the size of a
single defect? How many
defects are on each object? Are
there any pattern or trends
identifiable?
… …
1
1
1
1
2
2
2
2
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Case Study Group Work 3
The Task:
 Study the “Felt Tip Marker” Case Study (Part 2) thoroughly
 Perform a Comparative Analysis on the “Felt Tip Marker” Case Study
30 Minutes
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Case Study - Comparative Analysis
PROBLEM SOLVING PROCESS WORKSHEET
Problem Statement
(What is wrong with what?):
Red Felt Tip Marker Leaks
IS IS NOT DISTINCTIONS CHANGES
TEST FOR MOST LIKELY CAUSES
(+) (-) (?)
Describe what does occur
Describe what does not occur, but
could occur
What could explain the IS-IS NOT?
(People, Methods, Material,
Machines, Environment)
What has changed in, on, around or
about this distinction?
When did it change?
Define Possible Root Cause
Theory
What?
Object: Red felt tip marker Blue, black or green marker
Red Plastic - Red Ink - Strawberry
Scent (2.5 weeks ago)
New Plastic Supplier (5 weeks ago) -
Added Powder (2.5 weeks ago)
Defect: Leaks Totally dry
Where? Tip Barrel (side or base) Felt Material New Felt Supplier (1 Week ago)
Where is the object when the
defect is observed? Where is the
defect on the object? Are there
any pattern or trends identifiable?
Both our place and next door Just us or just next door
All other places/customers No other places/customers
When? First seen two weeks ago Before two weeks ago
New Outside Sleeve Packaging (2
Weeks ago)
New Outside Sleeve Packaging (2
Weeks ago)
When was the defect observed
first? Can or was the defect be
observed before, during or after
other events? When since has the
defect occurred? Are there any
pattern or trends identifiable?
Daily Just some days
Continuing Stopped
Last ten days shipments Just some daily shipments
Upon arrival
Develops later (on shelf) in supply
room
How Big? All red felt tip markers (100)
Just some red felt tip markers (less
than 100)
How many objects have the
defect? What is the size of a single
defect? How many defects are on
each object? Are there any pattern
or trends identifiable?
All shipments Just some shipments
All ten per day Less than 10 per days
Slow drip Steady or pressurized stream
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Fishbone Diagram - Phase 2
In Phase 2 of the Fishbone Diagram, the team tries to reduce the large number of
possible causes to a short list of most likely causes, using the Problem Description,
Comparative Analysis, data analysis and the team’s combined process knowledge
and experience.
Remember, the root cause(s) convincingly supports and explains ALL facts available
and thus accounts for the problem. So, you need to ask yourself “If this would be
the root cause of the problem, would it explain the Problem Description?”
Machines
Materials Methods
Environment
Trunk
Primary Possible Cause Category
Main Branch
Minor Branch
Second-Level
Possible Causes
Men/People
Problem
Statement
Most Likely
Cause #1
Most Likely
Cause #3
Most Likely
Cause #2
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Root Cause Theory Testing
 Step 1: Use the 8D Problem Solving Process Worksheet, supported by the CE
Matrix or Why-Why Diagram or Fishbone Diagram, to formulate Root Cause
Theories based on the identified most likely cause(s) of the problem.
 Step 2: Enter a short description of a Root Cause Theory as header into the last
column of the 8D Problem Solving Process Worksheet.
 Step 3: Assess the Root Cause Theory against each “IS” – “IS-NOT” statement.
 Enter a “+” if the theory explains or does not conflict with the “IS”–“IS-NOT”
statement.
 Enter a “-” if the theory conflicts with the “IS”–“IS-NOT” statement.
 Enter a “?” if you are not sure and further investigation may be necessary.
 The Root Cause(s) convincingly supports and explains ALL “IS”–“IS-NOT”
statements and thus accounts for the problem.
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Root Cause Theory Testing
PROBLEM SOLVING PROCESS WORKSHEET
Problem Statement
(What is wrong with what?):
Red Felt Tip Marker Leaks
IS IS NOT DISTINCTIONS CHANGES
TEST FOR MOST LIKELY CAUSES
(+) (-) (?)
Describe what does occur
Describe what does not occur, but
could occur
What could explain the IS-IS NOT?
(People, Methods, Material,
Machines, Environment)
What has changed in, on, around or
about this distinction? When
did it change?
Define Possible Root Cause
Theory
What?
Object:
Defect:
Where?
Where is the object when the
defect is observed? Where is the
defect on the object? Are there
any pattern or trends identifiable?
When?
When was the defect observed
first? Can or was the defect be
observed before, during or after
other events? When since has the
defect occurred? Are there any
pattern or trends identifiable?
How Big?
How many objects have the
defect? What is the size of a single
defect? How many defects are on
each object? Are there any
pattern or trends identifiable?
2
3
3
3
3
+ - ?
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Root Cause Theory Testing - Example
PROBLEM SOLVING PROCESS WORKSHEET
Problem Statement
(What is wrong with what?):
Red Felt Tip Marker Leaks
IS IS NOT DISTINCTIONS CHANGES
TEST FOR MOST LIKELY CAUSES
(+) (-) (?)
Describe what does occur
Describe what does not occur, but
could occur
What could explain the IS-IS NOT?
(People, Methods, Material,
Machines, Environment)
What has changed in, on, around or
about this distinction? When
did it change?
New Plastic Supplier - Plastic is
too porous … ink leaks through.
What?
Object: Red felt tip marker Blue, black or green marker
Red Plastic - Red Ink - Strawberry
Scent (2.5 weeks ago)
New Plastic Supplier (5 weeks ago) -
Added Powder (2.5 weeks ago)
(-)
Defect: Leaks Totally dry …
Where? Tip Barrel (side or base) (-)
Where is the object when the
defect is observed? Where is the
defect on the object? Are there
any pattern or trends
identifiable?
… … …
When? First seen two weeks ago Before two weeks ago (-)
When was the defect observed
first? Can or was the defect be
observed before, during or after
other events? When since has
the defect occurred? Are there
any pattern or trends
identifiable?
… … …
How Big? All red felt tip markers (100)
Just some red felt tip markers (less
than 100)
(+)
How many objects have the
defect? What is the size of a
single defect? How many defects
are on each object? Are there
any pattern or trends
identifiable?
… … …
40 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
Root Cause Verification
 Active Verification is a process where …
 … the problem solver uses the variable thought to be the root cause to
make the effect come and go. Both coming and going are important tests
to confirm root causes.
 Passive Verification is done by observation.
 With passive verification, you look for the presence of the root cause
without changing anything. If you cannot prove the presence of the root
cause, then chances are great that this most likely cause is not the root
cause.
Step 1: Identify, document and perform a passive and/or active
root cause verification method.
Step 2: Continue with the 8D Problem Solving Process if the
passive and/or active root cause verification was successful.
Otherwise, develop and test additional Root Cause Theories.
41 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
Escape Point Identification
Step 1: Using the Process Flowchart, identify Escape Point(s)
for the verified root cause(s).
Step 2: Determine if Control Points were missing or ineffective
to detect the root cause of the problem at the escape point.
Control System: A control system is a system deployed to monitor the product
or process and ensure compliance to Customer requirements. It consists of
responsibilities, procedures and resources.
Control Point: A control point is a location within the control system where the
product or process is checked for compliance to certain specified requirements.
There may be multiple locations within a control system.
Escape Point: The escape point is the earliest location in the process, closest
to the root cause, where the problem could have been detected, but was not.
42 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
“Phase 4” Checklist Questionnaire
Root Cause(s):
 The factual information in the Problem Description has been updated?
 Differences unique to the “IS” when compared to the “IS NOT” have
been identified?
 For a “Change-Induced” problem, changes in or around the differences
have been uncovered?
 The root cause theories developed have been tested against each “IS”
- “IS NOT” statement?
 The final root cause theory accounts for all “IS” - “IS NOT” statements?
 For multiple root causes, the causes were reviewed to
determine if, collectively, they account for all of the problem
description?
 The root cause(s) was/were verified passively and actively?
43 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
“Phase 4” Checklist Questionnaire
Escape Points:
 The process flow was reviewed and control points associated with the
root cause(s) identified.
 A determination was made as to the existence of a control system to
detect the problem?
 If a control system exists, changes from its original design (if any) have
been identified?
Project Management:
 The Project Champion has reviewed and supports the
analysis, findings and conclusions?
 8D Problem Solving Process Worksheet  Project
Documentation has been updated?
44 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
1
• Establish the Team
2
• Describe the Problem
3
• Develop Interim Containment Actions
4
• Define and Verify Root Causes and Escape Points
5
• Choose and Verify Permanent Corrective Actions
6
• Implement and Validate Permanent Corrective Actions
7
• Prevent Recurrence
8
• Recognize Team and Individual Contributions
The 8D Problem Solving Process
45 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
“Choose Permanent Corrective Actions” Key Activities
Purpose: Select the best Permanent Corrective Actions to remove the root
cause and to address the escape point in the process. Verify that both decisions
will be successful when implemented and not cause any undesirable effects.
 Develop solution(s) to remove the root cause(s)
 Develop solution(s) to address the escape point(s)
 Select the best solution(s) to remove the root cause(s)
 Select the best solution(s) to address the escape point(s)
 Verify that effectiveness of the selected solutions
 Verify that selected solutions do not cause any
undesirable effects
46 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
Mistake-Proofing Principles, Methods  Devices
Six Mistake-Proofing
Principles
1. Elimination
2. Prevention
3. Replacement
4. Facilitation
5. Detection
6. Mitigation
Five Mistake-Proofing
Methods
1. Variation Control
2. Workplace Organization
3. Identification
4. Process Checks
5. Poka-Yoke Devices
Seven Mistake-Proofing
Devices
1. Guide “Pins”
2. Error Detection  Alarms
3. Limit Switches
4. Sensors
5. Vision Systems
6. Counters  Timers
7. Checklists
47 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
Human Errors → Mistake-Proofing Examples
SIM cards only fit one way.
The right way.
Expose your team to (simple) everyday Mistake-Proofing devices and
examples and make them think about how they could use these concepts
in their own work area.
48 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
Double-Team  Multivoting
3 - 5 Solutions
Three Solutions from
the 1. Double Team
3 - 5 Solutions
3 - 5 Solutions
Three Solutions from
the 2. Double Team
3 - 5 Solutions
Board
1 2 3
4 5 6
|||| || ||||
| |||| | |||
Selection of the
2-3 most voted
solutions
5 3 1
49 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
Double-Team  Multivoting
1. Present the problem statement Team Leader ~ 2 min
2. Create ideas (3-5 ideas per person) All Individually ~ 10 min
3. Discussion of ideas in double teams Double Teams ~ 15 min
 choose the 3 best ideas
 hang on the wall
4. Present ideas to the entire team Double Teams ~ 5 min
 no discussion
5. Place similar solutions into groups Team ~ 5 min
6. Voting All Individually ~ 5 min
 5 votes per person
 max 2 votes per solution
 max 1 vote for own solutions
7. Counting the votes Team Leader ~ 5 min
8. Choose the solution(s) with most votes Team ~ 2 min
Double team (“22”) is a team working technique which ensures everybody’s
contribution in creating ideas.
50 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
“Phase 5” Checklist Questionnaire
Solution Selection:
 Criteria have been established for selecting solutions for root cause(s)
and escape points?
 Project Champion agrees with selection criteria?
 The right experience is on the team to choose the best solutions?
 Full range of alternatives have been considered for the solutions?
 The features and benefits for the perfect choice have been preserved?
 A risk analysis was performed on the solutions selected?
 All affected parties were consulted on the selected solutions?
 Consideration has been given to the resources required for
the implementation and ongoing support or maintenance of
the solutions?
51 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
“Phase 5” Checklist Questionnaire
Solution Verification:
 Evidence (proof) exists that these solutions will resolve the problems
at the root cause level?
 Variables measured during the verification step ensure sound
verification?
 Verification methods evaluated the solutions over the full range of
operating conditions?
Project Management:
 8D Problem Solving Process Worksheet  Project
Documentation has been updated?
52 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
1
• Establish the Team
2
• Describe the Problem
3
• Develop Interim Containment Actions
4
• Define and Verify Root Causes and Escape Points
5
• Choose and Verify Permanent Corrective Actions
6
• Implement and Validate Permanent Corrective Actions
7
• Prevent Recurrence
8
• Recognize Team and Individual Contributions
The 8D Problem Solving Process
53 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
Purpose: Plan and implement selected Permanent Corrective Actions,
remove the Interim Containment Action. Monitor long-term results.
 Implement the best solution(s) to remove the root cause(s)
 Implement the best solution(s) to address the escape point(s)
 Validate the effectiveness of the implemented solutions from the
Customer perspective
 Monitor the effectiveness of the implemented solutions and assure that
they do not cause any undesirable effects
 Remove Interim Containment Action(s)
“Implement Permanent Corrective Actions” Key Activities
54 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
“Phase 6” Checklist Questionnaire
Planning:
 Need for Permanent Corrective Actions implementation support from
other departments has been evaluated?
 Consideration was made to the need of Customer and Supplier
involvement?
 An action plan has been defined (responsibilities, timelines, financial
resources, support requirements, …)?
 The plan has been communicated to those that have a need to know?
 The Champion agrees with the plan?
 Measurables have been identified for the validating the
outcome of the Permanent Corrective Actions?
55 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
“Phase 6” Checklist Questionnaire
Validation:
 The Interim Containment Action has been discontinued?
 Validation measurables have been proven that the unwanted effect
has been totally eliminated?
 Long-term results are continuing to be monitored?
 The Customer has provided confirmation that the Permanent
Corrective Actions are effective?
Project Management:
 8D Problem Solving Process Worksheet  Project
Documentation has been updated?
56 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
1
• Establish the Team
2
• Describe the Problem
3
• Develop Interim Containment Actions
4
• Define and Verify Root Causes and Escape Points
5
• Choose and Verify Permanent Corrective Actions
6
• Implement and Validate Permanent Corrective Actions
7
• Prevent Recurrence
8
• Recognize Team and Individual Contributions
The 8D Problem Solving Process
57 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
Purpose: Modify the necessary systems, including policies, methods,
and procedures, to prevent recurrence of the problem and similar ones.
 Identify opportunities to improve systems, policies, methods and
procedures for the present problem
 Identify opportunities to improve systems, policies, methods and
procedures for similar problems
“Prevent Recurrence” Key Activities
58 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
Process Control Plan
A Control Plan is a written statement of an organization’s quality planning
actions for a specific process, product, or service.
The Objective of an effective Process Control Plan is to
 operate processes consistently on target with minimum variation,
which results in minimum waste and rework
 assure that product and process improvements that have been
identified and implemented become institutionalized
 provide for adequate training in all standard operating procedures,
work instructions and tools
Customer
Requirements
Product  Part
Characteristics
Process
Input  Output
Characteristics
Process
Controls
Process
Control
Plan
59 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
Start
Checkpoints
Activators
Corrective Actions
No
No
No
Yes
Yes
Yes
Yes
Yes
Yes
End
No
No
Out-of-Control-Action-Plans (OCAP)
 The OCAP is a systematic and ideal problem-solving tool for process problems because it reacts to
out-of-control situations in real time.
 OCAPs standardize the best problem-solving approaches from the most skilled and successful
problem solvers (experts/operators).
 The OCAP also allows (and requires) off-line analysis of the terminators to continually improve OCAP
efficiency.
60 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
“Phase 7” Checklist Questionnaire
Problem History:
 How and where the problem entered the process has been identified?
 Why the problem occurred there and why it was not detected has been
confirmed?
 We have considered whether confusion or lack of knowledge
contributed to the creation of this root cause and escape?
 Affected parties have been identified?
Corrective  Preventive Solutions:
 Policies, methods, procedures, and/or systems have been modified,
documented and implemented to prevent recurrence
of the root cause(s) and/or escape?
 Practices needing standardization have been identified,
defined and implemented?
61 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
“Phase 7” Checklist Questionnaire
Corrective  Preventive Solutions (cont.):
 Plans have been written to coordinate preventive actions and
standardize the practices?
 A method for communicating to those affected by the changes in the
new practices has been determined?
 The Champion concurs with the identified corrective  preventive
actions and plans?
Project Management:
 8D Problem Solving Process Worksheet  Project
Documentation has been updated?
62 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
1
• Establish the Team
2
• Describe the Problem
3
• Develop Interim Containment Actions
4
• Define and Verify Root Causes and Escape Points
5
• Choose and Verify Permanent Corrective Actions
6
• Implement and Validate Permanent Corrective Actions
7
• Prevent Recurrence
8
• Recognize Team and Individual Contributions
The 8D Problem Solving Process
63 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
“Recognize the Team” Key Activities
Purpose: Complete the team experience and sincerely recognize both
team and individual contributions. Celebrate success and identify lessons
learned.
 Perform a final review of the problem solving project
 Finalize and archive project documentation
 Recognize the team’s success and individual contributions
 Capture lessons learned and integrate findings into the 8D Problem
Solving Process
 Reward and celebrate
64 – 2/12/2013 – v1.0
OPERATIONAL EXCELLENCE
C O N S U L T I N G
The End …
“Perfection is not attainable, but if we chase perfection we can catch
excellence.” - Vince Lombardi
Frank G. Adler, Ph.D.
Principal  Managing Partner
Operational Excellence Consulting LLC
info@operational-excellence-consulting.com
www.operational-excellence-consulting.com

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OpEx-8D-Problem-Solving-Process-ASQ-Overview.pdf

  • 1. 1 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Welcome to 8D Problem Solving Process - An Overview Clinic #2 ASQ Orange Empire Monthly Dinner Meeting February 12, 2013 Frank G. Adler, Ph.D. Principal & Managing Partner Operational Excellence Consulting LLC info@operational-excellence-consulting.com www.operational-excellence-consulting.com
  • 2. 2 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G 8D Problem Solving Process - An Overview Presenter: Frank G. Adler Operational Excellence Consulting “People and their managers are working so hard to be sure things are done right, that they hardly have time to decide if they are doing the right things.” Stephen R. Covey
  • 3. 3 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Learning Outcomes: understand the purpose and objectives of each phase of the 8D Problem Solving Process learn how to utilize key problem solving tools in each phase of the 8D Problem Solving Process use assessing questions effectively at the end of each phase of the 8D Problem Solving Process be able to apply some of the problem solving tools and key learning points on a simple case study Case Study: We will have a case study throughout the presentation so that you can apply and practice some of the key learning points. Purpose Key Learning Points
  • 4. 4 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Problem Solving Process - The Terminology Symptom – A quantifiable event or effect, experienced by a Customer (internal external), that may indicate the existence of one or more problems. Problem – A deviation from an expectation, standard, or status quo; a perceived gap between the existing state and a desired state. In the context of the 8D Problem Solving Process the cause(s) of the problem is not known. Possible Cause – Any cause, identified through Process Mapping and C E Matrix, Why-Why Diagram or Fishbone Diagram, that describes how an effect may occur. Most Likely Cause – A theory, based on available or collected data, that best explains the problem description. Root Cause – A verified cause that convincingly supports and explains ALL facts available and thus accounts for the problem; verified passively and actively, by making the problem come and go. Root causes are the fundamental, underlying reasons for a problem, e.g. management policies, product design, system design, process capabilities, technology constraints, standard operating procedures and human errors.
  • 5. 5 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Problem Solving Process - The Tool Box If you only have a hammer, everything looks like a nail. → You need the right tools for the right tasks.
  • 6. 6 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G The 8D Problem Solving Process 1 • Establish the Team 2 • Describe the Problem 3 • Develop Interim Containment Actions 4 • Define and Verify Root Causes and Escape Points 5 • Choose and Verify Permanent Corrective Actions 6 • Implement and Validate Permanent Corrective Actions 7 • Prevent Recurrence 8 • Recognize Team and Individual Contributions
  • 7. 7 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Purpose: Establish a small group of people with the process and/or product knowledge, allocated time, authority, and skills in the required technical disciplines to solve the problem and implement corrective actions. Review and scope the problem or improvement opportunity. Review priorities, scope and complexity Identify if a team is needed Identify team members and establish the team Nominate a team leader, project champion and facilitator Establish roles and responsibilities Establish basic team guidelines Consider team building exercises “Establish the Team” Key Activities
  • 8. 8 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G The Problem Solving Team: Are the people affected by the problem represented? Does each person have a reason for being on the team? Do the team members agree on membership? Is the team large enough to include all necessary input, but small enough to act effectively? The Team Leader has been identified? The Champion of the team has been identified? Need for a Facilitator to coach the process has been considered? Have the roles and responsibilities been reviewed? “Phase 1” Checklist Questionnaire
  • 9. 9 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G The 8D Problem Solving Process 1 • Establish the Team 2 • Describe the Problem 3 • Develop Interim Containment Actions 4 • Define and Verify Root Causes and Escape Points 5 • Choose and Verify Permanent Corrective Actions 6 • Implement and Validate Permanent Corrective Actions 7 • Prevent Recurrence 8 • Recognize Team and Individual Contributions
  • 10. 10 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Purpose: Describe the internal or external problem by identifying “what is wrong with what” and detailing the problem in quantifiable terms. Develop a Problem Statement Develop a Problem Description using the “IS – IS NOT Matrix” Develop a flowchart of the process and identify critical process steps with respect to the Problem Description and Escape Point(s) Determine whether the problem describes a “something changed” or a “never been there” situation Develop a Cause Effect Matrix, Why-Why Diagram or Fishbone Diagram to identify “all” possible causes? Establish a high-level project plan, including milestones, project goals and objectives “Describe the Problem” Key Activities
  • 11. 11 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G There are two steps to develop a good Problem Statement. The first step is used to identify the object and the defect and develop the initial Problem Statement. The object and the defect are defined by asking “What is wrong with what?” “What is wrong?” is the defect The defect is an unwanted characteristic present in a product or process – broken, missing, wrong, too short, … “… with what?” is the object The object is the name given to a specific product or process that exhibits the defect The Problem Statement (Step 1)
  • 12. 12 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G The 5 Why’s Description: The 5 Why’s Analysis helps to identify the final problem statement or in some cases even the root cause. Step 1: Develop an initial problem statement of the specific problem to be solved. Write it in the upper left corner of a piece of paper, flip chart or white board. Step 2: Ask “Why?” this problem does or could occur. Write the cause (object defect) underneath the initial problem statement. Step 3: The cause identified in Step 2 now becomes a new problem statement. Repeat Step 2 and ask “Why?”, e.g. “Why would this situation occur?, again. Step 4: Continue Step 2 and Step 3 until you cannot for certain answer the question or reach an answer that is fundamental and actionable.
  • 13. 13 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Once the initial problem statement (object defect) is established, the second step is to use the “5 Why’s” and ask “Why would this situation occur?” or “Why is that happening to that object?” The objective of this step is to refine the initial problem statement to determine the problem, rather than the symptom of the problem focus efforts on a single problem with a single root cause get as near as possible to the root cause using existing knowledge information check if the root cause of the problem is really unknown If you are certain that you have found the root cause, then you can immediately go to Phase 4 “Define and Verify Root Cause” and test your root cause theory. However, if the cause is unknown and there is a need to find the root cause, then the last object and defect with an unknown cause is the final Problem Statement. The Problem Statement (Step 2)
  • 14. 14 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Problem Statement - Example What is the Problem Statement (Object Defect)? WHY? → The tool was not in inventory. WHY? → The Supplier did not deliver the replacement tools. WHY? → The Supplier did not receive our Purchase Order on-time. WHY? → We did not submit the Purchase Order on time. WHY? → We did not have the “right” rework tool. WHY? → We don’t know. Initial Problem Statement Final Problem Statement
  • 15. 15 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Case Study Group Work 1 The Task: Read the introduction to the “Felt Tip Marker” Case Study Develop the Problem Statement for the Case Study 5 Minutes
  • 16. 16 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Process Flowchart Most problem solving projects will require a process flowchart as the problem is associated with a process that is failing. The team needs to understand how that process works or at least is intended to work. A Process Flowchart is a graphical process description of the work flow or activities using standard symbols for each of the activities. Different types of activities are described with standard symbols. The problem areas in the process are often relatively easy to discover when assessing the flowchart. An ellipse shows the start and the end point of the process. A box describes an activity or process step. A diamond shows a decision making step. An arrow shows the direction from one activity to another.
  • 17. 17 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G “Change-Induced” vs. “Day-One-Deviation” Change Performance SHOULD Past Present DEVIATION When the process performance once met the SHOULD and no longer does, then you have a “Change-Induced” problem. Performance ACTUAL Performance SHOULD Present DEVIATION Day One When a condition required for achieving the SHOULD never existed, then you have a “Day-One-Deviation” problem.
  • 18. 18 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G The Problem Description The Problem Description defines the boundaries of the problem, in terms of what it is and what it is not but could be. Scientific description of any event can be made by providing information on What the problem is and what it is not but could be? IS - The long brackets are missing IS NOT - The short brackets are not missing (but could be) Where the problem is and where it is not but could be? IS - The order entry defects are in direct ship orders IS NOT - The order entry defects are not in stock orders (but could be) When the problem occurs and when it does not but could? IS - The clips started breaking in early 2010 IS NOT – The clips did not break before early 2010 (but could have) How big the problem is and how big it is not but could be? IS - About 50% of the paychecks are incorrect IS NOT – Not all paychecks are incorrect (but could be)
  • 19. 19 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G The “IS – IS NOT” Matrix PROBLEM SOLVING PROCESS WORKSHEET Problem Statement (What is wrong with what?): Red Felt Tip Marker Leaks IS IS NOT DISTINCTIONS CHANGES TEST FOR MOST LIKELY CAUSES (+) (-) (?) Describe what does occur Describe what does not occur, but could occur What could explain the IS-IS NOT? (People, Methods, Material, Machines, Environment) What has changed in, on, around or about this distinction? When did it change? Define Possible Root Cause Theory What? Object: Defect: Where? Where is the object when the defect is observed? Where is the defect on the object? Are there any pattern or trends identifiable? When? When was the defect observed first? Can or was the defect be observed before, during or after other events? When since has the defect occurred? Are there any pattern or trends identifiable? How Big? How many objects have the defect? What is the size of a single defect? How many defects are on each object? Are there any pattern or trends identifiable? 1 2 3 4 5 2 3 4 5
  • 20. 20 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Case Study Group Work 2 The Task: Study the “Felt Tip Marker” Case Study (Part 1) thoroughly Develop the Problem Description for the Case Study 30 Minutes
  • 21. 21 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Case Study - Problem Description PROBLEM SOLVING PROCESS WORKSHEET Problem Statement (What is wrong with what?): Red Felt Tip Marker Leaks IS IS NOT DISTINCTIONS CHANGES TEST FOR MOST LIKELY CAUSES (+) (-) (?) Describe what does occur Describe what does not occur, but could occur What could explain the IS-IS NOT? (People, Methods, Material, Machines, Environment) What has changed in, on, around or about this distinction? When did it change? Define Possible Root Cause Theory What? Object: Red felt tip marker Blue, black or green marker Defect: Leaks Totally dry Where? Tip Barrel (side or base) Where is the object when the defect is observed? Where is the defect on the object? Are there any pattern or trends identifiable? Both our place and next door Just us or just next door All other places/customers No other places/customers When? First seen two weeks ago Before two weeks ago When was the defect observed first? Can or was the defect be observed before, during or after other events? When since has the defect occurred? Are there any pattern or trends identifiable? Daily Just some days Continuing Stopped Last ten days shipments Just some daily shipments Upon arrival Develops later (on shelf) in supply room How Big? All red felt tip markers (100%) Just some red felt tip markers (less than 100%) How many objects have the defect? What is the size of a single defect? How many defects are on each object? Are there any pattern or trends identifiable? All shipments Just some shipments All ten per day Less than 10 per days Slow drip Steady or pressurized stream
  • 22. 22 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Identifying Possible Causes To learn more about a specific problem and identify “all” possible causes, the following tools are often very helpful and widely used. Process Flowchart and Cause Effect Matrix or Why – Why Diagram or Fishbone Diagram These tools work really great in a team environment to ensure that everyone has a voice and every voice is being heard. Select the Cause Effect Matrix, the Why-Why Diagram or the Fishbone Diagram based on the problem you try to solve and/or your personal or team’s preference.
  • 23. 23 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Cause-and-Effect or Ishikawa Diagram is another way of looking at the possible causes of a problem. It organizes large numbers of possible causes into pre- defined categories, e.g. 4Ms 1 E or 4 Ps, or team-defined categories. Fishbone Diagram - Phase 1 4M’s = MEN METHODS MATERIALS MACHINES + ENVIRONMENT 4P’s = PEOPLE PRODUCT PRICE PROMOTION Machines Materials Methods Environment Trunk Primary Possible Cause Category Main Branch Minor Branch Second-Level Possible Causes Men/People Problem Statement
  • 24. 24 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Problem Statement: The initial question “What’s wrong with what?” has been answered? The “5 Why’s” were used to asking questions “Do we know for certain why this is occurring?” A final problem statement (or specific root cause) has been defined (object and defect) and documented? Problem Description: A thorough “IS – IS NOT” Analysis has been performed (what, where, when, how big) and documented? The problem description has been confirmed as to what the Customer and/or affected party(s) are experiencing? Physical evidence of the problem has been obtained? “Phase 2” Checklist Questionnaire
  • 25. 25 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G “Phase 2” Checklist Questionnaire Problem Description (cont.): Determination has been made as to whether this problem describes a “Change-Induced” or a “Day-One-Deviation” situation? The current process flow has been identified and documented (if applicable)? Process detail has been reviewed to determine where this problem first appears? Problem pattern(s) has been considered / evaluated? Similar components and/or parts have been reviewed for the same problem? All required data has been collected and analyzed? A Cause Effect Matrix, Why-Why Diagram or Fishbone Diagram has been developed to identify possible causes?
  • 26. 26 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G 1 • Establish the Team 2 • Describe the Problem 3 • Develop Interim Containment Actions 4 • Define and Verify Root Causes and Escape Points 5 • Choose and Verify Permanent Corrective Actions 6 • Implement and Validate Permanent Corrective Actions 7 • Prevent Recurrence 8 • Recognize Team and Individual Contributions The 8D Problem Solving Process
  • 27. 27 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G “Develop Interim Containment Actions” Key Activities Purpose: Define, verify and implement Interim Containment Action to isolate the effects of the problem from any internal and/or external Customer until Permanent Corrective (Preventive) Action are implemented. Define potential Interim Containment Action Verify effectiveness of potential Interim Containment Action Select and implement Interim Containment Action Validate effectiveness of implemented Interim Containment Action with the Customer
  • 28. 28 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G “Phase 3” Checklist Questionnaire Planning: Appropriate departments have been involved in the planning of the Interim Containment Action Plans, including action steps, have been developed considering who needs to do what by when? The Customer’s viewpoint has been considered for the Interim Containment Action The Customer’s approval has been obtained? A validation method for the Interim Containment Action has been determined? Post Implementation: The validation data indicates that the Customer is being protected from the symptom of the problem?
  • 29. 29 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G 1 • Establish the Team 2 • Describe the Problem 3 • Develop Interim Containment Actions 4 • Define and Verify Root Causes and Escape Points 5 • Choose and Verify Permanent Corrective Actions 6 • Implement and Validate Permanent Corrective Actions 7 • Prevent Recurrence 8 • Recognize Team and Individual Contributions The 8D Problem Solving Process
  • 30. 30 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G “Define and Verify Root Causes” Key Activities Purpose: Isolate and verify the root cause by testing each root cause theory against the Problem Description and supporting data. Isolate and verify the place in the process where the effect of the root cause could have been detected and contained but was not (escape point). Establish any additional data collection plans needed to learn more about the problem and/or possible causes. Utilize the Cause Effect Matrix, Why-Why Diagram or Fishbone Diagram created earlier to identify the most likely cause(s). Isolate and verify the most likely cause(s) by testing each Root Cause Theory against the Problem Description and the collected data. Isolate and verify the place in the process where the effect of the root cause could have been detected and contained but was not (escape point).
  • 31. 31 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Comparative Analysis The Comparative Analysis is the third part of the 8D Problem Solving Process Worksheet. The Comparative Analysis connects the facts from the Problem Description (“IS – IS NOT” Matrix) with the analysis of possible causes using the Process Flowchart and the CE Matrix or Why-Why Diagram or Fishbone Diagram. Step 1: Compare each “IS” with its corresponding/contrasting “IS NOT”. List any known distinctions and uncommon factors that could explain the “IS” and “IS NOT”. Ask: What is unique, odd, different, distinctive, unusual about the “IS”? Consider the possible causes identified so far. Step 2: List all known changes in distinctions and uncommon factors. Ask: What has changed in, on, around or about this distinction and uncommon factors?
  • 32. 32 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Comparative Analysis - Example Problem Description: “WHAT” IS – The Red Makers leak “WHAT” IS NOT – The Blue Markers could leak, but are not Comparative Analysis: Distinctions 1. Different Color Plastic 2. Different Color Ink 3. Strawberry Scent in Red Marker Changes 1. New Plastic Supplier (5 weeks ago) 2. Added Powder to Red Marker (2.5 weeks ago)
  • 33. 33 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Comparative Analysis PROBLEM SOLVING PROCESS WORKSHEET Problem Statement (What is wrong with what?): Red Felt Tip Marker Leaks IS IS NOT DISTINCTIONS CHANGES TEST FOR MOST LIKELY CAUSES (+) (-) (?) Describe what does occur Describe what does not occur, but could occur What could explain the IS-IS NOT? (People, Methods, Material, Machines, Environment) What has changed in, on, around or about this distinction? When did it change? Define Possible Root Cause Theory What? Object: Red felt tip marker Blue, black or green marker Defect: Leaks Totally dry Where? Tip Barrel (side or base) Where is the object when the defect is observed? Where is the defect on the object? Are there any pattern or trends identifiable? … … When? First seen two weeks ago Before two weeks ago When was the defect observed first? Can or was the defect be observed before, during or after other events? When since has the defect occurred? Are there any pattern or trends identifiable? … … How Big? All red felt tip markers (100%) Just some red felt tip markers (less than 100%) How many objects have the defect? What is the size of a single defect? How many defects are on each object? Are there any pattern or trends identifiable? … … 1 1 1 1 2 2 2 2
  • 34. 34 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Case Study Group Work 3 The Task: Study the “Felt Tip Marker” Case Study (Part 2) thoroughly Perform a Comparative Analysis on the “Felt Tip Marker” Case Study 30 Minutes
  • 35. 35 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Case Study - Comparative Analysis PROBLEM SOLVING PROCESS WORKSHEET Problem Statement (What is wrong with what?): Red Felt Tip Marker Leaks IS IS NOT DISTINCTIONS CHANGES TEST FOR MOST LIKELY CAUSES (+) (-) (?) Describe what does occur Describe what does not occur, but could occur What could explain the IS-IS NOT? (People, Methods, Material, Machines, Environment) What has changed in, on, around or about this distinction? When did it change? Define Possible Root Cause Theory What? Object: Red felt tip marker Blue, black or green marker Red Plastic - Red Ink - Strawberry Scent (2.5 weeks ago) New Plastic Supplier (5 weeks ago) - Added Powder (2.5 weeks ago) Defect: Leaks Totally dry Where? Tip Barrel (side or base) Felt Material New Felt Supplier (1 Week ago) Where is the object when the defect is observed? Where is the defect on the object? Are there any pattern or trends identifiable? Both our place and next door Just us or just next door All other places/customers No other places/customers When? First seen two weeks ago Before two weeks ago New Outside Sleeve Packaging (2 Weeks ago) New Outside Sleeve Packaging (2 Weeks ago) When was the defect observed first? Can or was the defect be observed before, during or after other events? When since has the defect occurred? Are there any pattern or trends identifiable? Daily Just some days Continuing Stopped Last ten days shipments Just some daily shipments Upon arrival Develops later (on shelf) in supply room How Big? All red felt tip markers (100) Just some red felt tip markers (less than 100) How many objects have the defect? What is the size of a single defect? How many defects are on each object? Are there any pattern or trends identifiable? All shipments Just some shipments All ten per day Less than 10 per days Slow drip Steady or pressurized stream
  • 36. 36 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Fishbone Diagram - Phase 2 In Phase 2 of the Fishbone Diagram, the team tries to reduce the large number of possible causes to a short list of most likely causes, using the Problem Description, Comparative Analysis, data analysis and the team’s combined process knowledge and experience. Remember, the root cause(s) convincingly supports and explains ALL facts available and thus accounts for the problem. So, you need to ask yourself “If this would be the root cause of the problem, would it explain the Problem Description?” Machines Materials Methods Environment Trunk Primary Possible Cause Category Main Branch Minor Branch Second-Level Possible Causes Men/People Problem Statement Most Likely Cause #1 Most Likely Cause #3 Most Likely Cause #2
  • 37. 37 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Root Cause Theory Testing Step 1: Use the 8D Problem Solving Process Worksheet, supported by the CE Matrix or Why-Why Diagram or Fishbone Diagram, to formulate Root Cause Theories based on the identified most likely cause(s) of the problem. Step 2: Enter a short description of a Root Cause Theory as header into the last column of the 8D Problem Solving Process Worksheet. Step 3: Assess the Root Cause Theory against each “IS” – “IS-NOT” statement. Enter a “+” if the theory explains or does not conflict with the “IS”–“IS-NOT” statement. Enter a “-” if the theory conflicts with the “IS”–“IS-NOT” statement. Enter a “?” if you are not sure and further investigation may be necessary. The Root Cause(s) convincingly supports and explains ALL “IS”–“IS-NOT” statements and thus accounts for the problem.
  • 38. 38 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Root Cause Theory Testing PROBLEM SOLVING PROCESS WORKSHEET Problem Statement (What is wrong with what?): Red Felt Tip Marker Leaks IS IS NOT DISTINCTIONS CHANGES TEST FOR MOST LIKELY CAUSES (+) (-) (?) Describe what does occur Describe what does not occur, but could occur What could explain the IS-IS NOT? (People, Methods, Material, Machines, Environment) What has changed in, on, around or about this distinction? When did it change? Define Possible Root Cause Theory What? Object: Defect: Where? Where is the object when the defect is observed? Where is the defect on the object? Are there any pattern or trends identifiable? When? When was the defect observed first? Can or was the defect be observed before, during or after other events? When since has the defect occurred? Are there any pattern or trends identifiable? How Big? How many objects have the defect? What is the size of a single defect? How many defects are on each object? Are there any pattern or trends identifiable? 2 3 3 3 3 + - ?
  • 39. 39 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Root Cause Theory Testing - Example PROBLEM SOLVING PROCESS WORKSHEET Problem Statement (What is wrong with what?): Red Felt Tip Marker Leaks IS IS NOT DISTINCTIONS CHANGES TEST FOR MOST LIKELY CAUSES (+) (-) (?) Describe what does occur Describe what does not occur, but could occur What could explain the IS-IS NOT? (People, Methods, Material, Machines, Environment) What has changed in, on, around or about this distinction? When did it change? New Plastic Supplier - Plastic is too porous … ink leaks through. What? Object: Red felt tip marker Blue, black or green marker Red Plastic - Red Ink - Strawberry Scent (2.5 weeks ago) New Plastic Supplier (5 weeks ago) - Added Powder (2.5 weeks ago) (-) Defect: Leaks Totally dry … Where? Tip Barrel (side or base) (-) Where is the object when the defect is observed? Where is the defect on the object? Are there any pattern or trends identifiable? … … … When? First seen two weeks ago Before two weeks ago (-) When was the defect observed first? Can or was the defect be observed before, during or after other events? When since has the defect occurred? Are there any pattern or trends identifiable? … … … How Big? All red felt tip markers (100) Just some red felt tip markers (less than 100) (+) How many objects have the defect? What is the size of a single defect? How many defects are on each object? Are there any pattern or trends identifiable? … … …
  • 40. 40 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Root Cause Verification Active Verification is a process where … … the problem solver uses the variable thought to be the root cause to make the effect come and go. Both coming and going are important tests to confirm root causes. Passive Verification is done by observation. With passive verification, you look for the presence of the root cause without changing anything. If you cannot prove the presence of the root cause, then chances are great that this most likely cause is not the root cause. Step 1: Identify, document and perform a passive and/or active root cause verification method. Step 2: Continue with the 8D Problem Solving Process if the passive and/or active root cause verification was successful. Otherwise, develop and test additional Root Cause Theories.
  • 41. 41 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Escape Point Identification Step 1: Using the Process Flowchart, identify Escape Point(s) for the verified root cause(s). Step 2: Determine if Control Points were missing or ineffective to detect the root cause of the problem at the escape point. Control System: A control system is a system deployed to monitor the product or process and ensure compliance to Customer requirements. It consists of responsibilities, procedures and resources. Control Point: A control point is a location within the control system where the product or process is checked for compliance to certain specified requirements. There may be multiple locations within a control system. Escape Point: The escape point is the earliest location in the process, closest to the root cause, where the problem could have been detected, but was not.
  • 42. 42 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G “Phase 4” Checklist Questionnaire Root Cause(s): The factual information in the Problem Description has been updated? Differences unique to the “IS” when compared to the “IS NOT” have been identified? For a “Change-Induced” problem, changes in or around the differences have been uncovered? The root cause theories developed have been tested against each “IS” - “IS NOT” statement? The final root cause theory accounts for all “IS” - “IS NOT” statements? For multiple root causes, the causes were reviewed to determine if, collectively, they account for all of the problem description? The root cause(s) was/were verified passively and actively?
  • 43. 43 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G “Phase 4” Checklist Questionnaire Escape Points: The process flow was reviewed and control points associated with the root cause(s) identified. A determination was made as to the existence of a control system to detect the problem? If a control system exists, changes from its original design (if any) have been identified? Project Management: The Project Champion has reviewed and supports the analysis, findings and conclusions? 8D Problem Solving Process Worksheet Project Documentation has been updated?
  • 44. 44 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G 1 • Establish the Team 2 • Describe the Problem 3 • Develop Interim Containment Actions 4 • Define and Verify Root Causes and Escape Points 5 • Choose and Verify Permanent Corrective Actions 6 • Implement and Validate Permanent Corrective Actions 7 • Prevent Recurrence 8 • Recognize Team and Individual Contributions The 8D Problem Solving Process
  • 45. 45 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G “Choose Permanent Corrective Actions” Key Activities Purpose: Select the best Permanent Corrective Actions to remove the root cause and to address the escape point in the process. Verify that both decisions will be successful when implemented and not cause any undesirable effects. Develop solution(s) to remove the root cause(s) Develop solution(s) to address the escape point(s) Select the best solution(s) to remove the root cause(s) Select the best solution(s) to address the escape point(s) Verify that effectiveness of the selected solutions Verify that selected solutions do not cause any undesirable effects
  • 46. 46 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Mistake-Proofing Principles, Methods Devices Six Mistake-Proofing Principles 1. Elimination 2. Prevention 3. Replacement 4. Facilitation 5. Detection 6. Mitigation Five Mistake-Proofing Methods 1. Variation Control 2. Workplace Organization 3. Identification 4. Process Checks 5. Poka-Yoke Devices Seven Mistake-Proofing Devices 1. Guide “Pins” 2. Error Detection Alarms 3. Limit Switches 4. Sensors 5. Vision Systems 6. Counters Timers 7. Checklists
  • 47. 47 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Human Errors → Mistake-Proofing Examples SIM cards only fit one way. The right way. Expose your team to (simple) everyday Mistake-Proofing devices and examples and make them think about how they could use these concepts in their own work area.
  • 48. 48 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Double-Team Multivoting 3 - 5 Solutions Three Solutions from the 1. Double Team 3 - 5 Solutions 3 - 5 Solutions Three Solutions from the 2. Double Team 3 - 5 Solutions Board 1 2 3 4 5 6 |||| || |||| | |||| | ||| Selection of the 2-3 most voted solutions 5 3 1
  • 49. 49 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Double-Team Multivoting 1. Present the problem statement Team Leader ~ 2 min 2. Create ideas (3-5 ideas per person) All Individually ~ 10 min 3. Discussion of ideas in double teams Double Teams ~ 15 min choose the 3 best ideas hang on the wall 4. Present ideas to the entire team Double Teams ~ 5 min no discussion 5. Place similar solutions into groups Team ~ 5 min 6. Voting All Individually ~ 5 min 5 votes per person max 2 votes per solution max 1 vote for own solutions 7. Counting the votes Team Leader ~ 5 min 8. Choose the solution(s) with most votes Team ~ 2 min Double team (“22”) is a team working technique which ensures everybody’s contribution in creating ideas.
  • 50. 50 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G “Phase 5” Checklist Questionnaire Solution Selection: Criteria have been established for selecting solutions for root cause(s) and escape points? Project Champion agrees with selection criteria? The right experience is on the team to choose the best solutions? Full range of alternatives have been considered for the solutions? The features and benefits for the perfect choice have been preserved? A risk analysis was performed on the solutions selected? All affected parties were consulted on the selected solutions? Consideration has been given to the resources required for the implementation and ongoing support or maintenance of the solutions?
  • 51. 51 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G “Phase 5” Checklist Questionnaire Solution Verification: Evidence (proof) exists that these solutions will resolve the problems at the root cause level? Variables measured during the verification step ensure sound verification? Verification methods evaluated the solutions over the full range of operating conditions? Project Management: 8D Problem Solving Process Worksheet Project Documentation has been updated?
  • 52. 52 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G 1 • Establish the Team 2 • Describe the Problem 3 • Develop Interim Containment Actions 4 • Define and Verify Root Causes and Escape Points 5 • Choose and Verify Permanent Corrective Actions 6 • Implement and Validate Permanent Corrective Actions 7 • Prevent Recurrence 8 • Recognize Team and Individual Contributions The 8D Problem Solving Process
  • 53. 53 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Purpose: Plan and implement selected Permanent Corrective Actions, remove the Interim Containment Action. Monitor long-term results. Implement the best solution(s) to remove the root cause(s) Implement the best solution(s) to address the escape point(s) Validate the effectiveness of the implemented solutions from the Customer perspective Monitor the effectiveness of the implemented solutions and assure that they do not cause any undesirable effects Remove Interim Containment Action(s) “Implement Permanent Corrective Actions” Key Activities
  • 54. 54 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G “Phase 6” Checklist Questionnaire Planning: Need for Permanent Corrective Actions implementation support from other departments has been evaluated? Consideration was made to the need of Customer and Supplier involvement? An action plan has been defined (responsibilities, timelines, financial resources, support requirements, …)? The plan has been communicated to those that have a need to know? The Champion agrees with the plan? Measurables have been identified for the validating the outcome of the Permanent Corrective Actions?
  • 55. 55 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G “Phase 6” Checklist Questionnaire Validation: The Interim Containment Action has been discontinued? Validation measurables have been proven that the unwanted effect has been totally eliminated? Long-term results are continuing to be monitored? The Customer has provided confirmation that the Permanent Corrective Actions are effective? Project Management: 8D Problem Solving Process Worksheet Project Documentation has been updated?
  • 56. 56 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G 1 • Establish the Team 2 • Describe the Problem 3 • Develop Interim Containment Actions 4 • Define and Verify Root Causes and Escape Points 5 • Choose and Verify Permanent Corrective Actions 6 • Implement and Validate Permanent Corrective Actions 7 • Prevent Recurrence 8 • Recognize Team and Individual Contributions The 8D Problem Solving Process
  • 57. 57 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Purpose: Modify the necessary systems, including policies, methods, and procedures, to prevent recurrence of the problem and similar ones. Identify opportunities to improve systems, policies, methods and procedures for the present problem Identify opportunities to improve systems, policies, methods and procedures for similar problems “Prevent Recurrence” Key Activities
  • 58. 58 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Process Control Plan A Control Plan is a written statement of an organization’s quality planning actions for a specific process, product, or service. The Objective of an effective Process Control Plan is to operate processes consistently on target with minimum variation, which results in minimum waste and rework assure that product and process improvements that have been identified and implemented become institutionalized provide for adequate training in all standard operating procedures, work instructions and tools Customer Requirements Product Part Characteristics Process Input Output Characteristics Process Controls Process Control Plan
  • 59. 59 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G Start Checkpoints Activators Corrective Actions No No No Yes Yes Yes Yes Yes Yes End No No Out-of-Control-Action-Plans (OCAP) The OCAP is a systematic and ideal problem-solving tool for process problems because it reacts to out-of-control situations in real time. OCAPs standardize the best problem-solving approaches from the most skilled and successful problem solvers (experts/operators). The OCAP also allows (and requires) off-line analysis of the terminators to continually improve OCAP efficiency.
  • 60. 60 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G “Phase 7” Checklist Questionnaire Problem History: How and where the problem entered the process has been identified? Why the problem occurred there and why it was not detected has been confirmed? We have considered whether confusion or lack of knowledge contributed to the creation of this root cause and escape? Affected parties have been identified? Corrective Preventive Solutions: Policies, methods, procedures, and/or systems have been modified, documented and implemented to prevent recurrence of the root cause(s) and/or escape? Practices needing standardization have been identified, defined and implemented?
  • 61. 61 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G “Phase 7” Checklist Questionnaire Corrective Preventive Solutions (cont.): Plans have been written to coordinate preventive actions and standardize the practices? A method for communicating to those affected by the changes in the new practices has been determined? The Champion concurs with the identified corrective preventive actions and plans? Project Management: 8D Problem Solving Process Worksheet Project Documentation has been updated?
  • 62. 62 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G 1 • Establish the Team 2 • Describe the Problem 3 • Develop Interim Containment Actions 4 • Define and Verify Root Causes and Escape Points 5 • Choose and Verify Permanent Corrective Actions 6 • Implement and Validate Permanent Corrective Actions 7 • Prevent Recurrence 8 • Recognize Team and Individual Contributions The 8D Problem Solving Process
  • 63. 63 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G “Recognize the Team” Key Activities Purpose: Complete the team experience and sincerely recognize both team and individual contributions. Celebrate success and identify lessons learned. Perform a final review of the problem solving project Finalize and archive project documentation Recognize the team’s success and individual contributions Capture lessons learned and integrate findings into the 8D Problem Solving Process Reward and celebrate
  • 64. 64 – 2/12/2013 – v1.0 OPERATIONAL EXCELLENCE C O N S U L T I N G The End … “Perfection is not attainable, but if we chase perfection we can catch excellence.” - Vince Lombardi Frank G. Adler, Ph.D. Principal Managing Partner Operational Excellence Consulting LLC info@operational-excellence-consulting.com www.operational-excellence-consulting.com