The document outlines an introduction to quality management tools for root cause analysis, including Pareto charts and Ishikawa diagrams. It will cover how to create and interpret Pareto charts to identify the most common issues and focus corrective efforts. Ishikawa or cause-and-effect diagrams will also be explained as a tool to visually map out the potential causes of a problem across categories like equipment, materials, procedures and people. The training aims to equip participants with basic tools to effectively analyze problems and identify root causes.
The document discusses quality management tools for root cause analysis. It introduces histograms and Pareto charts for analyzing problems, and cause-and-effect diagrams for identifying possible causal factors. The document provides examples and guidance for constructing Pareto charts to identify the main issues contributing to a problem. It also outlines the root cause analysis process of defining a problem, collecting data, identifying causes, identifying root causes, and recommending solutions.
The document outlines the 5S methodology, which is a program used to improve project performance through workplace organization and standardization. It describes the five steps of 5S - Sort, Set In Order, Shine, Standardize, and Sustain. For each step, it provides definitions, examples of activities that can be done, and how success can be measured. The overall goal of 5S is to enhance work efficiency, reduce costs, eliminate waste, and improve productivity and work ethics through an organized, standardized workplace.
This document provides an introduction and overview of quality management tools for root cause analysis (RCA) and problem solving. It covers two modules: Module 1 focuses on basic RCA tools like histograms, Pareto charts, and cause-and-effect diagrams. Module 2 will cover the 8-D problem solving method. The document provides definitions of key terms, objectives for each module, and examples to illustrate how to create and use the different tools for analyzing problems and identifying root causes.
Tech Talk: The New CA Application Performance Management Team Center—Faster T...CA Technologies
CA Application Performance Management (APM) r10 delivers new patent-pending innovations based on the E.P.I.C. application performance management strategy that takes easy, proactive, intelligent and collaborative to new levels, enabling you to delight your users while protecting your experts. Learn more about how these new, patent-pending innovations for perspectives, timeline and differential analysis and how these new capabilities help you to quickly triage and diagnose application performance. Seating is limited and available first come-first served.
For more information, please visit http://cainc.to/Nv2VOe
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ISO 9001:2008 helps ensure that customers get consistent, good quality products and services, which in turn brings many business benefits. This presentation will guide you in upgrading your quality management system to the latest version of the standard
The document discusses quality management tools for root cause analysis. It introduces histograms and Pareto charts for analyzing problems, and cause-and-effect diagrams for identifying possible causal factors. The document provides examples and guidance for constructing Pareto charts to identify the main issues contributing to a problem. It also outlines the root cause analysis process of defining a problem, collecting data, identifying causes, identifying root causes, and recommending solutions.
The document outlines the 5S methodology, which is a program used to improve project performance through workplace organization and standardization. It describes the five steps of 5S - Sort, Set In Order, Shine, Standardize, and Sustain. For each step, it provides definitions, examples of activities that can be done, and how success can be measured. The overall goal of 5S is to enhance work efficiency, reduce costs, eliminate waste, and improve productivity and work ethics through an organized, standardized workplace.
This document provides an introduction and overview of quality management tools for root cause analysis (RCA) and problem solving. It covers two modules: Module 1 focuses on basic RCA tools like histograms, Pareto charts, and cause-and-effect diagrams. Module 2 will cover the 8-D problem solving method. The document provides definitions of key terms, objectives for each module, and examples to illustrate how to create and use the different tools for analyzing problems and identifying root causes.
Tech Talk: The New CA Application Performance Management Team Center—Faster T...CA Technologies
CA Application Performance Management (APM) r10 delivers new patent-pending innovations based on the E.P.I.C. application performance management strategy that takes easy, proactive, intelligent and collaborative to new levels, enabling you to delight your users while protecting your experts. Learn more about how these new, patent-pending innovations for perspectives, timeline and differential analysis and how these new capabilities help you to quickly triage and diagnose application performance. Seating is limited and available first come-first served.
For more information, please visit http://cainc.to/Nv2VOe
Pivot Chart for Lean Startup Problem Management: Pivoting from Plan A to Plan BRod King, Ph.D.
"How can anyone apply the principles, strategies, and tactics of Lean Startup Problem Management in no time?" The Pivot Chart is the answer. Unlike in other tools, the Pivot Chart comprehensively summarizes the experimental scientific approach which underlies Eric Ries's Lean Startup methodology. The Pivot Chart provides a simple roadmap for anyone to navigate an extremely uncertain environment while building a sustainable and profitable startup. The best of luck as you pivot from Plan A to Plan B while discovering a repeatable and scalable business model that achieves your vision.
ISO 9001:2008 helps ensure that customers get consistent, good quality products and services, which in turn brings many business benefits. This presentation will guide you in upgrading your quality management system to the latest version of the standard
This document provides an agenda for a training on practical auditing for internal quality auditors. It discusses key audit concepts like the PDCA cycle and process approach. It also covers important audit skills like interview techniques, note taking, report writing, and auditing difficult clauses. Common audit findings are presented along with tips for auditing undocumented processes and improving audit practices. The document concludes with an auditor code of ethics emphasizing integrity, objectivity, confidentiality and competence.
Starts with the basic learning in Critical Path Method and continued with the the use of MS Project software. Even though the software is upgraded to teh latest version, the basic fundamentals in using the software does not change
This document provides a suggested template for preparing and presenting a project kick-off meeting. The template includes sections for an introduction stating the objective, agenda, project overview with a short description, scope defining logical boundaries, team organization listing members and responsibilities, major deliverables and descriptions, estimated effort including budget, infrastructure, manpower allocation and timeline, assumptions, risks and issues, and project acceptance conditions. The presentation advises preparing a project quality plan and following standard processes to deal with contingencies.
5 s – a program to improve project.ppt [compatibility mode]Isidro Sid Calayag
5S is the name of a workplace organization method that uses a list of five Japanese words: seiri, seiton, seiso, seiketsu, and shitsuke. Transliterated into English, they all start with the letter "S".
This document summarizes changes made to TPI's quality management system to comply with the updated ISO 9001:2008 standard. Some key changes include defining outsourced processes, focusing on measuring process effectiveness, adding training requirements to achieve competence, and including physical and environmental factors in the definition of work environment. The update resulted in changes to TPI's QMS manual and procedures.
This document provides an overview of a Microsoft Project 2007 training module that introduces participants to project management concepts and planning projects using Microsoft Project. The training covers topics such as the basics of project management, using Microsoft Project to plan tasks and resources, and project scheduling techniques like PERT charts and the critical path method. The course objectives are to teach participants how to identify, organize, manage and schedule tasks, resources, time and costs to complete a project.
The document provides an overview of cleanroom and cleanzone protocols. It discusses cleanroom basics like definitions, components, construction stages, apparel requirements and other protocols. The key aspects covered are preventing dust entry, minimizing dust generation, removing dust, and not accumulating or scattering dust. Cleaning protocols like daily and regular cleaning are also summarized. The document aims to educate people on cleanroom requirements and practices to maintain cleanliness.
This document provides an overview of internal quality auditing techniques and common ISO 9001 requirements. It discusses using a process approach and PDCA cycle in audits. Interview skills like questioning techniques and taking notes are covered. Creating checklists and potential issues with "cheat sheets" are also summarized. The document reviews writing audit reports and addressing nonconformities. It identifies some of the toughest ISO 9001 clauses to audit and the most common nonconformities found in internal and registrar audits.
Typical Quality Management System Based On Iso 9001 2008Isidro Sid Calayag
This document outlines the key elements of a quality management system (QMS) based on ISO 9001:2008. It discusses the objectives of implementing a QMS, including achieving organizational success and meeting requirements. The QMS focuses on customer focus, leadership, involvement of people, process approach, and continual improvement. It addresses management responsibility, resource management, product realization, measurement and improvement to ensure a process-based approach that meets customer needs and enhances supplier relationships.
The document discusses quality assurance and quality control concepts in construction projects based on ISO 9001:2008. It outlines a quality management system with four levels - quality manual, procedures, plans, and forms/records. Key elements include defining roles for QA/QC departments in verifying requirements and monitoring activities. Quality control focuses on inspection, monitoring and reducing variation. The presentation provides an example of applying the quality system to a HOYA construction project, with the goal of zero defects and identifying problems before customers.
This document provides a template for a project kick-off meeting presentation. It includes an introduction outlining the purpose and objectives, an agenda with sections on the project overview including description and goals, scope, team organization, major deliverables, estimated effort including budget, infrastructure, manpower allocation and timeline, assumptions risks and issues, project acceptance including customer acceptance conditions, and concludes with an end of presentation slide. The template provides placeholders for specific project details.
This document provides an agenda for a training on practical auditing for internal quality auditors. It discusses key audit concepts like the PDCA cycle and process approach. It also covers important audit skills like interview techniques, note taking, report writing, and auditing difficult clauses. Common audit findings are presented along with tips for auditing undocumented processes and improving audit practices. The document concludes with an auditor code of ethics emphasizing integrity, objectivity, confidentiality and competence.
Starts with the basic learning in Critical Path Method and continued with the the use of MS Project software. Even though the software is upgraded to teh latest version, the basic fundamentals in using the software does not change
This document provides a suggested template for preparing and presenting a project kick-off meeting. The template includes sections for an introduction stating the objective, agenda, project overview with a short description, scope defining logical boundaries, team organization listing members and responsibilities, major deliverables and descriptions, estimated effort including budget, infrastructure, manpower allocation and timeline, assumptions, risks and issues, and project acceptance conditions. The presentation advises preparing a project quality plan and following standard processes to deal with contingencies.
5 s – a program to improve project.ppt [compatibility mode]Isidro Sid Calayag
5S is the name of a workplace organization method that uses a list of five Japanese words: seiri, seiton, seiso, seiketsu, and shitsuke. Transliterated into English, they all start with the letter "S".
This document summarizes changes made to TPI's quality management system to comply with the updated ISO 9001:2008 standard. Some key changes include defining outsourced processes, focusing on measuring process effectiveness, adding training requirements to achieve competence, and including physical and environmental factors in the definition of work environment. The update resulted in changes to TPI's QMS manual and procedures.
This document provides an overview of a Microsoft Project 2007 training module that introduces participants to project management concepts and planning projects using Microsoft Project. The training covers topics such as the basics of project management, using Microsoft Project to plan tasks and resources, and project scheduling techniques like PERT charts and the critical path method. The course objectives are to teach participants how to identify, organize, manage and schedule tasks, resources, time and costs to complete a project.
The document provides an overview of cleanroom and cleanzone protocols. It discusses cleanroom basics like definitions, components, construction stages, apparel requirements and other protocols. The key aspects covered are preventing dust entry, minimizing dust generation, removing dust, and not accumulating or scattering dust. Cleaning protocols like daily and regular cleaning are also summarized. The document aims to educate people on cleanroom requirements and practices to maintain cleanliness.
This document provides an overview of internal quality auditing techniques and common ISO 9001 requirements. It discusses using a process approach and PDCA cycle in audits. Interview skills like questioning techniques and taking notes are covered. Creating checklists and potential issues with "cheat sheets" are also summarized. The document reviews writing audit reports and addressing nonconformities. It identifies some of the toughest ISO 9001 clauses to audit and the most common nonconformities found in internal and registrar audits.
Typical Quality Management System Based On Iso 9001 2008Isidro Sid Calayag
This document outlines the key elements of a quality management system (QMS) based on ISO 9001:2008. It discusses the objectives of implementing a QMS, including achieving organizational success and meeting requirements. The QMS focuses on customer focus, leadership, involvement of people, process approach, and continual improvement. It addresses management responsibility, resource management, product realization, measurement and improvement to ensure a process-based approach that meets customer needs and enhances supplier relationships.
The document discusses quality assurance and quality control concepts in construction projects based on ISO 9001:2008. It outlines a quality management system with four levels - quality manual, procedures, plans, and forms/records. Key elements include defining roles for QA/QC departments in verifying requirements and monitoring activities. Quality control focuses on inspection, monitoring and reducing variation. The presentation provides an example of applying the quality system to a HOYA construction project, with the goal of zero defects and identifying problems before customers.
This document provides a template for a project kick-off meeting presentation. It includes an introduction outlining the purpose and objectives, an agenda with sections on the project overview including description and goals, scope, team organization, major deliverables, estimated effort including budget, infrastructure, manpower allocation and timeline, assumptions risks and issues, project acceptance including customer acceptance conditions, and concludes with an end of presentation slide. The template provides placeholders for specific project details.
1. TA I K I S H A P H I L I P P I N E S , I N C OPEN CHALLENGE QUICK RESPONSE
QUALITY MANAGEMENT
ROOT CAUSE ANALYSIS
CA / PA BASIC TOOLS
Presented in TPI Makati H.O.
Date: September 11, 2009
CA/PA BASIC TOOLS Rev 0 09.01.09
2. Objectives
Module 1:
Participants will learn how to:
• Create and use Pareto chart in the
analysis of a problem
• Implement steps for carrying out
effective RCA
• Select and apply tools that support
RCA
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3. Objectives
Module 2:
Participants will be able to:
• Define and explain the 8 – D as a
Problem Solving Method
• Apply the 8 Disciplines and
Concepts
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4. HOME PAGE
• INTRODUCTION
• MODULE 1
• MODULE 2
• APPLICATION
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5. INTRODUCTION
To
ROOT CAUSE ANALYSIS
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6. Introduction
Introduction MODULE 1 MODULE 2
Definition of Terms
What it is
Why use it
RCA Process
How to use it
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7. Terms and Definition
Cause (causal factor) - a condition or event that results
in an effect
Direct Cause - cause that directly resulted in the
occurrence
Contributing Cause - a cause that contributed to the
occurrence, but by itself would not have caused the
occurrence
Root Cause - cause that, if corrected, would prevent
recurrence of a non-conformity and similar
occurrences
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8. RCA Definition
Root Cause Analysis - a process
designed for use in investigating and
categorizing the root causes of
events
A process of tracing a Problem to its Origins
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9. Root Cause Analysis Process
Step One:
Define the Problem
Step Two:
Collect Data
Step Three:
Identify Possible Causal Factors
Step Four:
Identify the Root Cause(s)
Step Five:
Recommend and Implement Solutions
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10. Module 1
Digging for the Root Causes
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11. Module 1 Table of Contents
MODULE 1 MODULE 2 APPLICATION
Histograms and Pareto Chart
Cause and Effect Diagram
What it is
How to use it
Examples
Summary
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12. Histograms- What it is
• A chart that graphically display the
distribution of a set of data.
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13. Pareto Chart - What it is
A Pareto chart allows data to be displayed as a bar chart
and enables the main contributors to a problem to be
highlighted.
It reveals that a
small number of
NCNs are
responsible for the
bulk of quality
issues,
a phenomenon
called the „Pareto
Principle‟.
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14. Pareto Chart – How to create it
1. Gather facts about the problem
2. Rank the contributions to the problem in order
of frequency.
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15. Pareto Chart – How to create it
(cont’n)
3. Draw the value as a bar chart.
4. add a line showing the cumulative
percentage of errors
5. Review the chart
6. Redefine classifications if necessary.
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16. Pareto Analysis Example
• Chart 1 : The chart gives summary information and starts the cumulative % count at
the top of the first bar:
Pareto of D3 Small Engine Card Faults
600 100
500 80
400
Percent
60
Count
300
40
200
20
100
ec . e r
Sp lan rd pai v al
c t. atp d Boa Re mo
lty Ee d
tFitlte He
r ed fotue h
i tg tec
tmid r y Re r
0 d Fau ee
. ting
h lde isr ni
os fo na m c to 0
ge t mp
Mg
noton Joc
T ou
n
iSo nt Mh
t Ecs
Mi ble t ne tion
ama en
n Ci
tMis s pt n t
ed o nenot
po s nd ds c autio
iee
ra Pr o horn
Co ina
t D po pg
Cmtn
ro ms
orn
fCm
t omeg iBeg
yo
WL
Pr e kol rty
lde l
S am er s
mp om W mp eJo i C L nk
n hio So au ont
C C C D L
Lo T F C Oth
Defect
Count 141 139 69 52 22 20 20 17 17 17 16 13 10 10 10 8 6 5 29
Percent 23 22 11 8 4 3 3 3 3 3 3 2 2 2 2 1 1 1 5
Cum % 23 45 56 65 68 71 75 77 80 83 85 87 89 91 92 94 95 95 100
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17. Pareto Analysis Example
• Example 2 : a series of Pareto charts drill down to more detail:
Fault by Main Cause
100
70 1st level Analysis
gives “Design”
60 80
50
Percent
60
Count
40 as main cause of
30 40
20 failure
20
10
0
ign pon
ent
er
0
2nd level Analysis gives
Des Com d
breakdown of “Design”
Buil Oth
Defect
Count 57 13 4 2
Percent 75.0 17.1 5.3 2.6
Cum % 75.0 92.1 97.4 100.0
Design Faults
100
50
80
40
Percent
60
Count
30
40
20
10 20
le
0 dule rs odu on 0
rM r ati
t Mo Moto rt uc e alib
nec que Sta r ans d IC C n
Con Tor Cold T AS IOP Imo
Defect
Count 21 10 8 8 5 3 2
Percent 36.8 17.5 14.0 14.0 8.8 5.3 3.5
Cum % 36.8 54.4 68.4 82.5 91.2 96.5 100.0
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18. Pareto Analysis Example
• Example 3 : if the original Pareto is very flat, be prepared to cut the defects in a
different way, here, it is 40:60
Pareto Chart for Child11
100
200
80
Percent
60
Count
100 40
20
0 - 10 7E 0
4- 4
116 823 727
788 646 777 780 782 795 564- 8 6- 7 - 564-
66 40
CC CC CC CC CC CC 40- 40- er s
KD KD KD KD KD KD Oth
Defect
Count 18 13 11 11 11 10 9 9 8 138
Percent 7.6 5.5 4.6 4.6 4.6 4.2 3.8 3.8 3.4 58.0
Cum % 7.6 13.0 17.6 22.3 26.9 31.1 34.9 38.7 42.0 100.0
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19. Pareto Analysis Example
How it helps
Pareto Analysis is a useful tool to:
• identify and prioritize major problem areas based on frequency of
occurrence;
• separate the „vital few‟ from the „useful many‟ things to do;
• identify major causes and effects.
The technique is often used in conjunction with Brainstorming and Cause and
Effect Analysis.
HINT !
The most frequent is not
always the most important! Be
aware of the impact of other
causes on Customers or goals.
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20. Pareto Chart and Analysis
A method for showing the distribution of Process Steps
quantitative data and identifying those Pareto
with the greatest impact.
Identify the problem and the potential
Summary
direct or contributing causes
Pareto Charts provide a visual representation of
the variables which contribute to problems or Collect data about each of the potential
direct or contributing causes
issues.
Pareto Charts can be used as a prioritization tool
to aid in focusing on the top issues which
Construct the Pareto Chart:
Causes on Horizontal Axis
contribute to specific conditions.
Frequency of events on Vertical Axis
Pareto analysis is an approach which ranks the
contributing factors and identifies which are the Identify the Vital Few (those with the
highest number of occurrences)
ones which have the most impact on a problem or
issue. Often referred to as an approach for
“separating the vital few from the trivial many”, Develop Corrective Action or
sometimes referred to as the “80-20 rule” Improvement Action Plans for those
identified as the Vital Few
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22. Coffee Break
15 Minutes Break Only
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23. CAUSE AND EFFECT
Ishikawa/Fish Bone Diagram
Procedures People
Problem
Equipment Materials
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24. Cause and Effect
• Cause and Effect Analysis is a tool for
identifying all the possible causes associated
with a particular problem
Valuable for:
• Focusing on causes not symptoms
• Providing a picture of why an effect is happening
• Establishing a sound basis for further data gathering
and action
• Identifying all of the areas that need to be tackled
to generate a positive effect
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25. Cause and Effect Sources of Variation
Sources of Variation is categorized as
follows
1. People
2. Method
3. Machine
4. Material
5. Environment
6. Measuring System
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26. How to do it
• 1. Identify the Problem/Issue
• 2. Brainstorm
3. Draw fishbone diagram
Place the effect at the head of the “fish”
Include the 6 recommended categories shown below
People Method Machine
Problem or
Issue
Material Environment Measurement System
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27. How to do it (cont’n)
• 4. Align Outputs with Cause Categories
• 5. Allocate Causes
• 6. Analyze for Root Causes
• 7. Test for Reality
Tip !
The 6 categories recommended will address almost all scenarios. However, there is no
one perfect set of categories. You may need to adapt to suit the issue being analyzed.
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28. Sources of Variation - People
People
• The activities of the workers.
• Variations caused by skill, knowledge,
competency and attitude
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29. Sources of Variation - Method
Method
• The methods used to produce the
products.
• Variations caused by inappropriate
methods or processes.
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30. Sources of Variation - Machine
Machine
• The equipment used to produce the
products.
• Variations caused by temperature,
tool wear and vibration.
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31. Sources of Variation - Material
Material
• The "ingredients" of a process.
• Variations caused by materials that
differ by industry, product
and stage of production.
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32. Sources of Variation - Environment
Environment
• The methods used to control the
environment.
• Variations caused by temperature
changes, humidity etc.
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33. Sources of Variation – Measurement System
Measurement System
• The methods and instruments used to
evaluate products.
• Variations caused by measuring
techniques, or calibration and
maintenance of the instruments.
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34. Cause and Effect Analysis Example
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35. Cause and Effect Diagram (Ishikawa)
A visual brainstorming tool used to help identify and categorize potential root causes named
for Kaoru Ishikawa.
Ishikawa Fishbone Template
Summary
The development of the cause and effect
Fishbone diagram is credited to Kaoru
Ishikawa, who pioneered quality management
processes in the Kawasaki shipyards. Measurement
Measurement Methods
Methods Machinery
Machinery
The cause and effect diagram is used to
explore potential causes (or inputs) that
result in a single undesirable effect (UDE, or
output). Causes are categorized under six UDE
headings, namely Machinery, Methods, Causes, inputs,
or sources
Measurement, Manpower, Materials, and of variation
Environment. Potential causes can be
arranged according to their level of
importance or detail, resulting in a depiction
of relationships and hierarchy of events. It is Manpower
Manpower Materials
Materials Environment
Environment
the hierarchy that creates a map that looks
somewhat like fish bones, hence the name.
The Ishikawa Fishbone Diagram is intended
help you brainstorm and search for potential
root causes or identify areas where there may A UDE is an UnDesireable Effect
be problems by questioning the existence of
causes under each of the six categories.
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37. Module 2
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38. Module 2 Table of Contents
MODULE 1 MODULE 2 APPLICATION
Five Whys and Fault Tree diagram
What it is
How to use it
Examples
Summary
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39. Five Whys
• Good technique for getting past first impressions
• 5 Whys technique is simply involves being
persistent enough to go beyond the first
impressions.
Continue to investigate the details because there
is often more to the situation than meets the eye.
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40. „Five Whys‟ technique is simply involves being
persistent enough to go beyond the first
impressions.
Continue to investigate the details because
there is often more to the situation than meets
the eye.
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41. Five Whys
• In problem solving you will find that the first
impressions do not always reveal the real
cause.
• Study the issue, ask why, investigate, as you
get more detail keep asking why. Practice
tells us that after 5 whys you will be close to
the real answer.
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42. Five Whys
Original Problem hy? InvestigateAnswer Why?
W
InvestigateAnswer Why?
InvestigateAnswer Why?
InvestigateAnswer Why?
InvestigateThe Real Answer
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43. 5 Whys Process
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44. Five Whys Example
We have a problem. There is high product waste causing
downtime and low production.
Why is there high waste?
Because the machine is inconsistent. Why?
Because the air valves are sticking. Why?
Because there is water in the lines. Why?
Because … the PM was skipped.
Why would we skip a PM?
…Because we needed more production.
… In this pretend example the problem is not the high
waste. … the problem is the decision to skip the PM.
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45. Five Whys
A method for rapidly determining the root cause of a problem
Summary Example
Problem: High reject rate of parts used by
The “Five Why’s” is a method for rapidly downstream aircraft assembly process
determining the root cause of a problem 1) Why? - There is bare material exposed
popularized by Taichi Ohno, the father of the
Toyota Production System. His technique was to 2) Why? - The primer paint coating does not
approach any problem and keep asking “Why” cover the whole part
until he was satisfied that the answer showed him 3) Why? - The priming process does not
what was really the source of the problem. In ensure full coverage
doing so, he then had a good idea of what needed
to be fixed to prevent the problem. He called it 4) Why? - The priming process is never done
the “Five Why’s” because he found over time that the same way twice
by asking “why” five times he usually ended up 5) Why? - The priming process has always
with the right information to go and fix the relied on word-of-mouth training and has no
problem. The Five Why’s should be used by standard process defined
individuals and teams when trying to quickly
assess and determine source of problems. Most To improve, get the primers together to create
problems can be handled this way, however more a standard work method that defines the
complex or life/mission critical problems typically exact sequence and tools for priming the
require a more formal root-cause methodology parts. This will significantly improve the
including documenting the analysis. However, process yield. They can then explore further
even the formal methodology requires asking improvements using their standard work as
“why” over and over again. the baseline.
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46. Coffee Break
15 Minutes Break Only
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47. APPLICATION
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48. Application Table of Contents
MODULE 1 MODULE 2 APPLICATION
ISO 9001:2000 CA/PA & IQA Report
Eight Discipline
What it is
How to use it
Examples
Summary
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49. Different Action to Improve Performance
Corrective - the action taken to eliminate the
cause of a detected non-conformity
(and prevent its recurrence.)
Preventive – the action taken to eliminate the
cause of a potential non-
conformity and to prevent its
occurrence.
After
Before
Action 2
Action 1
Time
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50. Different Action to Improve Performance
Continual Improvement
Breakthrough
P
e Continual
r
f
o
r
m
a Continuous
n
c
e
TIME
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51. Corrective Action
Steps to Complete
Document plan for implementing C/A
Implement Containment Action
Implement the Corrective Actions
Remove the Containment Actions
Verify the Corrective Actions Overtime
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52. V- Verify Corrective Actions
Your Guide in verification
1. Are SOLUTIONS and not PATCHES
2. Are Doable and Time-bounded
3. Will not introduce a new problem or effect
Verify Effectiveness
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53. 3 Steps in Verifying Effectiveness
1. The “after” condition eliminates the
problem.
2. There is a difference between the
“before” and “after” condition.
3. The “after” condition does not create
another effect
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54. PROBLEM SOLVING FAILURE
• Jumping to conclusion
• Failure to define problem
• Failure to find the root cause
• Weak problem solving
• No execution of corrective action
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55. PROBLEM SOLVING SUCCESS
- Problem is clearly defined.
- Problem is accepted
- As an opportunity/challenge to improve
- - True root cause is found
- - Implemented an effective and
irreversible corrective and preventive
action
- - Problem did not re-occur
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56. Action Reflection
PROBLEM SOLVING SUCCESS
- Which principle or
technique will I apply
$$$
right away when I get
back to work?
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57. Your Guide to Conformance
• Say what you do
– Document the system
• Do what you say
– Implement the system
• Prove it
– Demonstrate implementation
Use our Standard Form
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59. PREVENTIVE ACTION
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60. PA INITIATIVES
The PA initiative may be derived from sources such
as:
• Lessons learned USING BENCHMARKING
• Lessons learned from any other performance
issues.
• Review of preventive/predictive maintenance
data records.
• Analysis of defect trends and outlier fallouts.
• Lessons learned from actual field failures and
customer COMPLAINTS
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61. Preventive Action Process Flow
1. Identify an Opportunity/Initiative based on gathered
information,
-define the success criteria
Defects Day1 Day2 Day3 Day4 Day5 Day6
Bent Lead 3 0 2 2 9 4
Control Chart Damaged
Leads
2
0
0 4
9
2
0
5
2
1
Joggled 0 7
Leads
Wrong 4 3 15 0 1 2
symbol
Mixed device 5 5 5 8 7 0
15
Chipped 0 5 0 9 1 1
package
Scrap Rework Illegible
symbol
2 0 3 2 0 1
10
Check Sheets
5
0
21
1 3 5 7 9 11 13 15 179
1 23 25 27 29 31 33 35 37 39 41 43 45
Histogram
Pareto Diagram
Scatter Diagrams
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62. Preventive Action Process Flow
2. Identify an Opportunity based on gathered information
- Root cause Analysis considers the potential problem and its
future risk
- Use error-proofing actions whenever possible
- Consider resource needs and costs
3. Identify and Implement Preventive Actions
- Verify effectiveness of PA
- Document actions into specs, Engineering designs etc.
- Confirm that the success criteria was met
- did the performance metric improve?
- plan to fan-out- create the implementation timeline/roadmap
chart
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63. SUMMARY
Symptom Problem (Is & Is Not) Containment
What ?
Where ?
When ?
How Big ?
X
Preventive Actions Corrective Actions Root Cause
What about ... Occur Cause Escape Cause
Occur Cause Escape Cause
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65. Feeling left-out?
Still clueless?
Friends
don’t
Nobody even
want to
wants to be with
help you?
you?
AND YOU
WONDER WHY? Just tell me where
you are . . .
And I will avoid Afterall,
that place. I am also
your
Friend.
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66. Created by:
Sid Calayag – Lead Auditor for
Taikisha Phils., Inc Quality Management
System
Presented by: Sid Calayag
“Sorry I don’t accept donation”
“I only did it for the love of my company”
But CASH is still acceptable if you will
not tell anybody about it …”
84
By: Anonymous
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67. End of Presentation
Still here?
Please go out now!
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Editor's Notes
The training is educational but not academic in approach, rather it is done in in a practical way where one can learn to use RCAimmediately in real life situation.This training consists of:lectures,practices, androle plays that provide participants with an in-depth understanding of how to analyze a system in order to identify the root causes of problems.
The training is educational but not academic in approach, rather it is done in in a practical way where one can learn to use RCAimmediately in real life situation.This training consists of:lectures,practices, androle plays that provide participants with an in-depth understanding of how to analyze a system in order to identify the root causes of problems.
The presentation is organized in such a way that we can move from one part (module) of the presentation to another. Also included are two ice breakers during or after the scheduled coffee break. Application form each module is also included although in such a way that it can be part of each or both module, although the advance application will require module 2 to better understand its application.
Root Cause Analysis - structured and thorough review of problem designed to identify and verify what is causing the symptomsa process for understanding and solving a problem. Useful process for understanding and solving a problem. Root Cause AnalysisTracing a Problem to Its OriginsIn medicine, it's easy to understand the difference between treating symptoms and curing a medical condition. Sure, when you're in pain because you've broken your wrist, you WANT to have your symptoms treated – now! However, taking painkillers won't heal your wrist, and true healing is needed before the symptoms can disappear for good.But when you have a problem at work, how do you approach it? Do you jump in and start treating the symptoms? Or do you stop to consider whether there's actually a deeper problem that needs your attention?If you only fix the symptoms – what you see on the surface – the problem will almost certainly happen again. which will lead you to fix it, again, and again, and again. If, instead, you look deeper to figure out why the problem is occurring, you can fix the underlying systems and processes that cause the problem. Root Cause Analysis (RCA) is a popular and often-used technique that helps people answer the question of why the problem occurred in the first place. Root Cause Analysis seeks to identify the origin of a problem. It uses a specific set of steps, with associated tools, to find the primary cause of the problem, so that you can:Determine what happened.Determine why it happened.Figure out what to do to reduce the likelihood that it will happen again. RCA assumes that systems and events are interrelated. An action in one area triggers an action in another, and another, and so on. By tracing back these actions, you can discover where the problem started and how it grew into the symptom you're now facing.You'll usually find three basic types of causes:Physical causes - Tangible, material items failed in some way (for example, a car's brakes stopped working). Human causes - People did something wrong. or did not doing something that was needed. Human causes typically lead to physical causes (for example, no one filled the brake fluid, which led to the brakes failing).Organizational causes - A system, process, or policy that people use to make decisions or do their work is faulty (for example, no one person was responsible for vehicle maintenance, and everyone assumed someone else had filled the brake fluid). Root Cause Analysis looks at all three types of causes. It involves investigating the patterns of negative effects, finding hidden flaws in the system, and discovering specific actions that contributed to the problem. This often means that RCA reveals more than one root cause.You can apply Root Cause Analysis to almost any situation. Determining how far to go in your investigation requires good judgment and common sense. Theoretically, you could continue to trace root causes back to the Stone Age, but the effort would serve no useful purpose. Be careful to understand when you've found a significant cause that can, in fact, be changed.
The Root Cause Analysis ProcessRoot Cause Analysis has five identifiable steps.Step One: Define the ProblemWhat do you see happening? What are the specific symptoms? Step Two: Collect DataWhat proof do you have that the problem exists?How long has the problem existed?What is the impact of the problem? You need to analyze a situation fully before you can move on to look at factors that contributed to the problem. To maximize the effectiveness of your Root Cause Analysis, get together everyone – experts and front line staff – who understands the situation. People who are most familiar with the problem can help lead you to a better understanding of the issues.A helpful tool at this stage is CATWOE. With this process, you look at the same situation from different perspectives: the Customers, the people (Actors) who implement the solutions, the Transformation process that's affected, the World view, the process Owner, and Environmental constraints. Step Three: Identify Possible Causal FactorsWhat sequence of events leads to the problem? What conditions allow the problem to occur?What other problems surround the occurrence of the central problem? During this stage, identify as many causal factors as possible. Too often, people identify one or two factors and then stop, but that's not sufficient. With RCA, you don't want to simply treat the most obvious causes - you want to dig deeper.Use these tools to help identify causal factors:Appreciation - Use the facts and ask "So what?" to determine all the possible consequences of a fact.5 Whys - Ask "Why?" until you get to the root of the problem. Drill Down - Break down a problem into small, detailed parts to better understand the big picture. Cause and Effect Diagrams - Create a chart of all of the possible causal factors, to see where the trouble may have begun. Step Four: Identify the Root Cause(s)Why does the causal factor exist?What is the real reason the problem occurred? Use the same tools you used to identify the causal factors (in Step Three) to look at the roots of each factor. These tools are designed to encourage you to dig deeper at each level of cause and effect. Step Five: Recommend and Implement SolutionsWhat can you do to prevent the problem from happening again?How will the solution be implemented?Who will be responsible for it?What are the risks of implementing the solution? Analyze your cause-and-effect process, and identify the changes needed for various systems. It's also important that you plan ahead to predict the effects of your solution. This way, you can spot potential failures before they happen.One way of doing this is to use Failure Mode and Effects Analysis (FMEA). This tool builds on the idea of risk analysis to identify points where a solution could fail. FMEA is also a great system to implement across your organization; the more systems and processes that use FMEA at the start, the less likely you are to have problems that need Root Cause Analysis in the future.Impact Analysis is another useful tool here. This helps you explore possible positive and negative consequences of a change on different parts of a system or organization.Another great strategy to adopt is Kaizen, or continuous improvement. This is the idea that continual small changes create better systems overall. Kaizen also emphasizes that the people closest to a process should identify places for improvement. Again, with kaizen alive and well in your company, the root causes of problems can be identified and resolved quickly and effectively. Key PointsRoot Cause Analysis is a useful process for understanding and solving a problem. Figure out what negative events are occurring. Then, look at the complex systems around those problems, and identify key points of failure. Finally, determine solutions to address those key points, or root causes. You can use many tools to support your Root Cause Analysis process. Cause and Effect Diagrams and 5 Whys are integral to the process itself, while FMEA and Kaizen help minimize the need for Root Cause Analysis in the future. As an analytical tool, Root Cause Analysis is an essential way to perform a comprehensive, system-wide review of significant problems as well as the events and factors leading to them.Why Do Root Cause Analysis?“Just fix it, there is too much to do.”“We don’t have time to think, we need results now.”Reality - fix symptoms without regard to actual causesRoot Cause Analysis - structured and thorough review of problem designed to identify and verify what is causing the symptoms
Pareto Analysis is used to record and analyse data relating to a problem in such a way as to highlight the most significant areas, inputs or issues. Pareto Analysis often reveals that a small number of failures are responsible for the bulk of quality costs, a phenomenon called the ‘Pareto Principle.’This pattern is also called the ‘80/20 rule’ and shows itself in many ways. For example: 80% of sales are generated by 20% of customers. 80% of Quality costs are caused by 20% of the problems. 20% of stock lines will account for 80% of the value of the stock.A Pareto diagram allows data to be displayed as a bar chart and enables the main contributors to a problem to be highlighted.As a basic Quality Improvement tool, Pareto Analysis can: define categories of defects which cause a particular output (product, service, unit) to be defective; count the frequency of occurrence of each defect; display graphically as a bar chart, sorted in descending order, by frequency of defect; use a second y axis to show the cumulative % of defects .Vilfredo Pareto was an economist who is credited with establishing what is now widely known as the Pareto Principle or 80/20 rule. When he discovered the principle, it established that 80% of the land in Italy was owned by 20% of the population. Later, he discovered that the pareto principle was valid in other parts of his life, such as gardening: 80% of his garden peas were produced by 20% of the peapods.Some Sample 80/20 Rule Applications· 80% of process defects arise from 20% of the process issues.· 20% of your sales force produces 80% of your company revenues.· 80% of delays in schedule arise from 20% of the possible causes of the delays.· 80% of customer complaints arise from 20% of your products or services.(The above examples are rough estimates.)
1. Gather facts about the problem, using Check Sheets or Brainstorming, depending on the availability of information.2. Rank the contributions to the problem in order of frequency.3. Draw the value (errors, facts, etc) as a bar chart.4. It can also be helpful to add a line showing the cumulative percentage of errors as each category is added. This helps to identify the categories contributing to 80% of the problem. 5. Review the chart – if an 80/20 combination is not obvious, you may need to redefine your classifications and go back to Stage 1 or 2. Examples When possible, use Minitab’s version, as an industry standard, rather than creating one in Excel - refer to Example 1 in this section Use a series of Pareto charts to drill down to more detail - Example 2 Recognise the 80: 20 principle but if the original Pareto is very flat be prepared to cut the defects in a different way, say 40:60 - Example 3 Minitab gives an extra dimension to Pareto Analysis - Example 4
1. Gather facts about the problem, using Check Sheets or Brainstorming, depending on the availability of information.2. Rank the contributions to the problem in order of frequency.3. Draw the value (errors, facts, etc) as a bar chart.4. It can also be helpful to add a line showing the cumulative percentage of errors as each category is added. This helps to identify the categories contributing to 80% of the problem. 5. Review the chart – if an 80/20 combination is not obvious, you may need to redefine your classifications and go back to Stage 1 or 2. Examples When possible, use Minitab’s version, as an industry standard, rather than creating one in Excel - refer to Example 1 in this section Use a series of Pareto charts to drill down to more detail - Example 2 Recognise the 80: 20 principle but if the original Pareto is very flat be prepared to cut the defects in a different way, say 40:60 - Example 3 Minitab gives an extra dimension to Pareto Analysis - Example 4
Construct the Pareto chart – Example 1Use a series of Pareto charts to drill down to more detail – Example 2 Recognise the 80: 20 principle but if the original Pareto is very flat be prepared to cut the defects in a different way, say 40:60 - Example 3 Create more Pareto by cutting across another variables- Example 4
At first glance, this looks unhelpful. But of 238 data points, most were counts of 1 or 2. A full Pareto would be very flat.Therefore after the first cumulative 42% of defects (100) , the balance of defects (138) are blocked together as “others”.This enables us to see that a “top 9” of defects can be analysed - most are “S-clip” problems (links between ICs and PCB
Examples of Unacceptable Root Cause- Operator Error- It was broken (equipment, gauge, tooling)The process didn’t do what it was supposed to doDidn’t know what to doIt only happened onceFrequent use of “not able to determine/unresolved”
valuable tool for: Focusing on causes not symptoms capturing the collective knowledge and experience of a group Providing a picture of why an effect is happening Establishing a sound basis for further data gathering and action Cause and Effect Analysis can also be used to identify all of the areas that need to be tackled to generate a positive effect.
1. Identify the Problem/IssueSelect a particular problem, issue or effect. Make sure the problem is specific, tightly defined and relatively small in scope and that everyone participating understands exactly what is being analyzed. Write the problem definition at the top of the flip chart or whiteboard.2. Brainstorm Conduct a Brainstorm of all the possible causes of the effect, i.e., problem.Have a mixed team from different parts of the process (e.g., assemblers and testers).Get a “fresh pair of eyes” - from someone who is not too close to the process.Have a facilitator - an impartial referee.Everyone is an equal contributor (“leave stripes at the door”).Fast and furious - go for quantity rather than quality (of ideas) at first.Involve everyone, or question why he/she is here.Timing - set an upper limit and best time/day of the week.Offer an incentive (free lunch?).Know when to stop.Recognize that this is a snapshot of how the group thinks today.Re-visit the problem again.Refer also to the Process Mapping tool.Consider (how) should you involve your customer?Write each idea on a Post-It® to make it easy to transfer them onto the fishbone diagram later. Be careful not to muddle causes and solutions at this stage. It is important to brainstorm before identifying cause categories otherwise you can constrain the range of ideas. However, if ideas are slow in coming use questions such as, ‘what about?’, to prompt thoughts.3. Draw fishbone diagram Place the effect at the head of the “fish” Include the 6 recommended categories shown below
4. Align Outputs with Cause CategoriesReview your brainstorm outputs and align with the recommended major cause categories, e.g., the People, Method, Machine, Material, Environment and Measurement System. Note:These may not fit every situation and different major categories might well be appropriate in some instances, however, the total should not exceed six. Other categories may include Communications, Policies, Customer/Supplier Issues etc.5. Allocate CausesTransfer the potential causes from the brainstorm to the diagram, placing each cause under the appropriate category.If causes seem to fit more than one category then it is acceptable to duplicate them. However, if this happens repeatedly it may be a clue that the categories are wrong and you should go back to step 4.Related causes are plotted as ‘twigs’ on the branches. Branches and twigs can be further developed by asking questions such as ‘what?’, ‘why?’ ‘how?’, ‘where?’ This avoids using broad statements that may in themselves be effects. Beware, however, of digging in and getting into bigger issues that are completely beyond the influence of the team.6. Analyze for Root CausesConsider which are the most likely root causes of the effect. This can be done in several ways:Through open discussion among participants, sharing views and experiences. This can be speeded up by using Consensus Decision Making.By looking for repeated causes or number of causes related to a particular category.By data gathering using Check Sheets, Process Maps, or customer surveys to test relative strengths through Pareto Analysis.Once a relatively small number of main causes have been agreed upon, Paired Comparisons, can be used to narrow down further.Some groups find it helpful to consider only those causes they can influence.7. Test for RealityTest the most likely causes by, e.g., data gathering and observation if this has not already been done.The diagram can be posted on a wall and added to / modified as further ideas are generated either by the team or by others who can review the teams' work.Cause and Effect Analysis can be combined with Process Mapping.A fishbone may be developed for each discrete activity within the process that is generating the output / effect so that causes are linked to particular steps in the process
Types of Questions that may be Asked Does the person have adequate supervision and support? Does the person know what he is expected to do in his job? How much experience does the person have? Does the person have the proper motivation to do his best work? Is the person satisfied or dissatisfied with his job?Is the person more- or less-productive at certain times of the day? Do physical conditions such as light or temperature affect their work? Does the person have the tools/equipment needed to do the job? Who does the person contact when problems arise? Is the work load reasonable?
Types of Questions that may be Asked How is the method used defined? Is the method regularly reviewed for adequacy? Is the method used affected by external factors? Have other methods been considered? How does the operator know if the method is operating effectively?Is statistical analysis used to verify the effectiveness of the method? What adjustments must the operator make during the process? Have any changes been made recently in the process?
Types of Questions that may be Asked How old is the equipment or machinery? Is it maintained regularly? Is the machine affected by heat or vibration or other physical factors? How does the operator know if the machine is operating correctly?Is statistical analysis used to verify the capability of the machine? What adjustments must the operator make during the process? Have any changes been made recently in the process?
Types of Questions that may be Asked How is the material produced? How is the material verified? How old is the material? How is quality judged prior to your operation? What is the level of quality?How is the material packaged? Can temperature, light or humidity affect the material quality? Who is the material supplier? Has there been a change in suppliers?
Types of Questions that may be Asked How are conditions monitored? How are conditions controlled? How is the control measuring equipment calibrated? Are there changes in conditions at different times of the day? How does change impact the processes being used? How does change impact the materials being used?
Types of Questions that may be Asked How frequently are products inspected? How is the measuring equipment calibrated? Are all products measured using the same tools or equipment? How are inspection results recorded? Do inspectors follow the same procedures? Do inspectors know how to use the test equipment?
A Cause and Effect diagram (also known as a Fishbone or Ishikawa diagram) graphically illustrates the results of the analysis and is constructed in steps. Cause and Effect Analysis is usually carried out by a group who all have experience and knowledge of the cause to be analyzed. Cause-and-Effect diagrams graphically display potential causes of a problem The layout shows Cause-and-Effect relationships between the potential causesAllow team members to specify where ideas fit into the diagramClarify the meaning of each idea using the group to refine the ideas. For example:Is also Called, “Fishbone" or "Ishikawa" diagram is named after its creator, Kaoru Ishikawa.Is used to systematically list all the different potential causes for a specific problem (or effect). Is often used to help identify the reasons why a process goes wrong.A Cause and Effect diagram graphically illustrates the results of the analysis and is constructed in steps. Cause and Effect Analysis is usually carried out by a group who all have experience and knowledge of the cause to be analyzed. Cause-and-Effect diagrams graphically display potential causes of a problem The layout shows Cause-and-Effect relationships between the potential causesThe Cause and Effect diagram is one of several charts used during Brainstorming to organizing ideas into common themes. This format helps with the process of distinguishing between alternatives, identifying common threads, and keeping the ideas flowing. This method also allows the team to easily divide up the ideas for further work.Organize the topic, team and write down the general categories on the chart. Brainstorm the ideas about the potential causes using good brainstorming practices (no bad ideas, everyone gets a voice). Illustrates how several potential causes may lead to the same effect. Generally takes on the shape of a fishbone. Potential causes are organized under common headings such as Materials, Machinery, Methods, Environment, Process & Measurement It is common for people working on improvement efforts to jump to conclusions without studying the causes, target one possible cause while ignoring others, and take actions aimed at surface symptomsCause-and-effect diagrams are designed to:Stimulating thinking during a brainstorm of potential causesProviding a structure to understand the relationships between many possible causes of a problemGiving people a framework for planning what data to collectServing as a visual display of causes that have been studiedHelping team members communicate within the team and with the rest of the organization
The “Five Why’s” is a method for rapidly determining the root cause of a problem popularized by Taichi Ohno, the father of the Toyota Production System. His technique was to approach any problem and keep asking “Why” until he was satisfied that the answer showed him what was really the source of the problem. In doing so, he then had a good idea of what needed to be fixed to prevent the problem. He called it the “Five Why’s” because he found over time that by asking “why” five times he usually ended up with the right information to go and fix the problem. The Five Why’s should be used by individuals and teams when trying to quickly assess and determine source of problems. Most problems can be handled this way, however more complex or life/mission critical problems typically require a more formal root-cause methodology including documenting the analysis. However, even the formal methodology requires asking “why” over and over again.Why not just ask “Why”?Need to systematically organize and analyze dataFirst understand “What happened” then “Why”Typically multiple root causesBlame is an obstacleGuidance needed to investigate human performance problemsNeed to ask right questions to completely understand whySome RCA techniques may provide easy answers that are either incomplete or wrong (but easy to find)
Now that you have already learned the technique of finding out the root cause using any of the tools in Module 1 or Module 2 of this training, you are now going to apply the acquired skill in preparing the CA/PA request and report.However, please note the following.Examples of Acceptable Root CauseProcess- acceptance criteria is unclearSystem or process allows errors-enumerate themCommunication-specs/work instructions changed without being communicatedEmployees unaware of defects or the effects of the defectsEquipment part malfunction due to set-up issues; parameter change without evaluation/risk assessmentExamples of Unacceptable Root Cause- Operator Error- It was broken (equipment, gauge, tooling)The process didn’t do what it was supposed to doDidn’t know what to doIt only happened onceFrequent use of “not able to determine/unresolved”
Corrective, Preventive, or Continual Improvement? I find that some organizations are having trouble distinctly identifying the three types of improvement in clause 8.5: corrective, preventive, and continual. Fixing an actual, detected problem in such a way as to prevent its "recurrence" is corrective action. When you anticipate a potential problem (based on risk planning or trend analysis) and take action to prevent its "occurrence", that is preventive action. Some people think that by correcting a known problem so it is prevented from happening again, they have taken preventive action. No, that is just part of a full and complete corrective action. While ongoing corrective and preventive actions provide improvement, another type of improvement can be made to conforming processes and products. You may want to do things faster and better, not triggered by problems or expected problems, but based on your monitoring of quality objectives and suggestions for improvement. Continual improvement is a recurring, step-by-step, activity that increases the ability of an organization to meet requirements. Don't rely solely on corrective and preventive actions to improve your system. Continually seek to improve the effectiveness and efficiency of your processes; don't wait for problems to reveal opportunities for improvement. Improvements can range from simple small-step improvements to strategic breakthrough projects. The key is to have a process in place to identify and manage the improvement activities. These improvements may result in changes to the product, processes, system, or even the organization. To set up a continual improvement process, read Annex B, Process for Continual Improvement, in ISO 9004:2000. Management review meetings cover process performance and product conformity, as well as, recommendations for improvement. These reviews should be the forum for identifying possible improvements and recording any decisions and actions. The results of planned improvements will be reviewed at future meetings and provide evidence of your continual improvement process. Corrective Action – the action taken to eliminate the root cause of an existing non-conformance andto prevent its recurrence. It is reactionary in naturePreventive Action – the action taken to eliminate a potential non-conformance and to prevent its occurrence. This is pro-active in nature.
OBJECTIVEProvide evidence that afterimplementation and overtime,the action works properlyand does not introducea new problem or effect.
3 Steps in Verifying Effectiveness1. The “after” condition eliminates the problem.2. There is a difference between the “before” and “after” condition.3. The “after” condition does not create another effect
PROBLEM SOLVING FAILURE- JUMPING TO CONCLUSIONS,NO FACT FINDING- SHOTGUN ROOT CAUSE - FAILURE TO DEFINE THE PROBLEM- FAILURE TO FIND THE ROOT CAUSEWEAK PROBLEM SOLVING SKILL-NO EXECUTION OF CORRECTIVE ACTIONSACTION IS ONLY FOR THE SHOW NO COMMITMENT/OWNERSHIPTIME FACTOR- COST CONSTRAINTS
PROBLEM SOLVING SUCCESSProblem is clearly defined.Problem is acceptedAs an opportunity/challenge to improve- True root cause is found- Implemented an effective and irreversible corrective and preventive action- Problem did not re-occur
PROBLEM SOLVING SUCCESSProblem is clearly defined.Problem is acceptedAs an opportunity/challenge to improve- True root cause is found- Implemented an effective and irreversible corrective and preventive action- Problem did not re-occur
This is the end of the presentation , now let us practice what we have just learned
This is the end of the presentation , now let us practice what we have just learned