Professional Documents
Culture Documents
8-D
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The Chosen
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Document a procedure
for problem solving
.
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DISCIPLINE #1 - (D1)
Team members must be:
Willing to contribute
Capable of intelligently diagnosing problems
Trainable - willing to learn:
New improvement methods
From each other
New problem solving methods
Team players
Trusting team members
Willing to do their part, bringing their expertise
and skills to bear on the problem
Basic team principles
Focus on the situation issue or behavior, not
other persons
Maintain the self-confidence and self-esteem
of others
Maintain constructive relationships with your
team members and support personnel
Take initiative to make things better
Lead by example
Good team members will
Encourage and be spontaneous
Accept and give consideration off the wall
ideas and out of the box thinking and
suggestions
- Overcome preconceived notions
- Never reject a possibility just because
we looked at that last year
De-emphasize rank
Not engage in brown nosing or power
pushing
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DISCIPLINE #2 - (D2)
Define the problem specifically and clearly
Determine the extent of the problem
Narrow the focus of the problem solving
Summarize ALL the known FACTS
In defining the problem:
Truth is separated from fiction
Opinion is separated from fact
Emotion is separated from reality
Frequently the wrong problem is solved and
the issue that caused the customer complaint
is not addressed.
It is imperative the customer complaint be
clearly understood.
The only method to ensure this is to have
direct customer contact.
It is not unusual for a complaint to be
misrepresented by someone who is
reporting it rather than experiencing it.
Reporting systems and tally sheets are often
used that mis-classify problems in prearranged
but incorrect standard categories.
Part of the 5W2H problem definition is to state
the customer complaint clearly and accurately.
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5W2H
WHO.
WHAT.
WHERE.
If a defect occurs on a part, where is the defect located?
What is the geographic distribution of customer complaints?
Where the difficulties being detected?
WHEN.
Identify the time the problem started and its prevalence in earlier time periods.
Do all production shifts experience the same frequencies of the problem?
What time of the year does the problem occur?
WHY.
HOW.
HOW MANY.
What is the extent of the problem?
Is the process in statistical control? (e.g., P chart)
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5W2H Questions
CUSTOMER TERMS/SYMPTOMS:
1.
2.
3.
4.
5.
6.
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DISCIPLINE #3 - (D3)
Isolate the customer from
reoccurrences of the problem
Immediate gathering, quarantine, and lock-up of all
suspect product
Stop production from known problem sources /
contributors
Examine DATA - FACTUAL EVIDENCE to help
determine what to contain and who to stop
Verify by experimentation and data tracking and
collection that the problem has been contained
CONTAINMENT ACTIONS
ARE NOT AND NEVER
SHOULD BE
CONSIDERED
PERMANENT SOLUTIONS
TO A PROBLEM.
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You are prepared for a review when you can answer these questions:
VERIFICATION
1. Have all alternative actions been evaluated?
2. Are responsibilities for correct actions clear?
3. Is the required support available?
4. When will the actions be completed?
5. Does the containment action protect the customer from the effects of the problem?
CONTAINMENT ACTIONS
1. What containment actions have been identified?
2. Have you ensured that implementation of the interim solution will not create other problems?
3. Will all interim actions last until long-range actions can be implemented?
4. Have you coordinated the action plan with the customer?
CONFIRMATION ACTIONS
1. Have tests been done to evaluate the effectiveness of the interim actions?
2. Can you conduct controlled experiments to predict the outcome of the actions?
3. Can you try out the actions on a small scale to test if they will be effective?
4. Is data being collected to ensure actions will remain effective?
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State how the potential cause could have resulted in the described problem.
Establish what type of data can most easily prove or disprove the potential cause.
Develop a plan on how the study will be conducted.
Identify the actions on an action plan.
Organize and prepare the required materials to conduct the study.
Collect the required data.
Use appropriate statistical tools emphasizing graphical illustrations of the data.
Outline conclusions from the study.
Does the data establish the potential cause as being the reason for the problem or does
the data point to another potential cause that needs to be investigated also?
Data collection may be as simple as check sheets or as sophisticated as design of experiments.
By using graphical tools, quick comprehension by all participants as well as accurately communicated information
will result.
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DISCIPLINE #4 - (D4)
The important thing here is to be sure you have Identified and tested
ALL potential causes
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Team members should each assume their activity causes the problem.
Each should ask themselves "How could what I do possibly generate the problem?".
Prepare a Time Line Analysis if the problem was not always present.
Identify "what changed, when"?
Identify several potential causes. Develop a plan for investigating each cause, and
update the Action Plan.
Evaluate a potential cause against the problem description.
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Hypothesis Generation: How does the potential cause result in the problem?
Design: What type of data can most easily prove or disprove the hypothesis?
Preparation: Obtain materials and prepare a check sheet.
Data Collection: Collect the data.
Analysis: Use simple, graphical methods to display data.
Interpretation: Is the hypothesis true?
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Clearly state root cause(s) and identify data which suggests a conclusion.
Verify root cause factors are present in the product or process.
Can we generate the problem independently?
Can we make it come and go?
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D4 - ASSESSING QUESTIONS:
POTENTIAL CAUSES:
1. Have you drawn the process flow and stratification C&E diagrams and identified all sources of variation?
2. Have all sources of information been used to define the cause of the problem?
3. Do you have the physical evidence of the problem?
4. Can you establish a relationship between the problem and the process?
5. Do you continually challenge the potential root causes with the question "why" then follow with "because"
to construct alternative potential causes?
6. Is this a unique situation or is the likely problem similar to past experience?
7. What are the "is, is not" differences?
8. Has a comparative analysis been completed to determine if the same or similar problem existed in
related products?
9. What are the experiences of recent actions that may be related to this problem?
10. Why might this have occurred?
11. Why haven't we experienced this before?
12. What changed?
Manufacturing:
- new suppliers?
- new tools?
- new operators?
- process changes?
- measurement system?
- raw materials?
- vendor-supplied parts?
- do other plants have a similar problem?
Engineering:
- any pattern to the problem?
- geographically?
- time of year?
- build dates?
- did the problem exist at program sign-off?
- was it conditionally signed-off?
- did the problem exist on prototype vehicles?
- did the problem exist on the functional builds?
- did the problem exist on the 4-p's?
(pre-production product prove-out)
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D4 - ASSESSING QUESTIONS:
DATA:
1. What data is available to indicate any changes in the process?
2. Does data exist to document the customer's problem?
ROOT CAUSE
1. If the potential cause is the root cause, then how does it explain all we know about
the problem? How has this been verified?
2. Is there any possibility that there is another contributing cause besides the one we
have identified? How is this being evaluated?
OTHER POTENTIAL CAUSES
1. What evidence do you have that other potential causes are actually occurring?
2. If they are occurring, what unwanted effects might they produce?
3. Do actions need to be taken to ensure that other potential causes do not create
unwanted effects?
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DISCIPLINE #5 - (D5)
To this point we have focused on:
Understanding and defining the
problem
Containing the effects of the
problem
Identifying and Verifying the root
cause of the problem
Now we need to
PERMANENTLY SOLVE the
problem
Select alternative solutions
Confirm the potential solutions
through testing programs
Verify that the solution
ELIMINATES the problem
and its effects
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DISCIPLINE #5 - (D5)
AVOID BAND-AID SOLUTIONS
Band-Aids generally:
FIX
When identifying solutions:
Consider the Cost and the Value
Consider Implementation issues
Consider Timing
Consider the Effectiveness
Reliability
Feasibility
Accuracy
Consider Potential Side Effects
You dont want to cure a cold only to develop pneumonia
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Monitor Results.
ASSESSING QUESTIONS:
CONFIRMATION TESTING QUESTIONS.
1. Can you list and measure all of the indicators related to this problem?
2. Which of the indicators are most directly related to the problem?
Can you use the indicators to measure problem severity?
3. Can you determine how often or at what intervals to measure the problem (hourly, daily, weekly,
monthly)?
4. If there are no changes in the indicators after taking action, can you determine what to do? Will
you need to take cause, action or verification measures?
5. Do all indicators reflect conclusive resolution?
6. Has the team prioritized the customer/user evaluation after the implementation?
7. What scientific methods are being used to verify effectiveness in the short term and to predict the
outcome in the long term?
VERIFICATION QUESTIONS:
1. Has the customer been contacted to determine a date when verification will be evaluated?
2. What data has been established for follow-up?
3. Has a time line chart been completed?
4. Have field tests been conducted using pilot customer groups?
5. Have dates been established when verification of effectiveness will be evaluated?
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DISCIPLINE #6 - (D6)
Install the best solution for permanent
corrective action
Use on-going monitoring to ensure root
causes have been eliminated
Monitor the long term effects
Back up the effectiveness with data
CORRECTIVE ACTIONS
REMOVE THE ROOT CAUSE
NOT JUST THE EFFECTS
CORRECTIVE ACTIONS ARE
PERMANENT
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Implement Solution.
ASSESSING QUESTIONS:
1. Do the actions represent the best possible long-term solution from the customer's viewpoint?
2. Do the actions make sense in relation to the cycle plan for the products?
3. Has an action plan been defined?
- Have responsibilities been assigned?
- Has timing been established?
- Has required support been defined?
- What indicators will be used to verify the outcome of the actions, both short- and long-term?
4. On-Going Controls
Ensure the problem will not recur
Seek to eliminate inspection-based controls.
Address 5M sources of variation.
Test the control system by simulating the problem.
5. Have the corrective action plans been coordinated with all the affected parties?
6. What indicators will be used to determine the outcome of the actions?
7. What controls are in place to assure the permanent fix is verified as intended?
FORECAST OUTCOME:
1. Will actions permanently solve the problem?
Can you try out the corrective actions on a small scale to test their effectiveness?
2. Can scientific experiments be conducted to gain knowledge to predict the outcome of the effects of
the implemented actions?
3. Do the permanent corrective actions require support from external sources to be effective?
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DISCIPLINE #7 - (D7)
OBJECTIVE:
Modify those management systems,
operating systems, practices, and procedures
to prevent recurrence of this problem and all
similar problems.
Address system follow-up responsibilities.
MODIFY (As Required):
METHODS
EQUIPMENT
MATERIALS
PROCEDURES
MANAGEMENT SYSTEMS
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DISCIPLINE #7 - (D7)
ASSESSING QUESTIONS:
1. Has the problem occurred due to a mechanical or behavioral system?
2. Has a process flow C/E diagram of the management system been prepared?
3. Have changes been made to the system?
4. Have action plans been written to coordinate actions, if so, who, what, when?
5. Have the practices been standardized?
6. Has a new FM.E.A. been prepared? (Failure Mode Effects Analysis)
7. Have all interested parties been notified of the resolution actions, including input into
the Computer Archiving System, if available?
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DISCIPLINE #8 - (D8)
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DISCIPLINE #8 - (D8)
OBJECTIVE: Recognize the collective efforts of the team.
Use all forms of employee recognition.
Documentation as necessary.
Celebrate successful conclusion of the problem solving effort.
Formal disengagement of the team, and return to normal duties.
ASSESSING QUESTIONS:
1. Have creative solutions been taken to warrant a review for a company sponsored award?
2. Has appreciation been shown to all the team members?
3. How has the team leader identified individual contributions to the problem resolution?
4. What are the presentation plans?
5. Could the problem and the solution be videotaped?
6. Could a paper of the team's effort be written and distributed throughout the organization?
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Managements Role
in the
Team Problem Solving Process
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MANAGEMENT ROLE
Have patience - Problem solving is an iterative process involving people who are continually learning.
There is no "absolute" timetable for the solution of a problem,
Take time and dedicate effort to understand the team problem solving process and "coach" the teams.
Be willing to accept failures and false starts as part of learning process.
Continuous improvement requires continuous learning/risk taking.
Provide training and "practice time" to individuals/teams.
Be personally INTERESTED/INVOLVED with teams and team dynamics.
State expectations clearly "up front."
Demand performance to expectations - teamwork, process . . .
Lead and teach by example - model the behaviors you expect.
Provide personal feedback to the team of impact/value added of problem solution.
Be willing to make teamwork/team skills and performance in team environment keys to recognition / reward.
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MANAGEMENT ROLE
Establish, maintain, and continuously improve the system.
Refrain from tampering/overriding the priority system.
Provide the "right" resources (people, facilities, etc.) in sufficient quantity and quality to
complete the task in a timely manner.
Respect resource commitments.
Provide clear expectations - before the fact.
Share significance (impact) of problem with team.
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MANAGEMENT ROLE
Be willing to give up the "right" people to the team.
Live up to commitments - People, time, resources . . .
Understand the process and support the team.
Give authority to team members.
Refrain from "Monday morning quarterbacking."
Provide constructive/supportive interest in team and process.
Review progress and ask constructive coaching questions.
Require adherence to proper process and appropriate documentation.
Be patient
Demanding "instant solutions" to problems forces teams to shortcut the process which
often results in failure to identify root cause or otherwise fatally flaws the process.
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When assessing
MEASUREMENT
SYSTEMS
a gage R & R is often
required
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8-D
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