Category Archives: NCR

Root Cause Analysis: 5 Whys

After the elaborate piece on the Cause and Effect diagram we will take a deeper look in the 5 Whys as a root cause methodology.

The concept behind 5 why’s is that you keep on asking the question why did it happen until you reached to the underlying cause. Due to this setup the 5 Whys methodology is a very power tool for the root cause analysis because it forces people to really think about what went wrong.

Example

A wrong product has been delivered by a supplier.

1 Why. Why was a wrong product delivered?

The purchase department provided the wrong information.

2 Why. Why did the purchase department provided the wrong info?

The found this info on the server which they assumed was the latest version.

3 Why. Why wasn’t the latest version on the server?

Sales had been negotiating with the customer and forget to update.

The analysis shows that something went wrong in the process. Modifying the process can prevent this from happening in the future. A possible solution could be adding an addition step in which purchase just cross check with sales before they purchase the goods.

Also in this example it is clear we didn’t reached till the fifth why. This is not important sometimes the root cause is clear after 3 steps sometimes after 5. But for sure the root cause is clear after 5 steps.

Boundaries

When it comes to 5 Whys there are not so many boundaries. The strong characteristic about 5 Whys is that it allows you to find a root cause within purchase while the issue occurred at sales. This broad and inter process root cause analysis can very effective because of characteristic.

However, with the 5 Whys it is very easy to reach a level where it is easy to just blame a person or department. It is important to leave the personal aspects out of the equation and focus on the processes and organisation. Blaming somebody doesn’t help, always try to look at the organisation. So when a particular person is making the same mistake multiple times maybe we should give him or her training to improve his way of working. Or maybe the recruitment process is not how it should be. Just try to prevent blaming people.

Published by:

Insight in Cost of Quality: the hidden gem

Total Cost of Quality is a very important topic but not well known by a lot of C-level managers. When asked about the total Cost of Quality, a lot of C-level managers simply don’t know or give an industry standard. This reaction is understandable but very striking at the same time. In many industries the estimated costs of quality is in the range of 20%, which is some serious money when you are talking about tens of millions or even hundreds of millions.

Open your eyes

Automation can help companies to get a better feeling for their cost of quality. This starts by providing employees with the tools to record a quality issue. A number of companies claim to have very little issues, only because their issue form is around 6 pages. No one in their right mind is going to fill that up so a lot of issues are not even registered. Providing a mobile app with just 2 or 3 fields and an option to add images lowers the burden significantly to report an issue. This will lead to a bigger influx of issues, which is great.

Pick up the issue

Now that the burden of reporting an issue is out of the window, the real power of automation kicks in. The different stages the issue needs to follow can be predefined with pinpoint accuracy which means that the right person can add information precisely at the right time. A good automation solution allows the option to create a structured actions plan, and distributes the action to the designated owner. This connects the corrective actions to the issue on hand.

The automation allows for the hidden costs to get exposed, for example costs like waiting hours by the team or repair hours required to fix the issue. Multiplying these hours with the internal hourly rate, the company will be able to put a price tag to the lost hours. Furthermore, the solution can give an indication of the costs the administration has cost based on the hours worked on the issue.

Finalize

When all the information required for the incident has been provided, the report can be closed. This way of tracking Total Cost of Quality allows management to get a real-time insight in the actual costs. They can always have a clear overview of what all these issues cost the company. Just check the example.

analyse issues

Dashboard

In the end it is very important to get a grip on your total cost of quality and clearly see where the company is bleeding money in order to fix this. You can only take this step when everybody in the company is able to file an issue easily. Have fun increasing your efficiency.

Published by:

Root cause analysis: Cause and Effect

A proper root cause analysis can be the difference between making money and losing money. The analysis is designed to get into the detailed fundamental causes of the issue, without any bias. The cause and effect analysis will lead to significant insight in why things went wrong.

It is very easy to come up with a result that describes the person that made the mistake. However, it is important to always go deeper than the particular person. When a person messes up there is almost always a more fundamental problem to the issue. This could include things like:

  • Lack of training
  • Company culture
  • Hiring the wrong people

These things can lead to people messing up for all kind of reasons. However, the company can change these things to reduce the number of issues for example by changing the recruitment plan or sending people to training. In the next part we will describe the Cause and Effect methodology.

Cause and Effect

With a cause and effect diagram you start off with an effect or outcome you want to analyze. This effect may be positive or negative but has to be described as clear as possible. Then the main causes are identified. The main causes that might have lead to the effect could be the following 5M’s for a manufacturing plant:

  • Machine
  • Method
  • Material
  • Man / mind power / personnel
  • Measurement / medium

When the main causes of the issue are identified the next step is to identify as many causes that might have lead to the effect. Classify the causes according to the main causes and place these below them. This will lead to a result like this.

To go one level deeper you can ask why a certain cause happened. This will give more detailed insight into this cause. Create another layer of causes that are linked to this for example speed or temperature.

When the diagram is ready you can analyze the information. The main causes with a significant number of causes under them need some further investigation. Also, when a certain cause shows up multiple times this might be the root cause. Then look for clusters, when there are a couple of causes close to each other, then that is something that needs your attention. The same is true when there are very little causes, you might need to further investigate these and why there are so few. To really start improving, identify the causes you can take actions on and put these actions in the action list with clear owners of each action.

Next post we will dive deeper into the 5 Why’s.

Published by:

How to prepare for an external audit!

Yes I know, ideally your company should be ready for an external audit every day of the year. However, most of the time, you will need at least a couple of weeks to gather all the information required. Here are a few important points that must always be checked before an external audit.

Perform a legislation compliance check

Make sure you have checked if your organisation complies with national and international laws and legislations. Most ISO standards are very clear on this. The company has to prove that it works according to statutory and regulatory requirements. Performing this check will help prevent a lot of uncomfortable discussions with the auditor.

Train Employees

It still happens often that employees get anxious when the auditor arrives at their desk for the external audit. You can prevent this by training the most anxious people in the team. The top performers on a regular day sometimes simply forget how they work the moment the auditor is next to them. If your management system is working as it should, the processes/procedures will describe how the people are working. There is no need for people to be anxious about the audit, just tell them to do their job as they always do.

Tools

Make sure all the tools are certified if required and properly calibrated. If during the external audit, the auditor spots an employee working with an uncertified tool this will most likely lead to an NCR, especially when he/she digs a little deeper and find more of these uncertified tools.

Documentation control

If you are not using any automated system then this is a must. Just sit down and go over every single document to make sure the latest version is available to the team and that the version is correct. You have to check these to prevent employees from using the wrong documents the moment the auditor sits next to them. Of course the easiest way is just to automate this, which will save you a lot of time.

These are by far all the points you have to take into consideration for an audit. If you have any more please share them in the comments.

Published by:

The non conformance report: When to create one?

Last week I had a very interesting discussion with a QHSE manager regarding Non conformance report (NCR). While working on improvements on their management system we tried to come up with a clear definition of when to write an NCR.

They form a valuable source for a company to learn from and discover room for improvement, however it is often unclear when to write an NCR. Therefore, we discuss a few situations which should lead to an NCR.

Procedure deviation

There is the situation when an employee deviates from a procedure. This is a clear NCR. The company created the procedure to streamline business activities and to define what people should do. Some of these procedures are even implemented to prevent frauds or breaking the law. Whenever an employee deviates of a procedure an NCR should be written. A good example is when a mechanic purchases some goods without approval by the financial manager. Due to rules set by financial auditors it is important that the financial manager signs the purchase orders. In this situation it is important that an NCR is written and the mechanic is trained on the reasons why the financial manager has to sign off on a purchase order.

Product deviation

What if a product is finished but not according to the specification of the customer, which is noticed before delivery? The customer hasn’t seen the product yet so no problem right? Wrong actually. When this NCR is not noted down the company can not investigate what went wrong in the production process. The NCR gives the company the opportunity to find out where the mistake was made and take the measures needed to prevent it from happening again.

Deviation from customer expectation

Inline with product deviation is the deviation from customer expectation. The most obvious deviation is just a customer complaint. But in addition, customers might also have expectations that haven’t been addressed in previous discussions. Though the product has been produced as per contract it could very well be that the customer is not satisfied. As an organisation it is important to notice such situations by discussing the satisfaction with the customer, preferably as soon as possible. Early detection of deviation from customer expectation is especially important because rework can get very costly in later stages of the project.

Qooling -- QHSE tooling

Unsafe situation

Another great example of an NCR which should be written is an unsafe situation. However, in practice the definition of an unsafe situation is unclear to a lot of people. Some might say that almost hit by a car was a near miss and should be registered while others don’t experience it as an unsafe situation. To get the definition consistent within the organisation, clear communication and proper training is required.

Deviation against statutory or regulatory requirements

It is always good to check if an employee acted within company values and of course within the law. It might happen that an employee acted within the boundaries of a procedure but did break with the company’s core values. Employees should never deviate from those values even when the employee acts according to a procedure, because they represent what the company stands for and breaking them causes harm to the integrity of a company. The same can obviously been said about the law.

Conclusion

In the end, there are thousands of reasons for when to write an NCR and when not. However, it is important that everyone within the organisation writes them down. In order to facilitate this it is crucial that the company clearly communicates the criteria the company has for an NCR. This could be elaborated by providing certain cases of when to write a NCR with the employees.

If you have any experience with this, please share it in the comments.

Published by: