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0:08
It's a formal brainstorming tool for identifying possible root causes.
The purpose of a cause and effect diagram is to gather information and ideas from
as many people as possible and to explore all possible causes of a problem.
0:25
It allows you to identify, explore and
display a problem and all the possible causes in a structured way.
0:34
Strangely this tool has three commonly used names.
Ishikawa called it a cause and effect diagram.
Others called it an Ishikawa diagram in his honor.
And because of its appearance, many people call it a fishbone diagram.
0:50
These are all names for the same tool.
0:54
There are a lot of ways to brainstorm ideas.
The fishbone or Ishikawa diagram is a somewhat structured
approach to brainstorming, specifically aimed at identifying potential causes.
1:09
This is the basic layout of a fishbone or Ishikawa or cause and
effect diagram, you see it looks like the skeleton of a fish.
And our analysis is intended to identify major factors,
those are the big bones, that contribute to the problem.
And then further break these down in to more elementary causal factors,
the little bones, that cause these factors to create or prevent problems.
1:39
There many different suggested categories for fishbone diagrams, but
you don't need to be constrained to follow any of them.
The major reason for
these labels is to get participants to think of different types of causes.
1:54
This scheme is probably the first one that was widely used.
And you can make up your own categories, whatever fits your department or
your application best.
Do not confine yourself to a certain number of categories.
The number of major bones is not critical, but it's usually four to six.
2:15
Let's consider a few other examples.
2:19
Oftentimes, customer service problems are caused by an institution's policies.
Legitimate and necessary policies may cause problems for a variety of reasons.
2:32
A policy intended for one purpose may have unintended consequences in another area.
Policy may have become absolute, but remains in place.
2:43
A policy maybe applied incorrectly because it's poorly understood or
ambiguously defined.
A policy maybe causing problems because no one has bothered to identify legal
approaches to living within the policy and still accomplishing what needs to be done.
3:02
Procedures are a frequent source of perceived waste in customer service
problems.
When a customers looking for a service, they're not likely to enjoy being told
that they must follow some lengthy procedure that from their point of view
has little or nothing to do with the service they're expecting.
3:20
Long lists of required signatures, multiple forms requiring
redone the information in inexplicable waiting periods cause people to
feel like the procedures rather than their needs are what is driving the process.
3:36
Service enterprises involve lots of people who interact directly with customers.
As such, people represent our greatest opportunity to delight customers and
our greatest opportunity to disappoint them.
3:50
People must have the knowledge, skills, and
authority to provide the services that our customers are looking for.
3:58
Every time one of our employees has to say to our customer I don't know how to do
that or I tried, but it didn't work or I'm not allowed to do that,
we create at the situation where our people disappointed our customers.
Finally, we have potential problems with our physical plant or facilities.
This can include lack of facilities or lack of access to these facilities,
or old and outdated facilities that do not meet customer requirements.
4:27
Some naming schemes seem to fit different situations better than others.
4:32
It's really not important which scheme you use or whether you create your own,
the important thing is to consider lots of different types of causes.
4:43
To use a fishbone diagram, first draw the fish
bone structure with the problem at the head.
If you've carefully constructed a problem statement, including measures,
it should go there.
Then add your categories, remember, these are just to spur different ideas,
different areas of thought.
Don't agonize over the categories.
Now you're ready to brainstorm with your team.
One approach is to use post-it notes.
Just write the idea on a post-it and stick it next to the appropriate bone.
5:19
Do not let the team get in a debate about which bone is the best fit,
this is a distraction.
Either pick a bone or write the idea twice.
When the diagram is complete, you can take a picture to preserve the work for
subsequent use.
5:35
Here is a customer service example.
A precise problem in the head is a good idea, but it can be a general
statement of the problem, it can be a product or a process or a service.
5:49
And the causes can be thought of more as enablers, rather than sources of problems.
5:56
This tool can be a lot of work to set up and use.
It's small groups that are often simpler tools for identifying root cause.
6:05
But, if a problem is particularly complex or difficult, or
if you want the input of a large number of people,
there's an alternative to the small group brainstorm.
You can create a large fishbone diagram perhaps on four by eight foot foamcore.
Then supply post-it notes and mount the diagram in an area where anyone and
everyone will see it.
Anyone walking by can read the diagram, and contribute by posting a note.
6:36
Used this way, the diagram must be actively managed.
At least once a day you should organize the notes, and
remove any that are not serious suggestions.
You might leave it up for a week.
And you can get suggestions from people on other shifts, even from suppliers or
customers visiting your work space.
6:58
Cause and effect diagrams may be an effective tool for
generating ideas from small or large groups.
This is a brainstorming tool.
It generates a large quantity of ideas about possible causes.
It does not identify root cause.
The team needs to investigate all of the ideas and
use other means to identify probable causes.
Checksheets are simple and flexible tools for collecting data.
When you begin an improvement project,
you may find that you don't have any of the data that you need.
A Checksheet is a simple, quick,
and usually temporary tool for collecting the initial data that you need to get started.
There is no single checksheet form that can be used in all applications.
Therefore, the design of the form must be
customized to the type of data that's to be evaluated.
You can use check sheets to count or measure defects,
complaints, phone calls, or many other things.
There are three main types of checksheets.
Recording checksheets, where you enter counts or measurement data.
Checklists, which are written reminders.
And the Measles chart,
which can be used to identify the physical location of defects or other issues.
An example of a checksheet is shown here.
It's based on the method that customers use to make a complaint.
Complaints were received four different ways: by letter to a post office box,
by calling a toll free 800 phone number,
by e-mail to a special email address,
by walking into the store and complaining to a customer service representative.
Each time one of these events happens,
a corresponding mark is made in the appropriate row.
This table summarizes how
complaints were received during the past week.
The total number of complaints is 25.
We can calculate the percentages as follows: There were three written complaints.
Three divided by 25 equal 0.12.
We can multiply that by 100 to obtain the percentage.
Repeat this for each row.
An analysis of complaint methods like this might help you to
start analyzing staffing needs.
This is another example of a Recording Checksheet.
This one is used to record the measured time to resolve a help desk issue.
If a call lasts less than a minute,
a mark is made in the first row in the calls column.
If it's more than one minute but less than two,
a mark is made in the second row in the calls column and so on.
It's always a good idea to include important information about the process,
the location, area, shift,
and who is involved.
This can be done at the top of the checklist.
If you've ever made a grocery list,
you've made a checklist.
Pilots routinely use checklists to make sure that nothing important is forgotten.
They're also used in areas such as housekeeping at a hotel or in medical procedures.
Whenever there is a complex or delicate procedure,
a checklist will help prevent errors.
A Measles Chart is a physical representation of something of interest.
This can be an accurate drawing or a rough sketch.
The idea is to make a mark on the drawing each time you find a defect,
and to make that mark in the same location on the drawing as the actual defect.
In this case we have a drawing of a bumper with several X marks
to indicate where defects have occurred.
It's also possible with the Measles Chart to record more than one type of defect.
And with every type of checkesheet you can
separate data by shift or by different production lines.
Before you collect any data,
even with something simple like a checksheet,
you should make a plan.
You should know what data you want, how,
and who is going to collect it,
and what you think you will do with it.
The data collection plan does not have to be complicated.
Just create some columns and list the answers to these three questions.
Checksheets are simple way to collect data that is not otherwise available.
They're quick, flexible, and can be customized to suit your needs.
When you don't have any of the data that you need this might be a good place to start.
One of the basic and primary tools for process improvement is a process map,
also called a flowchart.
A process map is often the starting point for improvement efforts.
They can be used to demonstrate actions or procedures.
Before we can understand a process map,we need to understand what a process is.
A process is any activity,
usually a number of steps that receive an input and convert that input to an output.
This could include changing raw material into
a component or finished product in manufacturing.
It could be the steps in the delivery of a service or it could be acting on information.
There are many types and variations of process maps.
Here we see five major types.
We will focus on the most basic.
There are also many different variations of process maps.
We'll discuss some of these in future modules.
The purpose of creating a process map is to gain
an understanding of a process so we can improve it.
Process maps are useful for documentation and for training,
for certification and other uses.
Process maps can help to eliminate
written procedures by presenting them in a visual schematic.
For high level business processes that cross functional boundaries,
there often is no one person who knows the whole process.
This is why we need teams to map processes.
The participants in a process mapping exercise should include
the people who actually use the process on a daily basis.
An example of a business process map might be the process of creating purchase orders.
Process maps are appropriate and necessary in nearly any process improvement effort.
They should be one of the first things that a process improvement team does.
It's important to map the process as it is actually being performed.
Not the way it was designed or the way the manager thinks it's done.
We call this the current state map.
As we mentioned, there are many levels of processes.
We're going to talk about two.
Business processes and work processes.
Business processes tend to be
high level processes like accounting, customer service, etc.
They often cut across functional departments.
They also contain work processes.
Most processes are also interrelated with
outputs from business processes and work processes,
being inputs for other processes.
Because business processes or high level processes,
they contain multiple work processes.
For example, accounting may include billing and tracking accounts receivable.
Each step in a business process may contain
one or more work processes which can be
mapped separately and will provide much more detail.
There are a number of different shapes that can be
used to create process maps and this may vary by industry.
These are some examples for manufacturing.
For our purposes we will use only a few.
The level of information in a process map can vary.
But we're focused on the simplest form.
There are many different symbols that can be used and we're going to show
you how to map a process with just three symbols.
The symbol for the start or end of
the process is an oval or a square with rounded corners.
Inside this symbol, it may say start or end.
A square or a rectangle is the symbol for a process step.
Inside this symbol you will name the step.
Decision points are of diamond shape.
They can only have two possible answers like yes/no, or pass/fail.
Usually one answer will lead to a continuation of
the process and the other answer will either end the process or redirect it.
If there are more than two possible outcomes,
you might need more decision points.
One easy way to map processes with the group is to use sticky notes.
As the steps develop you can rearrange as needed to get the right sequence.
A standard sticky note can be turned 45 degrees to use for a decision point.
When the team is done with the sticky note map,
it can be preserved by taking a picture.
For a more permanent and professional looking map,
the information can be easily transferred to
one of many computer programs that have drawing tools.
This could be something like Microsoft Word or Excel using the drawing tools function.
There's also free software that will do this such as
Google Docs or Sheets or Open Office.
Vizio is software that's designed specifically for this type of application.
This is an example of a simple process map.
In this case, it's someone's morning routine.
Yours is probably different,
but it includes begin and end points,
a decision point, and multiple steps.
One of the biggest challenges for a process mapping team is
determining the appropriate level of detail and using it consistently.
There is no rule for this.
It's a judgement call by the mapping team.
PDCA is a simple improvement model that has evolved over decades with many contributors.
It probably began with Walter Shewhart,
although W. Edwards Deming often gets credit for it.
PDCA stands for Plan Do Check Act.
Another variation of this model comes from Deming in its PDSA or,
Plan Do Study Act.
In either case the simple four step circular model can be easily
understood and it can be mapped against
nearly any other improvement model such as the DMAIC model.
The PDCA model is a simple approach that can be
applied to process improvement in manufacturing,
service, education, healthcare et cetera.
It provides the team with a disciplined approach and helps them manage the improvement.
Without the discipline of an improvement model,
teams have a tendency to just do it without
the necessary discussion, documentation et cetera.
The first step, of course, is Plan.
In this step the team will define the problem and discuss possible causes and solutions.
The problem definition is critical.
It helps limit the scope of the project and acts
as a touchstone if the team begins to wander.
Ishikawa added determining goals and targets to the step.
The team might also develop predictions and plans in this step.
In the Do step the team implements their solution.
Ishikawa added education and training to this step.
This is where plans from the plan step are carried out.
New problems or observations should be documented and data analysis can begin.
It should also be noted that if possible a pilot
or a simulation is a good way to minimize risks.
In the Check step,
the team evaluates the results of their solution and looks for other effects.
It's not uncommon for a solution to be partially successful.
That is why the model is presented as a circle.
The data analysis is completed in this step.
The predictions are compared with results and lessons learned or documented.
Successful parts of the implementation should be
documented and standardized in the Act step.
For further improvements, return to the Plan step and begin the process again.
Demming considered his model more of a plan for management.
Instead of Check, he identified the third step as Study.
In the Study phase the results of the improvement would be compared with
predictions that were made in the Plan step to ensure learning.