Root Cause Analysis Course Introduction This course is designed to give you an overview of Root Cause Analysis and how it can improve company performance. This class is best taught using your company’s specific examples, allowing for interaction among the students Feel free to modify and change this course any way you like. Simply click View  Master  Master Slide to edit the master slide so that all slides show your company logo and name. You may also teach it exactly as it is. We recommend about 4 hours to teach the course. This course is intended to teach an individual or group with no prior knowledge of root cause analysis, as well as provide the knowledgeable individual an excellent review of the concepts. We recommend that someone with prior experience and training with root cause analysis teach the course. If not being used as a course, valuable information can still be obtained by following through the presentation. If you have any questions, please visit http://www.biz-pi.com

When should root cause analysis be performed? When PROBLEMS occur !! Supplier Defects Out of Control Process Excess Inventory Computer issues Scrap Problems medical errors Human Error Audit Finding When should we perform root cause analysis? All the time! When you do not dig deep enough into the detail of these problems, you should expect them to continue to reoccur time and time again Add your company lingo and terminology! Missed Deliveries Safety Issues Machine Defects Overspending Budget Workmanship Defects

Nothing is allowed to further escape to the customer How does it work? Contain the problem… PROCESS A PROCESS B PROCESS C PROCESS D Contain the problem. Make certain that the group (customer in this case) that finds the problem does not see it again! CUSTOMER Nothing is allowed to further escape to the customer

Immediate Action Step #3 Must isolate effects of problem from customer 1 8 2 7 3 6 4 5 Immediate Action Must isolate effects of problem from customer Usually “Band-aid” fixes 100% sorting of parts Re-inspection before shipping Rework Recall parts/documents from customer or from storage Only temporary until corrective action is implemented (very costly, but necessary) Must also verify that immediate action is effective The third step is to address the immediate action needed to keep the problem from spreading any further. Often times, this involves some sort of band-aid, or containment effort, such as: sorting of parts or paperwork, re-inspection, rework, or recall Whatever immediate action is done, it should only be temporary, and not stay in place after the root cause has been corrected. A check should also be made to see that the containment and immediate action actually kept the problem from spreading any further

Root Cause Root Cause Part reversed Worker not sure of correct part orientation Part is not marked properly The team determines that the engineering process does not adequately account for manufacturing issues during the selection or specification process. Notice that they did not put the blame on the individual engineer. Engineering ordered it that way from vendor Root Cause Process didn’t account for possible manufacturing issues

Cause and Effect Procedures Personnel Didn’t complete project on time Lack of worker knowledge Poor project plan Poor project mgmt skills Lack of resources Didn’t complete project on time The team decides, based on experience and the available data, to focus on the “lack of resources” as the major reason for the delay. Inadequate computer programs Poor documentation Inadequate computer system Materials Equipment

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