When a new problem is declared, we don’t throw ourselves headlong into it: we define the team that will work to solve it, the objectives we set ourselves, the time we expect to spend on it. We make sure that the necessary skills are present in the team, and we designate a driver.
The problem has been declared, the team must now describe it. This can be an opportunity for initial brainstorming. The objective: not to be short of details. It’s time to release our first tool: the 5W2H. We must absolutely ask ourselves the following questions: Who is involved, What (what happened), Where did it happen, When, How (in what context, at what point in the process, following what procedure), How much (how much involved) and finally Why (what failure generated the problem).
The question of Why is the most complicated, to answer it we will use the 5 Whys in the next step. The Measure step is also the time to identify the issues, constraints, consequences of the problem. If they are significant, it is generally there that we decide to start with an 8D resolution. If this is the case, we move on to 3D: the implementation of immediate curative actions. Even before identifying the root causes, we correct the effects to limit the consequences.
Let’s get the gear out! The problem is described, now it is a question of identifying the root causes. The team meets for a new brainstorming session. In some industries, this is called a technical fact-finding committee. We will then complete an Ishikawa diagram (or cause and effect diagram). It is composed of 5 branches (5M or fish bones): Materials (the inputs to the process), Equipment, Methods (the processes, operating procedures), Manpower (the human factor), and finally the Environment (the environment, the context).
One then wonders why the problem occurred in each of the branches, and one wonders it more than once, hence the 5 Whys. Five is not an immutable number, but we must not stop at superficial causes: here we look for the root causes. A common representation is in the form of a post-it, as presented below.
Figure 1 : Search for root causes in TEEXMA®
Once the root causes have been identified, we can begin to define an action plan.
Once corrective actions are implemented and evaluated, they can be standardized to prevent the problem from reoccurring on a larger scale. The preparation and coordination of preventive actions are similar. It may involve updating documents, methods or tools, or conducting training.
The effectiveness of the corrective and preventive action plan must be evaluated based on criteria defined by the person in charge. These criteria may relate to monitoring several months after the plan has been implemented. Then comes the time to congratulate the team for its work! This moment is also very important to capitalize on feedback: difficulties, good practices.
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