Problem Solving – There is no magic pill

Humans Naturally wired to solve problems:

As long as humans have been in existence we have always attempted and usually succeeded in identifying and most times solving issues that have plagued us. On average, humans are one of the physically least suited to defend ourselves with just our physical tools. We do not have sharp teeth, or claws of a lion, the eyesight of an eagle, the hearing of a dog nor the ability to fly like an eagle. Humans have however, overcome many of these challenges and have made ourselves the ruler of our planet because of our brains.

Decision Making and Problem Solving Flaws:

For all of the prowess of our mental abilities, we humans still make a lot of errors in our decision making and problem solving process. We tend to rely on things that we recall have “worked the last time on this issue”, or would solve an issue based on our education, skill set, or experience.

Often times our brains start working on a solution without having the necessary information. We rely on a number of mental shortcuts known as mental biases or heuristics. I am no psychologist but I have heard, read and experienced firsthand, that there are over 200 different decision-making biases that exist. Going back to the days of our ancestors, we faced life or death every day. This may be from trying to feed our families, or just to prevent being the dinner of another creature. We were forced to make snap decisions based on the facts about a situation that we had instantaneously. This is referred to as fight or flight sometimes.

Though life has gotten much easier for most of our species, our brains are still wired to take in information that is available and make a decision. We rely on the biases or heuristics that I referred to above. Some of the more relevant ones as they pertain to my topic of interest are listed below: (Note – I will get more into these in a later post)

• Anchoring bias
• Availability bias
• Bandwagon effect
• Representative heuristic
• Affect heuristic
• Confirmation bias
• Expectation bias
• Blind-spot bias
• Selective perspective
• Escalation of commitment
• Risk aversion

Systems 1 & Systems 2 Thinking:

Our brains also use what is called systems 1 and systems 2 type thinking. Systems 1 thinking can be described as the fast, intuitive thinking that relies on fast, low focus, almost automatic thinking based on our intuition, past experiences, biases and heuristics.

Systems 2 thinking is more focused, in-depth thinking processes. For example, if we are trying to solve a very complex math problem or word problem and we must process and think through the data and facts. I have heard or read that at least 95% of our decisions take pace in the systems 1 thinking realm.

The Role of Managers and Quality Professionals:

The question is, what are managers, and quality professionals to do in trying to overcome these shortcomings in our decision making and problem solving processes?

It is my opinion that we must “slow down” the initial rush to judgement to allow the gathering of necessary information, resources (additional brains, inputs, opinions, experience and knowledge). We must also provide series of different decision making, problem solving tools and processes to our employees. This means training them, and reinforcing the use of them as well as what we measure and reward.

Some steps that I have found useful that we can use to improve our problem solving efforts and overcome some of these hard-wired habits that we have are as follows:

• Take the emotion out of the discussion/ issue
• Use, train and reinforce the use of a structured problem solving process to take guessing and jumping to conclusions out of the process
• As management, reinforce the successes of no repeat root causes to problems experienced
• Make sure cross-functional problem solving teams are used
• Use available tools such as 5-why, time-line (when did the issue first become known and what changed), common corrective action templates such as 8D, 5 Principles, etc…
• Don’t look to determine “who did it”, focus on the problem solving process and facts
• Ask as many questions as possible about the situation/ issue and prove and disprove the possible causes with facts and data

My next post will delve into more detail on the more common biases and heuristics that are run into as well as details and examples on systems 1 and 2 thinking.

Best of luck.

Mark

Striving For Perfection: Preventing Defects by Preventing Errors.

In very simplistic terms, a defect is most instances is caused by the occurrence of an error. This can be human error, such as inserting a component into an assembly jig in the incorrect position, by entering the wrong program number into a PLC, forgetting to include a component into a assembly machine to make an assembly and the list goes on.

A simple example (as I am a simple minded person) would be a manufacturing process where the machine operator places a component into a machine where it can be welded to another component. This sounds simple enough but, the machine operator can put the component in the wrong way, use the wrong component or forget to put the component into the machine before actuating the process. Many (non-defect prevention minded) companies will blame the machine operator for this, write them up, scream at them and tell them what a bad person that they are. This merely means that it will eventually happen again. Good (defect prevention minded) companies will have already thought of these occurring and will devices, fixtures, sensors, etc…. in place to not allow the machine operator to make the error. This is the ideal situation (error prevention). The next level of effectiveness would be to detect the error or the resulting defect at the source where it occurred and prevent it from leaving the operation where it was created. Following this level would be downstream detection through more sensors, or devices, etc… that does prevent the customer from receiving the defect but does nothing to keep the company from absorbing the costs of either scrap or rework.

It stands to reason then, that anything that we can do that prevents errors will result in either zero or very few defects in my view. The question is, how does an organization go about putting in place a culture and process for error or defect prevention? My hallucination is, that this starts at the top of the organization. After all, top management is ultimately accountable for the culture that exists in an organization by what they teach, reinforce, talk about and provide resources for in any company.

There are many great tools for identifying potential sources of defects in a process, such as a PFMEA, suggestion systems and work based improvement teams or Kaizens. If top management however, does not promote, require and reinforce this culture it does not happen on its own.

What does an organization do to promote a defect prevention, quality minded culture? They can do things like training all employees on this concept of “error = defect = dissatisfied customer” chain and have clearly defined duties and roles in this process. This also means that the senior level management needs to have the same beliefs that these efforts and resources to have this sort of a culture are worth the costs (ROI). They can look for the use of and potential new ideas for error-proofing methods in the plant. They can have metrics that reflect these important activities, talk about them to employees, reward employees for coming up with and implementing these methods. They can implement effective pre-launch PFMEA processes and after launch have regular meaningful reviews of them.

If the employees in the plant do not see that this is important and not a priority of top management, they will feel that they must just “do their best with what they have”, which is a formula for a low morale, low quality culture type of an organization and eventually the customers will also feel this.

Who’s Job Is It?

This is subject to how an organization is setup, but there are some very common roles that I have encountered over the years. I will lay these out below by typical position in a typical manufacturing organization:

Operator/ Line Worker:

• Study the process they are running and try to identify ways that they can do it incorrectly.
• Make suggestions on how to make the process better.

Foreman/ Area Lead:

• Conduct audits of the error-proofing process.
• Provide training on error-proofing/ mistake proofing.
• Talk about it (individually and at dept meetings)

Manager/ Senior Management

• Establish targets and goals centered around these activities.
• Hold everyone accountable.
• Talk about it, (individually and at company meetings).

Here is to prevention!

Mark

Root Cause Analysis Pitfalls: Trying to fix the wrong thing.

Solving problems in a quality environment is much like pulling weeds in a garden. If you do not get to the true roots of the weed, it will continue to resurface. It is easier in the short term to merely grab that pesky weed at the surface and tear off the visible portions without getting down to and removing the roots. In the long term however, the weed will actually cost you more time and effort because you will continue to do this again and again.

It is my sincere belief that doing a good job in your permanent corrective action (PCA) process typically means that the majority of your time should be spent focusing on data gathering and root cause analysis. In my estimation the 70/ 30 rule applies most of the time. This simply means that 70 percent of the time of the team will be spent in these areas.

Ask questions (a lot of them)

Before you start defining “potential” root causes to investigate you need to make sure that you have clearly defined the details of the problem. One of my favorite tools for this process is the IS/ IS NOT questioning technique. As the name implies this means asking the questions of where, and when the problem is being experienced and where it is not being experienced. This becomes extremely important in defining the problem. Let’s say for example that your company produces widgets for numerous global customers. One specific product that you supply is the same used in over 30 customer plants around the world, but only one is experiencing an issue. Using the IS/ IS NOT questioning technique will help your team to realize this and will force a different set of questions and cause you to ask why only this facility? Is there something different in how they use the product? Did they change their process? This line of thinking can change your list of potential root causes that need to be investigated instead of jumping right into brainstorming a list of potential causes.

Example of IS/ IS NOT questions:

IS (where is the problem)

• Who (is seeing the problem)
• When (did they start seing the problem)
• Where (on the product or process is the problem being seen/ experienced)
• How (often/ frequent is the problem being seen)
• Why (is this truly a problem)

IS NOT (Where is the problem not being seen but could or should be)

• Who (is not seeing the problem – plant/ area/ etc…Why)
• When (could the problem have first been experienced but was not/ why)
• Where (else could/ should the problem be but is not/ why)
• How (often/ frequent is the problem not being seen but could be/ why)
• Why (is this not really a problem)

The goal of this exercise is merely to make the team ask more questions at the outset not to ask a bunch of useless questions. If the question does not make sense for the issue, move on.

Root cause Analysis – my favorite tool to identify “Potential” root causes:

The fishbone diagram is in my opinion on of the best techniques to help teams identify potential root causes. The fishbone diagram is a tool that forces the root cause team to look in compartments or categories that could either be a cause or a contributing cause. The name “fishbone” is merely because the shape of the diagram looks like the head of a fish with the “bones” being the compartments/ categories to look at. Typical categories are the 5M/1E which is simply:

• Machine

• Methods

• Material

• Manpower

• Measurement

• Environment

There are others that work well in which the categories might be steps in the process that is experiencing the problem, departments, etc… The possibilities are endless and the creativity of the team will allow more ways to use the tool effectively.

Another tool that works well and can be used with the fishbone is the 5 Why questioning technique. This simply means that instead of accepting the stated potential root cause we ask “why” until it makes no more sense to the team or leads to a fix that is out of their control.

Example of 5 Whys:

Issue – I was late for work

Why 1 – I got up late

Why 2 – My alarm clock did not go off

Why 3 – Stopped running

Why 4 – Power went out

Why 5 – storm knocked the transformer our in my neighborhood

As I mentioned above this question could likely continue but we are already at a point that is out of my control. I cannot prevent storms or transformers from being knocked out but I can get a battery operated clock as an action to fix my issue. There are others as well such as back up power methods, etc… but I think you see my point.

The more we use these tools and techniques the more comfortable our teams become with them and more effective at using them which will result in less repeat issues.

Happy Problem Solving.

Mark

Organizational Excellence Consists of Doing MANY Right Things Correctly.    

Let’s face it there are no shortcuts when it comes to organizational excellence. It is similar to a jigsaw puzzle. If you are missing just one piece you miss completing the big picture. If you have the wrong piece in the wrong place you also will not achieve your best performance.

With the myriad of different management techniques and quality improvement tools/ methods that we see and hear about it is easy to think that there is a “magic pill” that will cure our ills. Unfortunately cherry picking a “tool of the month” for implementation in itself does not guarantee improvement in terms of making large improvements in overall performance. Why you ask? In my experience there are many great tools and techniques out there but there are usually many contributing factors that lead to poor organizational performance. It is usually not just one factor (again for overall organizational performance).

It is very similar to good health and fitness. Many folks want the magic diet pill or exercise equipment that will cure our weight or health problems. To be effective we typically must attack it from many different areas. For example: to use a health related example (since most can relate) of needing to lose a few pounds, decrease our body fat to lean tissue ratio. Merely cutting back on caloric intake by itself is not the most effective means. We should also look at weight bearing and cardiovascular exercise, improving what we eat and in some cases working on our mental processes of how we view diet and exercise. In my experience and opinion improving organizational excellence/ performance must be handled in an approach as well that looks at the many involved factors.

Here is a brief list (not all inclusive by any means as much depends on the organization) of some typical areas that must be looked at:

1)      Goal Alignment. Review or develop your driving vision and top level goals for the organization. All other goals and objectives that you have must be in support of this. Many times we may have conflicting goals. Goal alignment is crucial.

2)      Define the areas where performance is not meeting expectations. Do not adjust the goal to meet performance. This happens often where management lowers expectations after numerous attempts to reach specific goals unsuccessfully. Example – raising product scrap percentage generated to xx % after not being able to solve the process issues causing them. Performance expectations will drive performance. Example – if we expect and accept that we will be overweight, then we will)  

3)      Use true root cause analysis to determine why the performance gaps exist. Do not assume that it will be just one cause. As with product quality issues, there are typically many related/ contributing causes. There are many root cause methods and the intent of this blog article is not to get into them as there are many good books on the market for this. I am a firm believer however that most of your time spent should be on the data gathering portion. This will ensure that your team has a thorough understanding of the problems. It also prevents working on the wrong problem.

4)      Make sure that the right team is in place to achieve organizational excellence. This means all levels of the company. You can have a great shop floor employee population, but if the management team is not right for the task and does not have the vision, drive and perseverance then it will still not happen. The opposite is also true. If you have a top notch management team but your hiring practice for non-management personnel is lacking you will likely fail as well. Managers must review each and every position in the company for the ideal traits, experience and background. At that point we can either hire the ideal candidate or elect to hire a candidate that can be developed to the desire level. The problem that I have seen in some organizations is that the ideal candidates are not brought in and then they also are not developed. To add to this, the expectations are then lowered for the employees and the organization.

5)      Correct and improve in an ongoing basis. Do not lose the desire to improve once a few of the low hanging fruit have been corrected with some success. We must instill a culture where all employees are constantly looking to fix issues and improve to the next level in all areas of the organization. This is one of the main reasons that I absolutely love the “process based approach” that ISO based systems drive when done correctly. The PDCA loop is key to this. To maintain this however (as stated above) requires the right mix of management and employees that have the drive and hunger to make the organization better.             

Here is to improvement.

Mark