The aim of the Corrective Action Process is to enable efficient, effective
and timely problem solving at all levels in the company. In order for
this to become reality it is crucial that problem solving is approached
in a structured way to ensure success. An effective way of releasing the
potential of the personnel involved in key processes must be found, so
that ownership is maximized.
The Corrective Action Process falls under four basic headings, which
These generic stages of structured problem solving are explained fully
in the 'IMPROVEMENT PROCESS CYCLE'.
For the purpose of clarity the starting point of the Define Step is
at the point where. a problem solving log (see problem solving log procedures)
has been completed, submitted to the Steering Group and a decision has
been made that a CAT (Corrective Action Team) is the most efficient vehicle for solving the problem.
The problem report submitted should contain an initial estimate of the
cost of the problem to the operation in terms of time and/ or material
wasted as a result of the current problem. The company is then able to
decide how much resource should be applied to the solution (how much It
will cost to gain the estimated benefit). It is important that this quantification
is done, even if it is not seen as important, so that if the solution
is questioned at any level in the company the business case can be proved.
An appropriate team leader can then be chosen who Is familiar with day
to day operating problems and who will see a direct benefit in their solution.
It is important to note that the Team Leader role is independent of hierarchy
seniority and that the team should avoid the consideration of seniority
when solving problems all
ideas and facts need to be considered on their merit.
The Team Leader should plan major milestones for the CAT activity, with
particular reference to reporting dates, business measures and targets
to be achieved. It is of prime importance that the end result of the activity
is defined. Until this is done, the problem has not been truly defined.
The Team leader will be satisfied that everyone understands the problem
and the scope of all relevant Business Processes. Any relevant Processes
that have not been defined will need to be defined and agreed by the CAT
before attempting to solve the problem itself, (a separate analysis team
can be used to define the processes in parallel if time is critical).
Team members then plan and implement necessary skills training (problem
analysis etc). When process owners (ie
people who are involved operationally with the process concerned) are
included in the Team, the CAT can function much more efficiently as the
results will be owned by the participants. The closer to the 'coal face'
these representatives are, the less theoretical and opinion based the
actions will be.
Preparation and training of the team can now take place which includes:
Team briefing on Roles and Responsibilities
CAT training workshops on relevant tools and techniques
Team agreement on plan, time scales and final
Process definition (if this is not complete) including
current dependencies, key operating costs
Planning and obtaining relevant permission for
planned CAT activities (outside the scheduled meetings)
The establishment and understanding of potential
measures of success
The next stage is to analyze the process which relates to the problem
assigned in detail so that the real root causes will be revealed and the
A root cause analysis is now carried out, determining cause and effect,
in order to trace the problem back to its initial cause.
Using the process definition, detailed workflow analysis is carried
out now to examine selected work methods, management control mechanisms,
communication between dependencies and existing service levels (for both
internal and external customers where appropriate). The detailed process
has to be examined for gaps (where activities that should happen do not
happen), mismatches (where outputs do not match requirements) and overlaps
(where one or more areas is duplicating work). Many of the issues will
be well known to CAT members and a list should be drawn up and included
with the above points in a summary of process problems. The above observations
now need to be validated and/ or quantified.
Select Major Causes
Key Costs of Non conformance and Costs of Conformance are determined
for the areas concerned.
Information tracking logs should be designed and installed to capture
any missing information. The appropriate method of capture will depend
on whether the problem is a short term or long term issue. For short term
problems that often recur during the day, a 2 week collection period is
usually sufficient. For longer term problems that only occur at certain
times, a year's base data is appropriate. Problems that occur on an infrequent
but nonetheless damaging basis can be picked up by individual case study.
Identify Key Improvements
Brainstorm all possible improvements, using Relation Diagrams. How-How
Diagrams, in order to examine all possible ways of overcoming the points
Select Key Improvements
Establish the feasibility of improvements and any new customer service
levels. Once potential methods for dealing with the problems have been
outlined, it is important that they are tested for feasibility by the
users, and that, at least in a pilot area, the ideas and any new service
level agreements are put to the test in 'real' operating conditions so
that they can be shown to work.
The CAT analyze the data and indicate priorities for action based on
operating and bottom line improvements. All recommendations must be accompanied
by an estimate of their yield to the business or operating area, which
will then be monitored using the measures defined. Until this is done,
cannot take place.
Agreed recommendations are then sent to the Steering Group and reviewed.
If the process owners were not represented on the CAT then they must be
involved in the agreement before recommendations are sent to the Steering
Group. The Steering Group ensures that the recommendations are of benefit
to the business and are reflected in operating results. The CAT chairman
should also be prepared to follow up on progress with the Steering Group
and feedback of any actions taken by senior management should be given
to originators (even if action has not yet been taken, a regular update
keeps participants interested). The Steering Group will set reporting
dates for the CAT in order to oversee the improvements.
The authorized actions are communicated to the CAT and implementation
details are then planned. The plan will include reporting and business
plan milestones indicated by the Steering Group. Any local work (such
as drawing up new forms, configuring a system etc) is assigned and the
improvements managed by the CAT.
It is recommended that key individuals are nominated to be responsible
for particular actions and that their work is followed up on a regular
short interval basis at first to secure a fast start to the process and
to enable timely correction of early problems. This can be relaxed as
the process gains momentum.
The agreed improvements are now carried out. The feedback and communication
loops are vital at this stage to ensure that all participants in the improvements
are kept on board.
Monitoring of measures is continued, relating improvements to the base
Where measures indicate that the problem has not been solved (there
is no improvement), either the improvement has not been implemented correctly
(in which case implementation must be repeated correctly), or it has not
dealt with the major root cause of the problem (in this case original
causes must be revisited and the most likely selected). The more time
and care that is invested in the Define and Analyze cycles, the less likely
it is that this will happen.
It is also possible for the measures to improve without process users
perceiving improvements. In this case it must be confirmed that the measures
are correct, and if this is the case, the process users can be shown the
improvements and decide how to measure them.
Now that the Corrective Action has been proved to work, all necessary
changes to procedures and systems need to take place to ensure that the
improvements are cemented in. It is in preventing the repetition of problems
that organizations achieve long term gain and free up valuable time to
concentrate on commercial issues.
any process changes needed and amend relevant process documentation. Consider
applying the discipline of standards such as ISO9001.
Train personnel where necessary to operate under changed arrangements.
Ensure old problems are not carried over in the habits of key personnel.
Identify areas for further improvement and feed to the Steering Group.
Roll improvements out to other areas. One of the major reasons for involving
the Steering Group in managing this activity is to enable senior management
to ensure that benefits that arise from one corrective action can be analyzed
and introduced to other areas so that the whole business can realize maximum
benefit from the effort of the teams. It is of prime importance that all
improvements are cross checked in this way to get fast track benefits.
The short interval measurement applied before can be relaxed once the
new system is working properly. This will release experienced resources
to continue the improvement process in other areas. Fixed intervals of
audit should now suffice to keep the improvements on track.
Evaluate the improvements in relation to the P & L
It is important to evaluate in this way, even if "the bottom line"
is not considered particularly important, in order to give a commercial
indication of success.
A summary of results will now be completed in order to demonstrate that
the problem outlined in the original log has been solved. This clears
the problem from the active system and provides useful case study material
for training new groups on problem solving.
should be validated before starting up to avoid duplication and rework.
The Steering Group should ensure that the work outline for the CAT does
not overlap or cover any work covered in existing CATs.
The Steering Group should also satisfy itself that single sites are not
examining company wide problems from their own exclusive perspective,
or work will have to be repeated later.
CONTINUOUS IMPROVEMENT TEAMS:
CONTINUOUS IMPROVEMENT TEAMS DON'T:
CONTINUOUS IMPROVEMENT TEAM GOALS:
CONTINUOUS IMPROVEMENT TEAM CODE OF PRACTICE:
SETTING UP CONTINUOUS IMPROVEMENT TEAMS
Identify the teams required
Which teams start first
Identify the team leaders
Do any of the team leaders require leadership
The team leader is normally the manager or supervisor
of a department, section or function with a continuous role
The team members must be from the department,
section or function
The number of team members would normally be between
four and seven
The appointment of team members should take account
of factors such as:
Membership Is on a voluntary basis and people
need to understand what they are volunteering for. Therefore, a well thought
out brief to enable people to understand is required.
The team leader should invite and encourage
all of the staff to apply for membership
Staff need to understand and be satisfied
with the membership selection process
MANAGEMENT OF TEAM TRAINING
Management needs to recognize that effective training
is essential to the Total Quality Implementation process and that omissions
or shortcuts could cause significant setbacks
The team leader is responsible for training the
team although he/ she may call on any support that is required; the team
leader must be seen to be delegating not abdicating
The team leader must plan the training programme
taking a realistic view of the time that people have available. Some companies
can afford a day or half day per week in the initial stages, however an
hour or so a week is more typical
The training and the commencement of the implementation
process should be made to coincide by ensuring that the team's purpose
analysis and problem solving activities are part of the training programme
CONTENT OF THE TRAINING PROGRAMME
The Total Quality Concept
Team Purpose Analysis
The aims and objectives of the department/
Analysis of key processes
Identification of department /section's internal
Establishing performance measures
Brainstorm to identify problems affecting
key performance measures
Prioritize problems to be addressed
Conduct cause and effect analysis of selected
Prioritize causes to be addressed
Carry out any necessary data collection and
Analyze data and measurements
Identify and analyze potential solutions
Measure the effect
AFTER THE TRAINING
Set improvement targets for each of the performance
Continue the problem solving process
The team should identify opportunities for corrective
action teams to senior management but only after the team has demonstrated
its commitment and credibility by solving a significant number of problems
within its total control
It should be recognized that the team's activities
are a way of life and that achievements will not be made overnight
If the team meets for an hour each week then the
training programme may take 15 week or so to achieve
PEOPLE IN THE DEPARTMENT WHO ARE NOT IN THE TEAM
Team members need to recognize that the work that
they do affects everybody in their department
The rest of the department must be kept well briefed
on the team's progress. This communication will reduce/ eliminate peoples'
It is a good idea to invite a few non members
from the department to each team meeting so that they may observe, contribute
and feel that they are involved
SOME PITFALLS TO AVOID
Bad meeting venue
Meeting times badly conflicting with other business
Vague /oversubscribed meeting agendas
Late arrival at meetings
Regular absence of some team members
Lack of visual aids eg
Omitting to involve everybody
Team members without actions
Oversubscribed meeting actions
Short cutting the problem solving process
We must have quick results
Frequent changes of team membership
Not asking for assistance when you need it
Poorly maintained performance graphs
Poor PR of your achievements