Unintended consequences come in many forms and have many causes. “Revenge effects” are a special category of unintended consequences, created by the introduction of a technology, policy, or both that produces outcomes in contradiction to the desired result. Revenge effects may exacerbate the original problem or create a new situation that is equally undesirable if not more objectionable.
Discussions of revenge effects often focus on technology – the most tangible cause of a predicament. However, “[t]echnology alone usually doesn’t produce a revenge effect.” It is typically the combination of technology, policy, (laws, regulations, etc.), and behavior that endows a decision with the power to frustrate its own intent.
This installment of “The Third Degree” explores five types of revenge effects, differentiates between revenge and other effects, and discusses minimizing unanticipated unfavorable outcomes.
The Law of Unintended Consequences can be stated in many ways. The formulation forming the basis of this discussion is as follows:
“The Law of Unintended Consequences states that every decision or action produces outcomes that were not motivations for, or objectives of, the decision or action.”
Like many definitions, this statement of “the law” may seem obscure to some and obvious to others. This condition is often evidence of significant nuance. In the present case, much of the nuance has developed as a result of the morphing use of terms and the contexts in which these terms are most commonly used.
The transformation of terminology, examples of unintended consequences, how to minimize negative effects, and more are explored in this installment of “The Third Degree.”
Effective Operations Management requires multiple levels of analysis and monitoring. Each level is usually well-defined within an organization, though they may vary among organizations and industries. The size of an organization has a strong influence on the number of levels and the makeup and responsibilities of each.
In this installment of “The Third Degree,” one possible configuration of Operations Management levels is presented. To justify, or fully utilize, eight distinct levels of Operations Management, it is likely that an organization so configured is quite large. Therefore, the concepts presented should be applied to customize a configuration appropriate for a specific organization.
As mentioned in the introduction to the AIAG/VDA aligned standard (“Vol. V: Alignment”), the new FMEA Handbook, is a significant expansion of its predecessors. A substantial portion of this expansion is the introduction of a new FMEA type – the Supplemental FMEA for Monitoring and System Response (FMEA-MSR).
Modern vehicles contain a plethora of onboard diagnostic tools and driver aids. The FMEA-MSR is conducted to evaluate these tools for their ability to prevent or mitigate Effects of Failure during vehicle operation.
Discussion of FMEA-MSR is devoid of comparisons to classical FMEA, as it has no correlate in that method. In this installment of the “FMEA” series, the new analysis will be presented in similar fashion to the previous aligned FMEA types. Understanding the aligned Design FMEA method is critical to successful implementation of FMEA-MSR; this presentation assumes the reader has attained sufficient competency in DFMEA. Even so, review of aligned DFMEA (Vol. VI) is highly recommended prior to pursuing FMEA-MSR.
To differentiate it from “classical” FMEA, the result of the collaboration between AIAG (Automotive Industry Action Group) and VDA (Verband der Automobilindustrie) is called the “aligned” Failure Modes and Effects Analysis process. Using a seven-step approach, the aligned analysis incorporates significant work content that has typically been left on the periphery of FMEA training, though it is essential to effective analysis.
In this installment of the “FMEA” series, development of a Design FMEA is presented following the seven-step aligned process. Use of an aligned documentation format, the “Standard DFMEA Form Sheet,” is also demonstrated. In similar fashion to the classical DFMEA presentation of Vol. III, the content of each column of the form will be discussed in succession. Review of classical FMEA is recommended prior to attempting the aligned process to ensure a baseline understanding of FMEA terminology. Also, comparisons made between classical and aligned approaches will be more meaningful and, therefore, more helpful.
In the context of Failure Modes and Effects Analysis (FMEA), “classical” refers to the techniques and formats that have been in use for many years, such as those presented in AIAG’s “FMEA Handbook” and other sources. Numerous variations of the document format are available for use. In this discussion, a recommended format is presented; one that facilitates a thorough, organized analysis.
Preparations for FMEA, discussed in Vol. II, are agnostic to the methodology and document format chosen; the inputs cited are applicable to any available. In this installment of the “FMEA” series, how to conduct a “classical” Design FMEA (DFMEA) is presented by explaining each column of the recommended form. Populating the form columns in the proper sequence is only an approximation of analysis, but it is a very useful one for gaining experience with the methodology.
Failure Modes and Effects Analysis (FMEA) is most commonly used in product design and manufacturing contexts. However, it can also be helpful in other applications, such as administrative functions and service delivery. Each application context may require refinement of definitions and rating scales to provide maximum clarity, but the fundamentals remain the same.
Several standards have been published defining the structure and content of Failure Modes and Effects Analyses (FMEAs). Within these standards, there are often alternate formats presented for portions of the FMEA form; these may also change with subsequent revisions of each standard.
Add to this variety the diversity of industry and customer-specific requirements. Those unbeholden to an industry-specific standard are free to adapt features of several to create a unique form for their own purposes. The freedom to customize results in a virtually limitless number of potential variants.
Few potential FMEA variants are likely to have broad appeal, even among those unrestricted by customer requirements. This series aims to highlight the most practical formats available, encouraging a level of consistency among practitioners that maintains Failure Modes and Effects Analysis as a portable skill. Total conformity is not the goal; presenting perceived best practices is.
A Pugh Matrix is a visual aid created during a decision-making process. It presents, in summary form, a comparison of alternatives with respect to critical evaluation criteria. As is true of other decision-making tools, a Pugh Matrix will not “make the decision for you.” It will, however, facilitate rapidly narrowing the field of alternatives and focusing attention on the most viable candidates.
A useful way to conceptualize the Pugh Matrix Method is as an intermediate-level tool, positioned between the structured, but open Rational Model (Vol. II) and the thorough Analytic Hierarchy Process (AHP, Vol. III). The Pugh Matrix is more conclusive than the former and less complex than the latter.
An effective safety program requires identification and communication of hazards that exist in a workplace or customer-accessible area of a business and the countermeasures in place to reduce the risk of an incident. The terms hazard, risk, incident, and others are used here as defined in “Safety First! Or is It?”
A hazard map is a highly-efficient instrument for conveying critical information regarding Safety, Health, and Environmental (SHE) hazards due to its visual nature and standardization. While some countermeasure information can be presented on a Hazard Map, it is often more salient when presented on a corollary Body Map. Use of a body map is often a prudent choice; typically, the countermeasure information most relevant to many individuals pertains to the use of personal protective equipment (PPE). The process used to develop a Hazard Map and its corollary Body Map will be presented.
Many organizations adopt the “Safety First!” mantra, but what does it mean? The answer, of course, differs from one organization, person, or situation to another. If an organization’s leaders truly live the mantra, its meaning will be consistent across time, situations, and parties involved. It will also be well-documented, widely and regularly communicated, and supported by action.
In short, the “Safety First!” mantra implies that an organization has developed a safety culture. However, many fall far short of this ideal; often it is because leaders believe that adopting the mantra will spur the development of safety culture. In fact, the reverse is required; only in a culture of safety can the “Safety First!” mantra convey a coherent message or be meaningful to members of the organization.
Choosing effective strategies for waging war against error in manufacturing and service operations requires an understanding of “the enemy.” The types of error to be combatted, the sources of these errors, and the amount of error that will be tolerated are important components of a functional definition (see Vol. I for an introduction).
The traditional view is that the amount of error to be accepted is defined by the specification limits of each characteristic of interest. Exceeding the specified tolerance of any characteristic immediately transforms the process output from “good” to “bad.” This is a very restrictive and misleading point of view. Much greater insight is provided regarding product performance and customer satisfaction by loss functions.
Myriad tools have been developed to aid collaboration of team members that are geographically separated. Temporally separated teams receive much less attention, despite this type of collaboration being paramount for success in many operations.
To achieve performance continuity in multi-shift operations, an effective pass-down process is required. Software is available to facilitate pass-down, but is not required for an effective process. The lowest-tech tools are often the best choices. A structured approach is the key to success – one that encourages participation, organization, and consistent execution.
A person’s first interaction with a business is often his/her experience in its parking lot. Unless an imposing edifice dominates the landscape, to be seen from afar, a person’s first impression of what it will be like to interface with a business is likely formed upon entering the parking lot. It is during this introduction to the facility and company that many expectations are formed. “It” starts in the parking lot. “It” is customer satisfaction.
There is some disagreement among quality professionals whether or not precontrol is a form of statistical process control (SPC). Like many tools prescribed by the Shainin System, precontrol’s statistical sophistication is disguised by its simplicity. The attitude of many seems to be that if it isn’t difficult or complex, it must not be rigorous.
Despite its simplicity, precontrol provides an effective means of process monitoring with several advantages (compared to control charting), including:
Lesser known than Six Sigma, but no less valuable, the Shainin System is a structured program for problem solving, variation reduction, and quality improvement. While there are similarities between these two systems, some key characteristics lie in stark contrast.
This installment of “The War on Error” introduces the Shainin System, providing background information and a description of its structure. Some common problem-solving tools will also be described. Finally, a discussion of the relationship between the Shainin System and Six Sigma will be presented, allowing readers to evaluate the potential for implementation of each in their organizations.
Despite the ubiquity of corporate Six Sigma programs and the intensity of their promotion, it is not uncommon for graduates to enter industry with little exposure and less understanding of their administration or purpose. Universities that offer Six Sigma instruction often do so as a separate certificate, unintegrated with any degree program. Students are often unaware of the availability or the value of such a certificate.
Upon entering industry, the tutelage of an invested and effective mentor is far from guaranteed. This can curtail entry-level employees’ ability to contribute to company objectives, or even to understand the conversations taking place around them. Without a structured introduction, these employees may struggle to succeed in their new workplace, while responsibility for failure is misplaced.
This installment of “The War on Error” aims to provide an introduction sufficient to facilitate entry into a Six Sigma environment. May it also serve as a refresher for those seeking reentry after a career change or hiatus.
While Vol. IV focused on variable gauge performance, this installment of “The War on Error” presents the study of attribute gauges. Requiring the judgment of human appraisers adds a layer of nuance to attribute assessment. Although we refer to attribute gauges, assessment may be made exclusively by the human senses. Thus, analysis of attribute gauges may be less intuitive or straightforward than that of their variable counterparts.
Conducting attribute gauge studies is similar to variable gauge R&R studies. The key difference is in data collection – rather than a continuum of numeric values, attributes are evaluated with respect to a small number of discrete categories. Categorization can be as simple as pass/fail; it may also involve grading a feature relative to a “stepped” scale. The scale could contain several gradations of color, transparency, or other visual characteristic. It could also be graded according to subjective assessments of fit or other performance characteristic.
While you may have been hoping for rest and relaxation, the title actually refers to Gauge R&R – repeatability and reproducibility. Gauge R&R, or GRR, comprises a substantial share of the effort required by measurement system analysis. Preparation and execution of a GRR study can be resource-intensive; taking shortcuts, however, is ill-advised. The costs of accepting an unreliable measurement system are long-term and far in excess of the short-term inconvenience caused by a properly-conducted analysis.
The focus here is the evaluation of variable gauges. Prerequisites of a successful GRR study will be described and methodological alternatives will be defined. Finally, interpretation of results and acceptance criteria will be discussed.
There is a “universal sequence for quality improvement,” according to the illustrious Joseph M. Juran, that defines the actions to be taken by any team to effect change. This includes teams pursuing error- and defect-reduction initiatives, variation reduction, or quality improvement by any other description.
Two of the seven steps of the universal sequence are “journeys” that the team must take to complete its problem-solving mission. The “diagnostic journey” and the “remedial journey” comprise the core of the problem-solving process and, thus, warrant particular attention.
Of the “eight wastes of lean,” the impacts of defects may be the easiest to understand. Most find the need to rework or replace a defective part or repeat a faulty service, and the subsequent costs, to be intuitive. The consequences of excess inventory, motion, or transportation, however, may require a deeper understanding of operations management to fully appreciate.
Conceptually, poka yoke (poh-kah yoh-keh) is one of the simplest lean tools; at least it was at its inception. Over time, use of the term has morphed and expanded, increasing misuse and confusion. The desire to appear enlightened and lean has led many to misappropriate the term, applying it to any mechanism used, or attempt made, to reduce defects. Poka yoke is often conflated with other process control mechanisms, including engineering controls and management controls.
To effectively reduce the occurrence of errors and resultant defects, it is imperative that process managers differentiate between poka yoke devices, engineering controls, and management controls. Understanding the capabilities and limitations of each allows appropriate actions to be taken to optimize the performance of any process.
Every organization wants error to be kept at a minimum. The dedication to fulfilling this desire, however, often varies according to the severity of consequences that are likely to result. Manufacturers miss delivery dates or ship faulty product; service providers fail to satisfy customers or damage their property; militaries lose battles or cause civilian casualties; all increase the cost of operations.
You probably have some sensitivity to the effects errors have on your organization and its partners. This series explores strategies, tools, and related concepts to help you effectively combat error and its effects. This is your induction; welcome to The War on Error.
While the Rational Model provides a straightforward decision-making aid that is easy to understand and implement, it is not well-suited, on its own, to highly complex decisions. A large number of decision criteria may create numerous tradeoff opportunities that are not easily comparable. Likewise, disparate performance expectations of alternatives may make the “best” choice elusive. In these situations, an additional evaluation tool is needed to ensure a rational decision.
The scenario described above requires Multi-criteria Analysis (MCA). One form of MCA is Analytic Hierarchy Process (AHP). In this installment of “Making Decisions,” application of AHP is explained and demonstrated via a common example – a purchasing decision to source a new production machine.
The rational model of decision-making feels familiar, intuitive, even obvious to most of us. This is true despite the fact that few of us follow a well-defined process consistently. Inconsistency in the process is reflected in poor decision quality, failure to achieve objectives, or undesired or unexpected outcomes.
Versions of the rational model are available from various sources, though many do not identify the process by this name. Ranging from four to eight steps, the description of each varying significantly, these sources offer a wide variety of perspectives on the classic sequential decision-making process. Fundamentally, however, each is simply an interpretation of the rational model of decision-making.
Uses of augmented reality (AR) in various industries has been described in previous installments of “Augmented Reality” (Part 1, Part 2). In this installment, we will explore AR applications aimed at improving customer experiences in service operations. Whether creating new service options or improving delivery of existing services, AR has the potential to transform our interactions with service providers.
Front-office operations are mostly transparent due to customer participation. Customer presence is a key characteristic that differentiates services from the production of goods. Thus, technologies employed in service industries are often highly visible. This can be a blessing or a curse.
When we see or hear a reference to advanced technologies, many of us think of modern machinery used to perform physical processes, often without human intervention. CNC machining centers, robotic work cells, automated logistics systems, drones, and autonomous vehicles often eclipse other technologies in our visions. Digital tools are often overlooked simply because many of us find it difficult to visualize their use in the physical environments we regularly inhabit.
There is an entire class of digital tools that is rising in prominence, yet currently receives little attention in mainstream discourse: augmented reality (AR). There are valid applications of AR in varied industries. Increased awareness and understanding of these applications and the potential they possess for improving safety, quality, and productivity will help organizations identify opportunities to take the next step in digital transformation, building on predecessor technologies such as digital twins and virtual reality.
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