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1、,Cause and Effect Analysis 因果分析,Learning Objectives 学习目标,What is the relationship between Cause and Effect 原因和结果之间的关系 What is Root Cause 什么是根因 Span Of Control and Sphere Of Influence 控制的跨度和可影响的范围,Brainstorming -Techniques 头脑风暴方法 Two type C&E analysis: 因果分析的两种工具 ： Fishbone Diagrams 鱼骨图 Cause and Effe
2、ct Matrix 因果矩阵,Learning Objectives 学习目标,How to Improve Your Process Effectively . . 如何有效地实施过程改善,Identify the characteristics of the process input and process Output in order to: 确定输入和输出特性，一旦测量后使你能够：,KEY PROCESS OUTPUT VARIABLES 关键过程输出变量,KEY PROCESS INPUT VARIABLES 关键过程输入变量,5,Have a better focus of y
3、our efforts and resources 更明确努力的方向 Solve process problems that will lead to improvement to current process performance 将现行过程的绩效与团队可解决的问题关联,Definition of Defect 缺陷的定义,The Six Sigma methodology is a systematic breakthrough solution to reducing NONCONFORMANCES that affect the customer. 6 SIGMA方法是以系统的突破
4、性解决方案减少影响客户满意 的不符合项 Since own objective is to reduce nonconformances, each improvement projet must clearly define the nonconformance that will be reduced. 由于6 SIGMA主要目标是解决不符合项，因此每个改善项目必须明 确定义可以减少的不符合项,Definition of Defect 缺陷的定义,3 Categories of Nonconformances : 不符合项有三种分类,Error: Results when an activ
5、ity/action does not comply with a standard 错误：活动不符合标准的要求 Defect: Results when a characteristic does not conform to a standard 缺陷：特性不能符合标准的要求 Fault: Results when a characteristic does not perform to a standard 故障：特性不能达到标准的要求,Cause-Effect Relationship 原因-结果关系,CAUSE原因 Events/conditions that led to the
6、problem 导致问题的事件/条件,EFFECT结果 Symptoms that provide evidence of the problem 提供问题证据的症候,Eliminates the CAUSE of a problem 消除问题的原因 CORRECTIVE 纠正措施,ADAPTIVE 应变措施 Limits the EFFECT of a problem or deviation 限制问题或偏差的效果,Dave Wessel, “An Ounce of Prevention”, Quality Progress, Dec, 1998,ACTION 行动,A PROBLEM WH
7、ICH HAS OCCURRED 已发生的问题,2 Most Commonly Used Tools for Cause-Effect Analysis 两种最常用的因果分析工具,Fishbone Diagram A useful tool to brainstorm and display diagramically the relationships between a primary effect and its causes 鱼骨图- 头脑风暴术和原因- 结果关系图的传统工具。当有一主要结果需要分析时是一很好工具。 Cause & Effect Matrix A table showi
8、ng the direct relationships between inputs (Xs) and outputs (Ys). 因果矩阵 显示输入（X）与输出（Y）之间关系的表格图,What is a Cause-Effect Diagram 什么是因果图？,Also known as Ishikawa diagram, Fishbone diagram. A very useful graphical tool that can be used to identify, display, and examine possible causes of any observed condit
9、ions. 用于识别，展示，检查任何事情的可能原因的非常有用的图形工具。 It enables the improvement team to focus on the key areas of the problem 使团队注意力放在问题的关键领域上 It display the collective knowledge of the whole improvement team 它展示团队的集体智慧,It draws consensus to the causes of a problem 它使大家对问题的原因看法一致 It provides the basis for recommend
10、ing solutions 它提供对解决方案的依据 It enables the improvement team to focus of the problem on causes not symptoms 它使团队注意力放在问题原因 (Xs) 而非症候上 (Y),What is a Cause-Effect Diagram 什么是因果图？,Why Use Cause-Effect Diagrams ? 为何使用因果图,To identify the most probable causes for further analysis 为未来的分析揭示尽可能多的原因 To graphicall
11、y display possible relationships between causes for any problem current or future 为现在或将来的问题及及其原因之间建立可能的联系 To pinpoint conditions causing customer complaints, process errors or non-conforming products 指出产生客户抱怨、过程错误或不合格产品的条件,Why Use Cause-Effect Diagrams ? 为何使用因果图,To provide focus for investigation 提供
12、调查的关注焦点 To aid in development of technical or other standards or process improvements 协助技术或其它标准的改进或过程改善,Fishbone Diagram “鱼骨”因果图,The effect to the analyzed is drawn at the right hand side of the diagram, at the end of a diagram. Each category of potential causes will the drawn as branches to the arr
13、ow. All possible causes for each branch are then added to the branches. 要分析的结果放在图的最右端大箭头处。可能原 因的主分类画在箭头的分支处。对每一个分支，列出所有可能的原因,“Fishbone” Diagram “鱼骨”因果图,Advantages 优点 Helps organize and categorize causes 协助组织和关联各因素 Provides a flame work for brainstorming 提头脑风暴的结构 Involves every team member 全员参与,“Fish
14、bone” Diagram “鱼骨”因果图,Disadvantages 缺点 May become too complicated 可能非常复杂 Time consuming 消耗时间 The causes are not ranked in any order 不能将原因以“如果那么”的形式列出,Construction of a Fishbone Diagram 因果图的构造,C = Control Factor 受控因素 N = Noise Factor 噪声因素,Use The Fishbone Diagram to Identify Single Out Variation Sour
15、ces within the “5Ms + E” 用因果图在“5M1E”中选出变异源,Five Main Sources of Variation 5个关键变异源,Manufacturing Process : 5M & 1E 生产过程： 5M & 1E,Example: Manufacturing Process 生产/制造的例子,*,Example: Manufacturing Process 产品/制造的例子,Use The Fishbone Diagram to Identify Variation Sources within the “4Ps + M&E” 用因果图在“4PME”中
16、选出变异源,Five Main Sources of Variation 5个关键变异源,Transactional Process : 4P&1M &1E 营运, 服务过程 : 4P&1M &1E,Example: Transactional Process 营运, 服务实例,沟 通,技能,关错货,运 输,程 序,Root Cause 根本原因,Cause-Effect Analysis is to identity the undesired situation and to find its underlying causes. 因果分析基于我们可以识别不希望 出现的情况，并一直追踪到根
17、本的原因。 The cause to an effect is the effect of another cause, and so on. How do we know where to stop ? 如此之多的因果层，我们怎么知道在何处停止？,Have we really found the ROOT CAUSE ? 我们到底是否真的找到了根本原因？,I f we trace along the chain of cause and effect, the root cause is the cause at the lowest layer ,this is the cause we
18、are able to resolve 根本原因是因果链最底部的原因，这是我们有能力解决的原因。,Getting to Root Cause 挖掘根本原因,Root cause is the lowest layer cause which we are able to change or break 根本原因是我们能够改变或破解的最低层原因 These are the cause we are capable to control, change or influence. 在我们的能力范围内可单方面控制、影响或改变的原因 We shall keep on asking “why” when
19、 a problem is identified,until we reach the root cause. 一旦定义了问题，就连续问“为什么”，直到挖掘到根本原因,Getting to Root Cause 挖掘根本原因,If there are a few potential causes to a problem, we must analyze every cause. 如果问题有多个潜在的原因，必须对每个原因进行分析 The team must determine which causes are within its Sphere of Control and Sphere of
20、 Influence. 确定哪些原因在控制范围内或影响范围内,Span of Control / Sphere of Influence 控制范围/影响范围,The scope and context of the cause-Effect analysis must be determined first 。 在进行因果分析之前，首先要决定分析的范围及其上游和下游领域。,Span of Control / Sphere of Influence 控制范围/影响范围,Span of Control 控制范围 Areas within which we can change anything,
21、i.e. we have direct control over products, processes and activities . 受我们直接控制的领域，我们可改变任何东西，如，产品、制程或活动。 Sphere of Influence 影响范围 - Areas within which we cannot have direct control ,but can have some influence. 不受我们直接控制的领域，但我们能够对其产生某些影响。 External Environment 外界环境- where we have neither control nor inf
22、luence. 我们不能控制也无法影响的领域。,EXTERNAL , UNCONTROLLED ENVIRONMENT,Description : Cause & Effects Matrix 描述 ：因果矩阵,Based on the process map as major input, relate and prioritize Xs to customer and Ys through numerical ranking. 使用过程图作为主要的输入，通过排序将X与客户和Y联系起来。 Ys are scored according to their importance to the c
23、ustomer 根据对客户的重要性给Y打分。 Xs are scored according to their relationship to the outputs 根据与输出的关系给X打分。,Cause & Effects Matrix 因果矩阵,RESULT : Assign the Xs in a Pareto diagram. This can be a starting point for KPIV evaluation 结果 ： X的排列图，可用作关键过程输入变量（KPIV）评估的起始点。 Rank the X,Y numerical. Assign importance to
24、each X&Y 对X,Y进行排序，给每对变量(X,Y)赋重要度 This is the teams first attempt to establish Y = f(X) 团队建立 Y = f(X) 的第一次尝试,Critical To . Characteristics 关键是 特性,What is critical to the customer: 对客户来说的关键是： Quality 质量 Cost 成本 Delivery 交货,The Customer Supplier Interaction 客户与供应商的相互关係,We strive for Six Sigma capabilit
25、y on Cycle Time, Cost, and Conformance to meet customer expectation on Delivery, price, and Quality. NEED DO INTERACTION 我们力求6 Sigma的能力在作业周期、成本及符合方面能达到顾客对交货、价格及品质的期望。需要与做的相互关系,Supplier 供应商,Customer 客户,Quality 品质,Delivery 交货,Price 价格,Defects 缺陷,Cycle Time 作业周期,Cost 成本,Cause & Effect Matrix 因果矩阵,The M
26、ethod 方法,List the output variables (Ys) along the top section of the matrix. These are outputs which the team and/or the customer deem to be important. These may be a subset of the list of Ys identified on the process map. 在表格上部列出输出变量Y。 这些输出是团队/客户认定是重要的。可能是在过程图中确定的Y的子集。 Rank each output numerically
27、using an arbitrary scale (possibly 1 - 10). The most important output receives the highest number. 用任意标度排列每个输出（可能是1-10）。 最重要的输出得分最高。,The Method 方法,Identify all potential inputs or causes (Xs) that can impact the various Ys and list along left hand side of the matrix. 确定影响Y的所有潜在的输入或原因(X)，列在矩阵的左边 Nume
28、rically rate (correlate) the effect of each X on each Y within the boundary of the matrix. This is based on the experience of the team. 在矩阵的边界内用数字(关联度）列出每个X对每个Y的影响。 Use the totals column to analyze and prioritize where to focus your effort when creating the preliminary FMEA. 用每列的总计分析和排列在初步实施 FMEA 时的
29、关注点,C&E Matrix : Step 1 C-E 矩阵 : 步骤 1,1. List key outputs (Ys) 列出关键输出(Y),C&E Matrix : Step 2 C-E 矩阵 : 步骤 2,2. Rank outputs with respect to customer importance 用对客户的重要性排列输出,C&E Matrix : Step 3 C-E 矩阵 : 步骤 3,3. List key inputs 列出关键输入,Input Variables,C&E Matrix : Step 3 C-E 矩阵 : 步骤3,You are ready to co
30、rrelate customer requirements to the process input variables 现在已准备好了将客户要求与过程输入变量关联 Allow sufficient time for assignment of scoring 留足够时间评分 Avoid confusion and inconsistency by establishing scoring criteria: 建立评分标准，避免混乱与不一致,C&E Matrix : Step 3 C-E 矩阵 : 步骤3,0 = No correlation 无关 1 = The process effect
31、 only remotely affects the customer requirement 过程结果对客户要求仅有微小的影响 3 = The input variable has a moderate effect on the customer requirement 输入变量对客户要求有中度影响 9 = The input variable has a direct and strong effect on the customer requirements 输入变量对客户要求有直接和重大影响,C&E Matrix : Step 4 C-E 矩阵 : 步骤 4,4. Relate Xs
32、 to Ys 将X与Y关联,Output Variables 输出变量,C&E Matrix : Step 5 C-E 矩阵 : 步骤5,5. Prioritize the input(X) 将X排优先次序,Output Variables 输出变量,More Example On C-E Matrix 因果矩阵例子,Example: Coffee Shop 例子：咖啡厅 A black belt at a local coffee shop wants to improve customer satisfaction with the coffee they serve. 一个黑带欲改善一间
33、咖啡厅的客户满意度 The team has completed a process map and they are ready to create a C&E matrix to identify the inputs that have the largest impact on customer satisfaction. 项目小组制定了过程图，并准备填写因果矩阵以识别对客户满意度有重大影响的过程输入,Example: Coffee Shop Process Map 例子：咖啡厅过程图,Clean Carafe,Fill Carafe w/Water,Pour water into M
34、aker,Place Filter in Maker,Put Coffee in Filter,Turn Maker on,Select Temperature Setting,Inputs,Hot water Soap Scrubber,Clean Carafe Cold Water Measuring Mark,Full Carafe,Filter,Cleaned Carafe Dirty Water Wet Scrubber,Full Carafe,Filled Maker Empty Carafe,Maker w/Filter,Maker w/Filter & Coffee,Opera
35、ting Maker Heat Brewed Coffee,Hot Clffee,Maker w/Filter Fresh Coffee Dosing Scoop,Maker w/Filter & Coffee,Brewing Coffee,Outputs,Inputs,Outputs,Receive Coffee Order,Pour Coffee into Cup,Offer Cream & Sugar,Complete Transaction,Say Thank You,Customer Order Size Specification,Complete Order,Filled Cup
36、,Complete Order Hot Coffee Cup,Filed Cup Customer Cream Sugar Amount Desired,Customer Reply Amount Specified Complete Order,Complete Order Money,Make Change Temperature Taste Strength,Coffee Delivery,Smile Happy Customer,Example: Coffee Shop 例子：咖啡厅 We will use the focused approach to help us narrow
37、our efforts to the process steps having the most impact on customer satisfaction. 我们的焦点将集中在对客户满意度有重大影响的过程步骤 We will limit this example to 3 key outputs. However, we could also look at other aspects of customer satisfaction. 在此案例中我们只讨论3个关键输出，但我们也可以探讨客户满意度的其他方面 We could consider speed of service, frie
38、ndliness, accuracy, etc. 我们可以考虑服务速度、友善程度、准确程度等,Example: Coffee Shop 例子：咖啡厅,Process Outputs 过程输出,Example: Coffee Shop 例子：咖啡厅,Importance Rating, A higher score indicates the output is more important to the customer. 重要度评分，高分数代表该输出对客户更加重要,Example: Coffee Shop 例子：咖啡厅,Process Steps 过程步骤,Example: Coffee S
39、hop 例子：咖啡厅,Process Step Correlation Scores. A higher number indicates stronger correlation. 过程步骤相关性评分,高分数代表相关性较高,Example: Coffee Shop 例子：咖啡厅,Process Step Total Scores 过程步骤总评分,Example: Coffee Shop 例子：咖啡厅,Defect Count Percent Cum%,Fit Carafe with water,Put Coffee in Fitter,Offer Cream & Sugar,Select T
40、emperature Setting,Pour Coffee into Cup,Clean Carafe,Place Fitter in Maker,Tum Maker On,Complete Transaction,Others,144 144 132 120 52 36 36 34 24 22 19.4 19.4 17.7 16.1 7.0 4.8 4.8 4.6 3.2 3.0 19.4 38.7 56.5 72.6 79.6 84.4 89.2 93.8 97.0 100.0,100,200,300,400,500,600,0,700,100,80,60,40,20,0,Count,P
41、ercent,Pareto Chart for Step 柏拉图,Conclusion For The C-E Example: Coffee Shop 咖啡厅案例结论,The pare to chart shows us that 4 process steps have the most impact on our process outputs. 柏拉图显示有4个过程步骤对过程输出影响最大 Fill carafe with water. 注水入咖啡瓶 Put coffee in filter. 将咖啡放入过滤袋 Offer cream and sugar. 送上糖和奶 Select temperature setting. 选择温度设定 We would follow this up with another C&E matrix using the process inputs from these 4 process steps. 我们将进一步用以上4个过程步骤的输入填写另一个因果矩阵 High ranked process inputs would then be evaluated with FMEA. 得分高的过程输入将用失效模式与效果分析（FMEA）作进一步评估,