Thomas Doyle  MSc.


Examples of Root Cause Analysis (RCA) Before, During and After Production:

​​​​​​​Background: Very popular movie themed toy premium becomes more collectible.
Requirement: Ship popular toy premiums faster while movie is still in theaters.  Third Party Test Lab hired by Client to monitor and test production before shipments.
Action Items: During Chinese New Year holiday, factory continued manufacturing to ship production earlier while the client hired third party test service to monitor production and perform pre-shipment testing. 

Root Cause Analysis (RCA):

1) Identify and define the problem.

Spinning toy with outer shells that open and close during use, sudden had shells fly off the toy during normal use.  Client expressed concerns of projectile hazard even though their hired third party test service conducted pre-shipment product safety testing that passed.

2) Collect Data

Attempts made to collected information from overseas stakeholders (Hong Kong staff, factory manager), however the initial incidents happened during the beginning of Chinese New Year when most staff and factory managers were off duty.

Client called their hired 3rd party testing service to request them to collect data.

3) Determine causal connection by asking "why".

Overseas stakeholders explained that the local factory manager requested permission to trim plastic critical dimension on "break away" design to make it easier and faster for workers to assemble.  However, if it is easier to go on it is easier to come off.  This break away design had critical dimension. The overseas stakeholders claim client hired third party test lab approved trimming the plastic which was the root cause of defects.

Client hired third party test lab service preformed pre-shipment tests and passed the defective product with trimmed critical dimensions.

4) Identify Corrections

The client third party lab service recommend to the client that they provide 100% inspection with function test to assess which unit were safe.

However, the root cause was that critical dimensions where randomly altered (i.e. trimmed). It was impossible to sort out defects because all the products were altered.  The "client hired third party test service" (CHTPTS) allowed the factory to trim these critical dimensions and conducted pre-shipment testing which passed.  The stakes were high to salvage a portion of this very popular toy.

5) Monitoring  and Logging

The "client hired third party test lab service"  retested with a new enhanced focus on projectile risk after sorting and 100% inspection with function testing and found shells still flew off during normal use.

6) Implementation

The product production lot was rejected due to the altered product specification without US based headquarters approval. 

7) Communication

​The client accepted their "client hired third party test lab service" recommendation.


A request was made locally to trim plastic components to ease assembly to improve through put.  However, the decision should have been evaluated and approved by US based management who hired the contract manufacturer.
Results: Modified component (trimmed part) was easier to assemble in the factory, however it changed the functionality by allowing the component to come off when in play mode.  US management  learned of this design modification after it passed third party testing and shipped to US market.
Lesson Learned: Example how third party service allowed a design modification to speed production without informing the contract manufacturer.

Background: Flag artwork PMS colors.
Requirement:
Action Items:
Results:
Lesson Learned:

Background: .Pre-wrapped gift, dropped test.
Requirement:
Action Items:
Results:
Lesson Learned:

Background: Importance to determine which party pays for corrective actions and air freight expense to meet delivery due dates.
Requirement:
Action Items:
Results:
Lesson Learned:

Background:Quality Control
Requirement:
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Results:
Lesson Learned:

Background: .Repeatability
Requirement:
Action Items:
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Lesson Learned:


Background:Rational Ignorance
Requirement:
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Lesson Learned:

Background: Customer Service Incident Database records reported a cluster of Fitness Digital Devices with feature functionality defects,  The cluster of incidents were reported from a correctional facility who received donated product .  When the product was used the same way by a group an otherwise hard to find  IC program defect was discovered.
Requirement:
Action Items:
Results:
Lesson Learned:

Background:  Fitness digital device
Requirement:
Action Items:
Results:
Lesson Learned:


Background: Post Mortem Analysis
Requirement:
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Lesson Learned:




Root Cause Analysis (RCA)