Bakgrund: På grund utav den ökade globala konkurrensen, den snabba teknologiska utveckligen och skiftet till ett kundorienterat synsätt, ställs högre krav på ständiga förbättringar inom verksamheter. Detta ställer i sin tur högre krav på effektiva processer och flöden. Genom att tillämpa Lean och verktyget Value Stream Mapping kan icke- värdeadderande aktiviteter, relaterade till slöserier, identifieras och minimeras för att maximera både material- och informationsflödet inom processer. Syfte: Syftet med denna studie är att identifiera slöserier inom Företagets inleverans- respektive utleveransprocess genom tillämpning av verktyget Value Stream Mapping. Vidare syftar studien till att urskilja rotorsakerna för respektive identifierat slöseri. Därefter avser studien att föreslå åtgärder som slutligen bidrar till att de identifierade slöserierna kan minimeras, alternativt elimineras. Metod: Studien baseras på en kvalitativ fallstudie av Företagets inleverans- respektive utleveransprocess, utifrån ett deduktivt angreppsätt. Den teoretiska referensramen utgår främst ifrån litterära källor från Linnéuniversitetets bibliotek samt vetenskapliga artiklar hämtade ifrån databaser. Empirisk data har samlats in under observationer samt semistrukturerade intervjuer. Urvalet av respondenterna utgår ifrån ett bekvämlighersurval som bottnar i ett snöbollsurval. Slutsatser: Utifrån de CSM som har illustrerats för inleverans- respektive utleveransprocessen kunde slöserierna väntetid, rörelse och överarbete identifieras, relaterat till icke-värdeadderande aktiviteter. Genom att undersöka dessa närmare identifierades rotorsaker layout, begränsade resurser och bristande rutiner. För att nå det tillstånd som beskrivs i FSM och minimera, alternativt eliminera, slöserierna har studien resulterat i följande förbättringsförslag; nedmontering av kontor och stängsel vid inleveransytan samt implementering av FIFU-system, implementering av 5S rapportering av felaktiga pallar och implementering av ett elektroniskt orderplockningsystem. / Background: As a consequence of the increased global competition, the rapid technological changes and the shift to a customer-oriented approach, it becomes more important with continuous improvements to achive efficient processes and flows. By applying Lean and Value Stream Mapping wastes can be identified, minimized in order to maximize both the material- and the information flow within a business process. Purpose: The purpose of this study is to identify wastes in a company’s inbound- and outbound process by applying the tool Value Stream Mapping. Furthermore, the study aims to identify the root causes and propose actions that contribute to minimize or eliminate the identified wastes. Method: The study is based on a qualitative case study of a company’s inbound- and outbound process. Empirical data has been collected during observations and semi- structured interviews. The theoretical framework is primarily based on literary sources that are retrieved from the Linnaeus University’s library and also scientific articles retrieved from databases. The selection is based on a convenience sample, a snowball sample. Conclusions: Based on the two CSMs that has been illustrated for the inbound- and outbound process, wastes were identified as waiting, motion and over processing, related to non-value added activities. By examining these wastes the root causes were identified as layout, limited resources and inadequate procedures. To reach the state described in the two FSMs by minimizing, or eliminating, the identified wastes, the study results in following proposals; dismantling of office and fence at the inbound area together with the implementation of a FIFU-system, implementation of 5S to report incorrect pallets and implementation of an electronic orderpicking system.

Epiroc har åtnjutit en längre period av kraftig tillväxt samtidigt som flertalet effektiviseringsprojekt har genomförts med syfte att öka produktionsvolymen för att möta marknadens efterfrågan. Detta genom att bland annat implementera en variant av Lean production – The Way We Produce. En av dessa förändringar är en takad flödesorienterad montering med just-in-time sekvenserad materialförsörjning. Detta har i sin tur ökat kraven på materialförrådet Logistikcenter (LC) där ledningen nu börjat undersöka möjliga effektiviseringsåtgärder. Därav är studiens syfte till att ta fram realiserbara förbättringsförslag för logistikverksamheten vid Logistikcenter tillhörande Epiroc Rock Drills AB i Örebro för att öka effektiviteten och leveranssäkerheten. Studien har genomförts i två faser; identifieringsfasen och fördjupningsfasen. Under identifieringsfasen genomfördes en kartläggning av nuläget i LC, där underlaget för kartläggningen baserar sig på intervjuer, observationer och analyser. Genom en rotorsaksanalys, med målet att identifiera källor till ineffektivitet, kunde nio förbättringsområden identifieras varav en av dessa vidare skulle utredas i fördjupningsfasen. Dessa utvärderades utifrån en effekt-insats matris för att välja det förbättringsområde med störst effektiviseringspotential i förhållande till den förväntande insatsen. Analysmodellen för effekt-insats matrisen var de åtta slöserierna i Lean (Petersson, et al., 2015), dess förväntade påverkan på effektiviteten samt den förväntade komplexiteten av en implementation. Resultatet från rotorsaksanalysen gav artikelklassificering som det primära förbättringsområdet där den undersökta åtgärden var en alternativ tillämpning av frekvensläggning för att minimera rörelsetiden mellan lagerplatser vid plock. Under fördjupningsfasen undersöktes den nuvarande artikelklassificeringen och frekvensläggningen genom syntes av en alternativ modell för klassificeringen av artiklar och lagerplatser utifrån en fördjupad litteraturstudie. För att undersöka om en alternativ klassificering kan öka effektiviteten utvecklades en utvärderingsmodell som modellerar rörelsetiden för historiskt data från plocklistor. Den användes för att testa vilken kombination av storlekar på artikelklasserna som gav den minsta möjliga totala rörelsetiden. En kombination av 60/30/10 % (A/B/C) av det ackumulerade antalet plock gav den lägsta totala rörelsetiden för en plockhistorik på 15 månader med en reduktion av rörelsetiden motsvarande 33 % (1760 h) jämfört mot nuläget. Vidare undersöktes en alternativ sortering av plocklistorna för automathissar respektive pallställage med utvärderingsmodellen som gav en reduktion på 4 % respektive 11 % mot nuläget. Slutligen undersöktes olika former på zonerna för klassificering av lagerplatser i pallställage W3, där utlämningsplatsen är placerad halvvägs in i ställaget. En tyngdpunkt placerat centralt mellan ingången och utlämningsplatsen gav det bästa simuleringsresultatet. Sammanfattningsvis fastställdes artikelklassificering som det förbättringsområde med störst realiserbar effektiviseringspotential med lägst komplexitet utifrån en rotsorsaksanalys. Epiroc rekommenderas att implementera klassificeringsmodellen med tre klasser av storleken 60/30/10 % (A/B/C) av den ackumulerade antalet plockrader, samt att implementera att den alternativa sorteringen av plockrader på plocklistor för pallställage. / Epiroc has had a long period of strong growth, where several efficiency projects have been implemented to increase production volume in order to meet market demand. A variant of Lean production has been implemented over several years – called The Way We Produce by Epiroc. A large part of that change has been the implementation of sequenced flow-oriented assembly with just-in-time sequenced material deliveries to the assembly floor. This, in turn, has increased the requirements for the warehouse Logistic Center (LC) and management has now begun to investigate ways to improve efficiency at LC. Hence, the aim of the study is to develop realistic improvement proposals for the logistics operations at Logistics Center of Epiroc Rock Drills AB at Örebro to increase efficiency and delivery reliability. The study has been conducted in two phases; the identification phase and the in-depth phase. During the identification phase, a mapping of the current situation in LC was carried out, where the basis for the survey is based on interviews, observations and analyzes. Through a root cause analysis, with the goal of finding sources of inefficiency, nine areas of improvement could be identified, one of which would be chosen for further investigation in the in-depth phase. The areas of improvement were evaluated with an effect-input matrix to choose the area of improvement that provides the greatest efficiency potential in relation to the expected effort. The analysis model for the effect-input matrix was the eight wastes of Lean based on Petersson et al. (2015), its expected impact on efficiency and the expected complexity of an implementation. The result of the root cause analysis gave article classification as the primary area of improvement, where the measure is an alternative slotting strategy to minimize the movement time between storage locations. During the in-depth phase, the current article classification and frequency setting were examined by synthesis of an alternative model for the classification of articles and storage locations based on an in-depth literature study. To investigate whether an alternative classification can increase efficiency, an evaluation model was developed that models the movement time from historical data from pick lists. It was used to test which combination of sizes for the article classes gave the smallest possible total movement time. A combination of 60/30/10% (A/B/C) gave the lowest total movement time for a picking history of 15 months with a reduction corresponding to 33% (1760 h) compared to the current situation. Furthermore, an alternative sorting of the pick lists for the vertical lift modules and pallet racking was examined with the evaluation model, which gave a reduction of 4% and 11% respectively. Finally, various forms for the zones were examined for the classification of storage locations in pallet rack W3, where the delivery site is located three-quarter way into the pallet rack. A center of gravity for the for the A-class placed between the entrance and the delivery point gave the best simulation result. In summary, the article classification improvement area was established with the greatest realizable efficiency potential with the least effort based on the root cause analysis. Epiroc is recommended to implement the classification model with three classes of size 60/30/10 % (A/B/C) of the accumulated number of picking rows, and to implement that alternative sorting of pick rows on picklists for pallet racking.

Research shows that, when unintentional harm to patients in outpatient and hospital settings occurs, root cause analysis (RCA) investigations should be conducted to identify and implement corrective actions to prevent future patient harm. Executives at a small healthcare consulting company that employs patient safety officers (PSOs) responsible for conducting RCAs were concerned with the low quality of RCA outcomes, prompting this postinvestigation assessment of PSOs' RCA training and experiences. Guided by adult learning theory, the purpose of this study was to assess PSOs' RCA training and investigation experiences by examining self-reported benefits, attitudes, barriers, and time since training, and the relationship between time since training and the number of barriers encountered during RCA investigations. This quantitative study used a preestablished survey with a purposeful sample of 89 PSOs located at 75 military health care facilities in the United States and abroad. Data analysis included descriptive statistics and Kendall's tau-b correlations. Results indicated that PSOs had positive training experiences, valued RCA investigations, varied on the time since RCA training, and encountered barriers conducting RCAs. Kendall's tau-b correlation analysis showed that the time since training was not significantly associated with the frequency of barriers they encountered. Findings suggest that the transfer of technical RCA knowledge was applied during actual RCA investigations regardless of time since training, and barriers contributed to subpar quality RCA outcomes. RCA professional development was designed to enhance nontechnical, soft competency skills as a best practice to overcome encountered barriers and promote social change in the field.

Purpose: Explore how historical data from a CMMS can be used in order to improve maintenance effectiveness and efficiency of activities, and investigate the possibilities for CBM in the manufacturing industry in the context of digitalization.  Research questions: RQ1: To what extent could condition-based maintenance or other maintenance types being used in order to predict, prevent or in other way eliminate historical breakdowns/faults?  RQ2: Which significance has an organization's degree of maturity to reduce the number of breakdowns?  Method: A case study was performed at Volvo Construction Equipment Operations in Eskilstuna, who manufactures machinery for the construction industry. The case study was compiled in two phases. Phase one was a quantitative study where raw data were collected from a CMMS and tabulated in order to later perform in-depth analysis. Phase two was designed to collect information that generated a wider understanding of the research area, by performing interviews and observations. A literature study was performed to compare the empirical findings with peer-reviewed information to ensure the quality of the study. The data is compiled and analyzed with an abductive approach. The analysis was followed by a discussion of how the research findings could support identifying possibilities of different maintenance types in the future.  Conclusion: The result showed that using historical breakdown data from a CMMS can be useful in order to identify organization’s current state and what possibilities different maintenance types have to decrease the number of breakdowns. To what extent the breakdowns can be decreased relies not only on the maintenance type but also an organizations maturity level. The case study´s result showed that by combining different maintenance types and increasing degree of maturity, Volvo could decrease the historical breakdowns with 86,5%. By only using CBM with current maturity level, 56% of the historical breakdowns could be predicted. However, to decide how many breakdowns that is cost-effective to prevent and precisely what maintenance type that should be used requires a cost analysis which this study is not covering.

Diplomová práce se zabývá návrhem procesů oddělení System Activation & Deactivation společnosti IBM Česká Republika, s.r.o. s cílem zlepšení těchto procesů a navýšení efektivity těchto procesů v rámci firmy.

Problem-solving ability is now the most sought-after trait in up-and-coming executives, according to a survey of 1 000 executives conducted by Caliper Associates, reported in the Wall Street Journal by Hal Lancaster (Hoenig, 2002:338). This trait would include the ability to solve human performance problems, something many people tend to steer clear of. According to Piskurich (2002:57-58) and Rothwell, Hohne and King (2000:67-71), the most common problem-solving tools that are used when solving human performance problems are brainstorming, cause-and-effect analysis, and the five why’s technique. Although techniques such as these have proven to be robust and useful, what is required to solve human performance problems is a logical and verifiable process that can establish a data point about which relevant information can be recognized and gathered, and against which the conclusion can be evaluated, to have confirmed knowledge of the root cause of the problems. Unfortunately, existing root cause analysis processes tend to focus on processes and systems, rather than on individual performance (Bowling, 2003). The main objective of this study was to develop a root cause analysis process that would uncover the root cause(s) of uncontrolled variation(s) in human performance and prevent the recurrence of events causing the variation. In addition to addressing individual human performance incidents, it is also necessary continually to manage people’s performance to detect and address any occurrences (or recurrences) of performance variations. Therefore, in addition to the main objective, the study also aimed to develop a Human Performance Management Model that incorporated the root cause analysis process as a problem-solving tool. Action research was used in this study, because of the cyclical iterative nature of this type of research, and because it is a rigorous, responsive and flexible process. The study consisted of three cycles. The end result was a structured root cause analysis process – the Human Performance Variation Analysis (HPVA) process – that enables the systematic collection of valid and reliable information, as is required to solve variation in human performance. The HPVA process is a three-part process that consists of 11 steps. The process is in turn a tool that forms part of a ten-step Human Performance Management Model. The study contributes to the body of knowledge on human performance management by presenting the following: • a systematic root cause analysis process that uncovers the root causes of human performance problems effectively and consistently and that controls these causes of problems in a way that prevents the problems from recurring; and • a Human Performance Management Model that will help to sustain the new, improved performance; prevent the same or similar performance problem(s) in other areas of the organisation; and ultimately, create an environment and culture of continuous human performance improvement. / Thesis (PhD)--University of Pretoria, 2009. / Human Resource Management / unrestricted

El presente trabajo se enfoca en la mejora de la calidad concerniente a los elementos estructurales de un centro comercial, a efectos de reducir y minimizar las No Conformidades más relevantes que se presentaron en obra. El proyecto se basó en la construcción y ampliación de locatarios de un centro comercial que tendrá como fin su alquiler. Mediante la aplicación del Análisis Causa Raíz y con las herramientas de diagrama de Ishikawa y diagrama de Pareto, se pudo encontrar las posibles causas del incumplimiento de la calidad en los elementos estructurales, las que subsecuente se validaron a fin de determinar acciones correctivas. En el primer capítulo se señala el planteamiento del problema, problemas principales, secundarios, justificación del estudio, limitación y los objetivos generales y específicos. En el Segundo Capitulo se señala el marco teórico, donde menciona la calidad en el Perú, la gestión de la calidad total, los costos de la calidad en la construcción, ingeniería de la calidad y definiciones. En el tercer capítulo se indica la utilización del Análisis Causa Raíz, las herramientas Diagrama Causa Efecto y Diagrama de Pareto. En el cuarto capítulo, se presenta el desarrollo del análisis de causa raíz mediante una secuencia de pasos. En el quinto capítulo, La Evaluación Económica, Presupuesto de obra, Costo de Reparación y Análisis del Gasto Incurrido. Finalmente, en el capítulo seis, se presentará las conclusiones y recomendaciones del presente trabajo. / This work focuses on quality improvement concerning the structural elements of a shopping center, in order to reduce and minimize the most relevant Non-Conformities that occurred on site. The project was based on the construction and expansion of tenants of a shopping center that will be rented as its purpose. By applying the Root Cause Analysis and using the Ishikawa diagram and Pareto diagram tools, it was possible to find the possible causes of quality noncompliance in the structural elements, which were subsequently validated in order to determine corrective actions. In the first chapter the problem statement, main and secondary problems, justification for the study, limitation and general and specific objectives are indicated. In the Second Chapter the theoretical framework is pointed out, where it mentions the quality in Peru, the total quality management, the costs of quality in construction, quality engineering and definitions. The third chapter indicates the use of Root Cause Analysis, the Cause Effect Diagram and Pareto Diagram tools. In the fourth chapter, the development of root cause analysis is presented using a sequence of steps. In the fifth chapter, The Economic Evaluation, Construction Budget, Repair Cost and Incurred Expense Analysis. Finally, in chapter six, the conclusions and recommendations of this work will be presented. / Trabajo de investigación

Diplomová práce se zabývá procesem vyhodnocování či poučení se z projektů, patřící mezi procesy projektového managementu, které umožňují projektovým manažerům zefektivňovat budoucí projekty. V této práci je využito teoretických znalostí a důkladné analýzy projektového prostředí a aktuální úrovně daného procesu pro vytvoření návrhu řešení, který cílí na odstranění identifikovaných nedostatků za účelem zefektivnění celého procesu.

Le Comité de Retour d’Expérience (CREX) est un dispositif de gestion de la sécurité des patients en équipe, engageant les professionnels de santé dans la pratique collective de l’analyse des causes racines des événements indésirables associés aux soins. Ce dispositif, développé en France en 2005, est désormais implanté dans la majorité des établissements de santé français. Curieusement, après 10 ans de développement dans des milliers d’équipes médicales, aucun travail scientifique publié ne s’était penché sur leur fonctionnement et leurs effets sur la sécurité des patients. Mon travail de thèse a permis d’évaluer le fonctionnement des CREX, ainsi que leur association aux dimensions de la culture de sécurité des professionnels de santé. Nous avons montré que les CREX sont appropriés pour fonctionner dans les diverses spécialités d’un établissement de santé. De plus, ce dispositif permet aux soignants de réaliser des analyses des causes racines, et de décider collectivement d’actions visant à corriger les défaillances profondes des organisations. Afin d’étudier les relations entre la participation à un CREX et les dimensions de la culture de sécurité des soignants, nous avons effectué une enquête auprès de 3888 professionnels de santé, en utilisant le questionnaire Hospital Survey On Patient Safety Culture (HSOPS), dont nous avons précisé les propriétés métrologiques (psychométrie, variabilité des méthodes d’agrégation des scores, méthodes d’imputation des données manquantes). Nous avons mis en évidence des relations favorables entre la participation à un CREX et la culture de sécurité des soignants. Les CREX permettent de favoriser le travail en équipe, la multidisciplinarité, ainsi que de modifier la culture de l’erreur. Malgré ses limites, notre travail contribue à mieux connaitre les CREX et leur place dans les dispositifs de gestion de la sécurité des patients. Cette thèse plaide pour le développement d’une recherche centrée sur l’implication des professionnels de santé dans la gestion de la sécurité des patients. / The Experience Feedback Committee (EFC) is a tool designed to involve medical teams in patient safety management, through root cause analysis of adverse events within the team. This program was created in 2005, and was implemented in the vast majority of French hospitals. Despite its wide implementation in thousands of French medical teams, the EFC still lacks scientific evaluation. To our knowledge, the EFC framework and the association between EFC and patient safety culture have never been assessed. In this context, our work aimed to determine whether patient safety culture, as measured by the Hospital Survey On Patient Safety Culture (HSOPS), differed regarding care provider involvement in EFC activities. Using the original data from a cross-sectional survey of 3,888 employees at a single university hospital in France, we analyzed the differences in HSOPS dimension scores according involvement in EFC activities. We also specified the metrological properties of the transcultural adaptation of the HSOPS into French (psychometrics properties, variability of scoring strategies and missing data imputation methods). Our findings suggest that EFC participation may improve patient safety culture, teamwork and non-blame oriented processes. Despite several limitations, our study contributes to a better understanding of EFC and its position amongst patient safety systems. This thesis advocates research developments centered on health care givers involvement in patient safety management.

Cloud datacenters comprise hundreds or thousands of disparate application services, each having stringent performance and availability requirements, sharing a finite set of heterogeneous hardware and software resources. The implication of such complex environment is that the occurrence of performance problems, such as slow application response and unplanned downtimes, has become a norm rather than exception resulting in decreased revenue, damaged reputation, and huge human-effort in diagnosis. Though causes can be as varied as application issues (e.g. bugs), machine-level failures (e.g. faulty server), and operator errors (e.g. mis-configurations), recent studies have attributed capacity-related issues, such as resource shortage and contention, as the cause of most performance problems on the Internet today. As cloud datacenters become increasingly autonomous there is need for automated performance diagnosis systems that can adapt their operation to reflect the changing workload and topology in the infrastructure. In particular, such systems should be able to detect anomalous performance events, uncover manifestations of capacity bottlenecks, localize actual root-cause(s), and possibly suggest or actuate corrections. This thesis investigates approaches for diagnosing performance problems in cloud infrastructures. We present the outcome of an extensive survey of existing research contributions addressing performance diagnosis in diverse systems domains. We also present models and algorithms for detecting anomalies in real-time application performance and identification of anomalous datacenter resources based on operational metrics and spatial dependency across datacenter components. Empirical evaluations of our approaches shows how they can be used to improve end-user experience, service assurance and support root-cause analysis. / Cloud Control (C0590801)