Quality Management

ASSIGNMENT

S.No ROLL NUMBER NAME

9
Q1. Multi Sigma Corp. has a process they believe is operating near a six-sigma level and
want to verify this. If the specification for a critical part in the process is 2.80cm ± 0.10 and
the standard deviation for the process is 0.02, at what sigma level is the process operating.

Ans :

Mean µ = 2.80 cm

Standard Deviation = 0.02 cm

Upper Specification Level = 2.80 +0.10 = 2.9 cm

Lower Specification Level = 2.80 – 0.10 = 2.7 cm

Sigma can be checked with following formula: k X σ = (USL-LSL)/2

k X 0.02 =(2.9 -2.7)/2

k = 0.1/0.02

k =5

This means that the process is operating at 5 Sigma level.

Q3. During one month, Invoco processed 25000 invoices of Alpha corp, 23000 for Beta Corp and 8000
for Gama Corp. Of these 205 of the Alpha, 175 of the Beta and 103 of the Gama invoices had to be
reprocessed for errors. What is the overall nonconformance rate and the sigma level for all the
combined batches? For individual Batch?

Ans.

Overall Nonconformance:

Finding the probability of Defects = Total Number of errors divided by total number of invoices.

= (205+175+103)/ (25000+23000+8000)

= 483/56000

=0.008625

i.e. Non-Conformance rate = 0.8625%

Now, Finding the sigma level for combined batches, we use the formula in excel:

= NORM.S.INV((1-p(defects))+1.5

=3.88 Sigma level.

This shows that there is more scope for improving the processes to achieve 6 Sigma.
Q5. Nanos Electron Inc manufactures 75,000 circuit boards per month. A random sample of 800
boards is inspected every week for three characteristics. During the recent week, 4 defects were
found for 1 characteristic,2 defects were found for another characteristic, and three defects were
found for the third characteristic. If these inspections produced defect counts that were
representative of the population, what is the overall sigma level for this process? What is the sigma
level for all characteristics that showed 4 defects?

Ans.

Overall Sigma Level

Let us find the probability of defects or Nonconformance = (4+2+3)/800 = 0.01125

Using the normal curve, and excel formula - NORM.S.INV (1 – p(defects)) +1.5 we get.

= 3.78 Sigma Level

Level that showed defects is characteristic 1:

P(defects) = 4/800 = 0.005

Sigma Level using NORM.S.INV(1-0.005))+1.5 = 4.08 Sigma Level.

Q7. Verasource Microprocessor Corporation (VMC) sells 2000 specialized microprocessor chips
each month at a price of $1,500 each. Variable costs amount to $1500000 and fixed costs are $500000.
Currently the company has a defect rate of 8 percent (which are chips returned by customer, scrapped
by VMC, and replaced). Note that the variable costs include the cost of producing the defective chips.

a. What is the hidden cost to the company of making this rate of defectives instead of 2,000
good chips each month?
b. Suppose a six-sigma effort can reduce the defects to a six-sigma level (assume for simplicity
that the defective rate is essentially zero). What is the impact on the profitability?

Ans.

a. If 2000 are the accepted good chips sold, then the probability of acceptance = 1-0.08 = 0.92
There the company will have to produce = 2000/0.92 = 2174 units.

That means the firm produces 2174 units of which 2000 can be sold in the market.

The variable cost includes the cost of defective pieces.

Hence cost of 2174 units = 1500000/2174 = 689.97 or $690.

Therefore, hidden cost of company = 174 (2174-2000) X 690 = $ 1,20,055. It incurs this cost-on
chips that cannot sold.

b. This can actually be solved to check the how much the profitability will increase if there are no
defects.

With 8% Defective Rate With No Defects

Sales = 2000 *1500 3000000 3000000
Variable cost
Defective = 2174 X
690
No Defects = 2000 X
690 1500060 1380000
Fixed Costs 500000 500000
Net Profit 999940 1120000
Profit % 33% 37%
Change 12.01%

Here, we can clearly see that profits increase to 37% from current 33% if there are no defects.
In other words, there is 12% increase in profits if the company will follow six sigma.
 BLACK ELK CENTER

Q. Suppose that you were consulting for this organization. What would your next steps be? How
would you use data gathered from the checklist? How would you design improved processes and
systems to improve and control the incidence of falls, and to reduce the fall rate effectively and
rapidly to be below 3.4 falls/1000 patient days?

For any given healthcare organization, patient safety is the main concern. Falls though are sudden, can
be avoided by using infrastructure that reduces the risks of falls. Considering that Black Elm Medical
Center caters to people who are 65+ years of age, it becomes even more crucial and becomes a major
challenge to provide a safe environment overall. Falls were common occurrences reported in hospitals
leading to death, serious injuries, or fractures.

If I were in the consulting board, my first step would be to conduct both primary research and secondary
research to understand all possibilities and case studies of how this might have been implemented in
any other health care hospitals. The next probe will be the cost benefit analysis, evaluating the benefit
for the cost incurred. Post which a proper bulletin with all protocols will have to be circulated and
followed diligently. Training for the staff if necessary to be conducted. These actions would in turn
reduce the no. of falls resulting in the benchmark rate of 3.4 falls/1000 patient days.

Step 1: Inspection of the premises

The starting point of the consultation is the inspection of the three Black Elm Hospital/Healthcare
premises. This is to be done via the DFMEA Approach. The Design Failure Mode and Effect analysis
would help to identify a score for each of the inspection points where potential fall risk can be seen. This
will help us to understand any external physical factor that can cause any falls and immediate action can
be taken on them. Areas of the occurrence rating can be cordoned off and should be done immediately.
This step essentially will help in finding potential hazardous points (ranking severity in rating)/ places
that can be paid attention to immediately.

Step 2: Collecting Primary Information.

After inspection, speaking to doctors/ patients/ nurses will help us understand why people fall. The
cause of a fall can be governed by several factors. To device what safety steps should the Black Elm take,
it is necessary to analyze the causes of these incidents. These factors can both be intrinsic or extrinsic.

To cite an example of an intrinsic factor, it could be poor vision due to aging, or chronic conditions
because of aging, balancing issues, muscle strength, slow thinking, and response etc. Extrinsic factors
are those whose risk can be reduced by elderly safety infrastructure. Hallways, passages, bathrooms are
main areas where falls occur frequently. This step will substantiate with step 1 and confirm if the
extrinsic factors identified are the same.

Step 3: Analyze recorded data.

In this step, both primary and secondary data is crucial to finalize the next steps and course of
action. The checklist- a document that is maintained for any injury that happens because of a fall is
the most crucial data set to understand the accurate reason for falls. Input on the fall prevention
program from important stakeholders, including patients, nurses, and clinicians, and discuss any
upcoming issues or possibilities.

Let us understand the important points that will come out from this checklist:

FALL CHECKLIST (To be done on all falls)

1. Patient Diagnosis: This will help us to understand the nature of medication given. if the
medication affects the level of consciousness, then the patient should be advised to remain in
one place until the medication effect reduces.
2. Number of days for which the patient was in hospital: If accidents are happening within a
couple of days of admission, it may mean that patients don’t have a map or floor plan and may
not know location well and hence the fall. If accidents are happening after 7 days of admission,
then an extra probe is required to understand why the situation is occurring.
3. Patients fall risk level on day of admission: This is an important question. If the patient is
under risk of fall, for any intrinsic factor, then protocols for the same must be taken into
consideration.
4. Was there a STAR up: Substantiates question 4. To be made as a protocol
5. Was fall risk level on the patients care map: If the answer to this question is a yes and yet the
fall occurred, then the external factors need to be probed thoroughly.
6. Did the patient have safety socks? - This also reveals the acceptance of the patient towards
wearing safety devices.
7. If necessary, a walker/cane at bedside: This is an important protocol.
8. Number of side rails up: Again, important protocol
9. Was patient in restraints: Important Protocol
10. Was bed alarm in use: Important Protocol
11. Was any family at bedside: Most important protocol
12. Mental health of the patient: Important to note the intrinsic factor
13. Patient to nurse ratio: This can help to understand if the nurses are overloaded or not. Timing
of the fall will help to understand if it's sleep related/ light reflection related etc.
14. Brief description will give more insights for qualitative analysis for example:

● What kinds of falls occur most frequently?

● Which fall-related risk factors are most prevalent?
● Which units experience the highest rates of fall?
● Which patients are most vulnerable to falls?

Step 4: Taking Corrective Action

A. The first step is making people aware of how falling can cause such disastrous consequences .

1. Informing and educating patients and their family members in how to prevent falls and train
them in case of any such incident happens.
2. Being observant of any such conditions that are unsafe and risky, loose tiling, carpet loose ends,
spilled water on the floor etc.
 3. Notify the same to the concerned Spoc Viz. Maureen Hebert to take necessary actions.
Cordon off that area in case necessary.

4. . Examining and updating the fall risk assessment procedure to ensure it is thorough,

grounded in evidence, and customized for patients.

On organization side, there will be two levels of strategy that will be required:

a. For e.g. Using anti- skid footwear within the premises for both the patients, families, and
doctors & staff.
b. Keeping assistive devices such as walkers or canes near the bed or well in reach of the
patient. Call- bell to be kept handy.
c. Mandatory use of elevators instead of stairs (Most falls that take place are on stairs and
alleys).
d. Having handrails across the corridor. Keeping the entire premises well lit so that there is
sufficient lighting.
e. If possible, replace the tiles to anti – skid tiles in the entire hospital.
f. Proper Master Plan to be kept in all junctions, rooms for easily accessibility.
g. Making specific mobile phone zones, so that patient or their families don’t talk while walking
in corridor or the stairs. (Mobile phones divert the mind and hence bring down cognitive
ability of the brain.
h. Training for all Nurses and doctors to prevent and handle falls. Creating and implementing a
fall prevention program entails patient and family education, environmental improvements,
and staff education and training.
i. The department also should have a dedicated person to scrutinize if all protocols are
followed.

B. Customized patient centric strategy so that hi risk patients are managed thoroughly.
● When doctors prescribe a medicine that can affect the level of consciousness, balance etc.,
the doctor must notify it to the relative of the patient and not allow the patient to move for
a given period.
● Compulsory family member at the bedside always.

● Interventions should be more specific and based on identified risk factors (such as
maintaining regular toileting, re-orienting confused individuals, and assessing for need of
side rails as enablers, need for ambulatory aids, need for sensor alarms, need for hourly
rounds or one-to-one nursing, need for room re-location close to nursing station etc.

To sum it up, there cannot be one single fall prevention plan, but a group of strategies that will have to
be implemented meticulously. Black Elm Healthcare Management team should focus on Design for
Excellence, which includes objectives of physical performance, user- friendliness, reliability, durability
safety, environmentally friendly and many more. It should focus on things done right, than things gone
wrong. This will have to be an ongoing process, and as the risk factors transform, revise the
protocols, and innovative solutions will have to be maintained. Periodical design review is also
essential, coming from surveys conducted, to make the entire premises foolproof of any falls that can
occur. Having followed this, a 0-fall rate for 1000 patient days can be achieved. A Cause-and-effect
diagram can help to explain the combination and conditions that can lead to a fall to passed across
departments.

A fall can occur

OR

Intrinsic Factors Extrinsic Factors

4.Fill in the following relationship matrix of a house of quality for a screwdriver. By sampling your
classmates, develop priorities for the customer attributes and use these and the relationship to
identify key technical requirements to deploy.
Ans:

This shows that Ratchet capability is the most important aspect to be worked
on, followed by interchangeable bits. Improvements in this will help increase
sales as it will be both easy to use and durable both.