Course overview
We’ve all heard the excuse: “it’s down to human error” with the assumption that there’s nothing we can do about it. However, when any type of quality issue was caused by an operator doing something incorrectly; there will be a deeper root cause of the incident. These precursors or preconditions are referred to as human factors.
TEC’s new 2-day course focuses on understanding why human errors occur in manufacturing operations, selecting and using the appropriate 'model' to search for root cause(s), finding and proving the human factor(s), then implementing effective ‘countermeasures’ to prevent or mitigate the consequences of human errors to downstream operations or the customer. You will also learn how to use practical psychology to help motivate staff to do the right thing, first time and every time – and strive for continual sustainable improvement. The course also includes physical devices to prevent future problems such as Ergonomics in manufacturing, Poka Yoke, Jidoka, TPM, Projected Augmented Reality (AR) and FMEAs.
human errors ~ human factors ~ countermeasures
By the end of this interactive course and workshop participants will be able to –
understand and interpret the requirements relating to human factors
understand how to implement practical countermeasures, using a battery of tools and methodologies, focused on human factors in manufacturing
The course covers everything that is needed to develop, document and implement 9100 series, AS13100 and RM13010 conforming processes to address human factors in the manufacturing and design environment. The CBs (Certification Bodies) will be auditing these topics as part of their routine surveillance and re-certification audits – so be fully prepared!
Course details
The course contains 12 sections which include many individual and team Exercises to check and confirm understanding of the principles and practices involved –
1. Understanding human errors, their causes, and consequences
Common areas in manufacturing generating human errors
Human errors and Human behaviour
Sources of errors
2. Human behaviour and types of human errors
Determine what ‘type’ of human error is involved
Explanation of ‘slips’, ‘lapses’, ‘mistakes’ and ‘violations’
The SRK framework and related errors
Understanding ‘events’ and ‘hazards’
Why operators don’t follow procedures
and/or work instructions
3. Collecting information and commencing the investigation
Gather and confirm the facts (‘IS–IS NOT’ questioning)
Use 5-Whys
Sequence of the investigation
4. Selecting the appropriate ‘model’ and determining human factor(s)
Directed brainstorming
IAQG’s human factors cause ‘codes’
The PEAR model
SCMH human factors categories
The ‘dirty dozen’
Combining Bow-tie and Ishikawa diagrams
5. Verifying human factors
Verify the human factor – the “therefore test”
Verify the human factor – IS – IS NOT ‘answers’
Verify the human factor – “Occam’s Razor”
Verify the human factor – “Sherlock Holmes quotation”
6. Just culture, Ethical Behaviour and Competence
Just culture definition and deployment
Edwards Deming and the 5 ‘commitments’
Ethical behaviour definition and deployment
Competency of operators
Organizational charts and job descriptions
7. Monitoring human factor types and associated human errors
Tracking Human Errors/Factors with KPIs and Goals
Human Errors/Factors performance KPIs and Goals
Specimen templates: – HE/HF KPIs and Goals
Clear and specific KPIs and their Goals
8. Addressing human factors with practical psychology
CBT (cognitive behavioural therapy)
Psychology of motivation
Herzberg’s data & conclusions
Influencing operator behaviour
On-purpose/situation feedback (TGR/TGW)
9. Avoiding human errors with workstation design, physical devices, TPM and AR
Ergonomics in manufacturing
Defects ~ Human Errors and the 6 principles
Poka-yoke (Mistake-Proofing)
Jidoka (Autonomation)
Total Productive Maintenance (TPM)
Overall Equipment Effectiveness (OEE)
Projected augmented reality (AR)
10. Selecting/deploying effective countermeasures to address identified human factors
Tools to select effective countermeasures
Six Hats Thinking
Impact & Effort Matrix
11. Preventing future human errors (FMEAs)
The Bow-Tie model
The Swiss Cheese model
FMEAs – Human Errors
Risk management process stages
Human Error – Risk identification tools
Design FMEA & Process FMEA worksheets
RPN and R-P-N
Mitigate risk (S – O – D)
Maintaining DFMEAs and PFMEAs
12. Closing remarks – Aeronautical safety record – Q&A session
Resolving human errors – summary
Quality Management and Human factors comparisons
Air crash deaths – minuscule but don’t get complacent!
Incidents still happen!
The impact of human errors – the “error iceberg”
Internal audit focused on ‘human errors’
Extended questions & answers session
Who should attend
Quality managers, Accountable managers, Quality engineers and all levels of management responsible for developing, documenting, implementing, managing and maintaining 9100 series conforming processes to address human factors.
Six Sigma 'belts' and Continual Improvement practitioners who want to incorporate human factors into their 'future-state' initiatives. The course is particularly useful for supervisors who have to manage operators on a day-to-day basis.
All aerospace/defence production organizations need to understand how they must develop, implement and maintain appropriate processes to effectively address human factors as part of new product introduction (APQP & PPAP) and nonconformity & corrective action.
TEC's practical 2-day course will empower organizations to demonstrate full conformity with 9100 series requirements, meet aerospace customer expectations and comply with applicable regulations.
Deliverables & benefits
This course is specifically aimed at the manufacturing sector – (i) Make-to-print and (ii) Design-and-make organizations.
All aerospace/defence organizations need to understand how they must develop, implement and maintain appropriate processes to effectively address human factors in a reactive and proactive manner.
This course is classified as ‘structured’ for continuing professional development (CPD) purposes by the CQI/IRCA. It contributes 16-hours to the required 45-hours of appropriate CPD for QMS Lead Auditors.