Main Stream Product Quality

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Main Stream Product Quality

• Ryan Connolly
• Jason Guhsé
• Jed McCann
• Rich Steffens

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Do you think youre safe?

• 2763 vehicle related quality recalls since
  January 2000

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Are Vehicles Safe?

• Mitsubishi admits to covering up quality -
  recalls 1 million vehicles (8/22/00)
• Kawasaki - Motocross Motorcycles, rear brakes can
  fail, may result in death (18,000 units) (1/2001)
• Kawasaki 2000 Ninja Motorcycles leak fuel may
  cause fire 7785 units. (2/16/2001)
• Isuzu Trooper 2000-2001 Fuel leaks upon front
  impact may cause fire. (18,462 units)
• Mercedes E-Class 1997 Side air bag deploys
  without crash. (16,255 units)

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More Vehicles...

• BMW R1200C Back support bracket can break
  allowing passanger to fall. (1,636). (1/23/2001)
• Saturn Fuel System Vent Valve may leak, can
  cause fire. 6092 units (1/23/2001)
• Honda Off Road Motor Cycles Handle bars
  separate from bike. 22,000 units (11/22/2000)
• Honda ATVs Faulty front suspension bracket,
  causes crash, may result in death, 126,000 units.
  (11/13/2000)

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Consumer Products?

• DeWalt Battery Charger, does not turn off after
  charging, battery explodes, may cause fire or
  burn, 1.7 Million
• AmeriGas Propane Tanks - leak unexpectedly and
  risk fire and explosion.
• Water Heaters - fail to vent carbon monoxide -
  (320 units) may cause death
• Gun Locks - Open without a key (400,000 units)
• Black Decker 12 miter saw - bolts loosen,
  cause blade to come off - risk of laceration
  (6400 units)

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Childrens Products?

• Graco - Highchair legs come out and fall to
  ground. 860,000 Highchairs (2/2001)
• Simmons - 68,600 baby cribs, mattress can
  collape, may cause suffocation.
• Childrens bikes - pedals are too low, they hit
  the ground, may cause injuries, (1400) units
  (1/2001)

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Food Quality?

• Tyson Foods recalls 2.3 million pounds of chicken
  (not fully cooked - in precooked packaging)
  2/21/01
• Cargill Turkey 16.7 million pounds of turkey
  and chicken Listeria. (12/14/2001)
• Cargill Turkey 10 more tons of Turkey
  Listeria contamination. (1/3/2001)
• Schreiber Foods Colby Cheese Listeria. 6
  months production / over 22 brand names.
• Safeway Drinking water- unfit for consumption -
  filth. 30,200 cases. (2/8/2001)

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Mini - Case Study 1

• You are the RD Manager - A possible design flaw
  has been brought to your attention
• The issue appears to be with an out-sourced
  component.
• The issue is a potential safety issue.

• The design problem affects an entire fleet of
  products.
• Supplier insists that the design is flawed.
• Correction per unit is very costly.
• This unit already has the best safety record on
  the market.

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The Boeing 737 Is It Safe To Fly?
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737 Airframe Data

• First introduced to service in 1967.
• 3,111 Airframes in service worldwide.
• Cost per Airframe 38-64 million
• The 737s have carried the equivalent of the
  world's population - about 6.1 billion
  passengers.

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The Problem Rudder PCU

• Power Control Unit (PCU)
• Only aircraft using non-redundant control system
• If system becomes stuck, uncommanded rudder
  movement may ensue
• Severe upset (rollover) may occur
• Most likely to happen during take-off and
  approach

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The Result Disaster

• 1991 United Airlines Flight 585
• All 25 people onboard killed
• 1994 USAir Flight 427
• All 132 people onboard killed
• Four more crashes still under investigation
• Aug 99 in Argentina
• April 99 in Turkey
• 1998 in Peru
• 1997 in Indonesia

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More Incidents...

• The National Transportation Safety Board (NTSB)
  lists 112 rudder events on Boeing 737 flights
  in the past two decades.
• The 737 series airplanes remain susceptible to
  rudder system malfunctions that could be
  catastrophic.
• 9-13-99 NTSB report on Boeing 737 Rudder
  Malfunctions

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Did Boeing Know about this problem?

• 1969 Bertea Corp. patents a solution to the
  jamming problem
• Result No buyers were interested
• 1982 Bertea again patents an anti-jamming patent
• Result Still no buyers.
• Bertea Corp. contracted with Boeing to
  mass-produce 737 rudder valves in the late 1960s.

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• One failure... Occurs when the valve becomes
  stuck or jammed. This may be the result of
  contaminants warpage, thermal expansion or
  contraction of the elements of (the valve) or
  numerous other reasons.
• 1969 Bertea corp. Patent on anti-jamming
  mechanism.

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Boeings Response

• Boeing initially stood behind the Design of the
  737 Rudder Control System.
• In 1998 the company issued an upgraded rudder
  valve in all US 737s and many Foreign models.
• However, the FAA was not satisfied with Boeings
  solution to the Rudder Control problem.

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The NTSBs Response

• While the Boeing 737 is one of the safest
  airplanes in the world, the Engineering Test and
  Evaluation Board (ETEB) found that
• The 737 rudder system is susceptible to numerous
  failures and jams
• The 737 Resistricted or Jammed Emergency
  Procedure is difficult to use and flight crews
  are not adequately trained in its use
• Maintenance inspections used to address
  undetected failures are insufficient.

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The NTSBs Response (cont.)

• Issued Alpha Safety Alert Bulletin 2000-7
• Overviews the safety issues of the 737
• Describes to pilots how to overcome uncommanded
  rudder movement
• Outlines the corrective action Boeing must follow
  to eliminate the Rudder Control problem

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The FAAs Reaction

• December 1, 1999 Federal Aviation Administration
  commences special audit of Boeing Company
  following recent quality issues.

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The Airlines Reactions

• USAirways Boeing Co. withheld flight test data
  on the twin-engine 737 jet that could have
  prevented the crash of the airlines Flight 427.
• If the airline had known of the aerodynamic data,
  it could have changed its flying procedures
  before the crash.
• I would have expected the 427 crew to have
  successfully been able to fly out of the
  situation
• -James Gibbs, USAir flight manager.

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The Publics Reaction

• The widow of Timothy McCoy has already received
  62 million in damages from her husbands death
  on Flight 427.
• McCoys attorneys are trying to prove willful
  and wanton conduct of both Boeing and
  Parker-Hannifan (manufacturer of the Rudder
  Mechanism) for concealing design defects.

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Boeings Final Fix

• Near Term
• Restricted or Jammed rudder procedure will be
  simplified (Oct 2000)
• Improved jammed rudder training will be
  incorporated into 737 training programs (Nov
  2000)
• Changes to airline maintenance programs will be
  made to limit exposure of undetected failures
  (First Quarter 2001)
• Flight crews and maintenance personnel will be
  trained to recognize the symptoms of rudder
  malfunctions (First Quarter, 2001)

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The Final Fix (cont.)

• In the long-term
• The Boeing 737 rudder control system will be
  redesigned to increase redundancy and enhance
  protection against undetected failures. One goal
  of the redesign is to eliminate the need for a
  jammed rudder procedure. Initial design changes
  should be defined by July 2001 with a target FAA
  certification date in mid-2003. The redesign
  should be finalized by July 2002 with
  implementation on the 737 production line by
  2003. A complete retrofit of the United States
  737 fleet should be completed by 2006.

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The Cost of Quality

• The cost of the new PCU 50,000 to 60,000
• Total number of airframes affected 3,111
• Total Estimated Cost of Redesign 155,550,000 to
  186,660,000

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Was this a Quality Issue?

• Quality Control does not just apply to
  production! Quality in Design must also be
  enforced.
• We can produce a product conforming to 6-sigma
  quality, but if the design produces a product
  that doesnt work (or endangers lives), it cannot
  be considered a quality product.

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Translation

• Boeing ignored the Rudder Control problem for 30
  years, until the FAA stepped in.
• Boeing argued that there was no problem.
  Reluctantly, the issued an upgrade valve to fix
  the problem
• 737s still had rudder problems. Boeing still
  said there was no problem.
• The FAA ordered a FULL redesign of the PCU
• Boeing now advertises this redesign as an
  enhancement

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The New Design
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Mini - Case Study 2

• You are the VP of Quality - A problem has been
  brought to your attention
• The issue appears to be with an out-sourced
  component.
• The issue is a potential safety issue.
• Improper Disclosure could land company in court.

• Supplier has long-term relationship with you.
• Their 1st product was on your 1st product.
• Supplier was recently purchased by a foreign
  company.
• Supplier insists that no problem exists.
• Same component is used across 5 major companies.

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Firestone Tires
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Tread Shedding
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Production Quality Issues

• Worker strike - 1,400 replacement workers
  (inexperienced)
• Financial Incentives to release poor quality
  tires - hides poor quality
• Bad plant conditions- high humidity causes
  corrosion
• Poor understanding between management and
  inspectors
• High production rate backup at inspection
• Unique process pelletized rubber

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Did Firestone Know About the Problem?

• 1996 Internal durability testing showed
  potential defects.
• Manufacturing procedure changed, but no further
  testing was done.
• Proper design-test-fix cycle was not followed.

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Ford Enters the Picture...

• Firestone refuses to issue a recall notice
• Ford begins tire replacement without Firestones
  consent
• Ford continues to press Firestone for recall
  Threaten to issue a recall with or without
  Firestones agreement
• Firestone buckles under Fords pressure and
  recall begins (Aug. 9, 2000)

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Fallout

• Ford closes 3 manufacturing plants for several
  days to provide needed replacement tires to the
  public.
• A One-day closure costs 24 million in profit
  per plant.
• Began in Saudi Arabia, moved to Thailand,
  Malaysia, Venezuela, then to the US.

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Firestone

• GM, Nissan, Toyota, Subaru, and Ford used the
  same Firestone Wilderness AT Tires.
• Firestone is currently replacing 100,000 tires
  installed on the Nissan Altima due to a design
  defect.
• Firestone is owned by Bridgestone Japan.
• GM announced 2/22/01 to drop Firestone and switch
  to Bridgestone.
• Toyota pledges to support Bridgestone.
• Ford is now switching to Michelin and Goodyear
  Tires to replace Firestone.

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Discussion?
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Summary

• Ensuring Quality is not an Easy Task!
• As outsourcing grows, who becomes liable?
• The buck will stop entirely at the company whose
  name is on the grill
• When does a design flaw become critical?
• What cost do you put on human life?
• Processing Chicken vs. Making Airframes Whats
  the difference?

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How safe would we be if YOU were in charge?