A joint project of NCMS called Volumetric Accuracy for Large Machine Tools (VALMT), partnering Automated Precision, Boeing, Siemens and Mag Cincinnati, has pioneered an innovative process and established new methodology in volumetric error compensation for large machine tools. Volumetric error compensation or VEC, is a true volumetric calibration that improves close tolerance and working accuracy of complex five- and six-axis machine tools throughout their entire working envelope.

Introduction

Day after day it’s the same problem for machine tool owners. They spend well into six figures for a high-precision machine tool and they have a great deal of difficulty determining why it’s not cutting parts accurately. The typical culprits are usually the same: ball screw or rack-and-pinion errors due to wear, machine-build tolerances, metal fatigue, maybe even foundation problems like sag all. All of these contribute to the inaccuracies they face.

The financials of an enterprise are a result of the integration and interaction of its processes, not of individual procedures in isolation. Using a whole-system perspective, one realizes that the output of a system is a function of its weakest link or constraint. If you're not careful, you can be focusing on a subsystem that, even though improved, doesn't affect the system's overall big-picture output.

In lean Six Sigma and lean kaizen event programs, improvement projects are often selected from a list of potential opportunities that were determined from a brainstorming session. This effort might provide some initial gains when starting a deployment; however, it typically stalls out and the process improvement teams are laid off when times get tough. The reason for this downsizing is that often process improvement efforts are not expended in areas where the overall enterprise benefits the most; e.g., focusing on sales and marketing when excess production capacity is available.

At the 2009 National Association for Healthcare Quality conference, I gave a speech on lean Six Sigma simplified. At the end of the session, one of the attendees asked, "If Six Sigma is so easy, why isn’t everyone doing it?" My answer: Because we’ve made it too complicated, expensive, and hard to learn.

Seth Godin, author of Unleashing The Ideavirus (Hyperion, 2001, download it from www.ideavirus.com), says: "Ideas that spread, win." Six Sigma has been spreading, but slowly, at great expense and mainly in large companies. How can the quality community make Six Sigma easier to spread?

Let me begin with a story.

A woman I know went on a date with a man she’d just met. He took her on a picnic where they had to walk up a trail onto a small hill with a view of the foothills. I saw her recently and she was still dating the same man. She told me, “I don’t know how it happened, but six months later I was standing on top of an 800 foot pinnacle in Utah after a free climb.”

The Acme Widget Co. needed to increase revenue and profits, so they undertook an initiative to attract new customers: They launched a new advertising campaign and offered special deals to first-time buyers. They were initially delighted to see a significant and immediate increase in new customers. Their joy was short lived, however, as they saw revenue and profits actually decline.

The Acme Widget Co. made a classic business blunder. As new customers came in the front door, existing customers were leaving in greater numbers through the back door. They had violated one of the most important rules of business: Never take your customers for granted.

Even a small reduction in customer defections can significantly increase profits. Because your fixed costs don’t change much regardless of how many customers you have, the retention of existing customers is vitally important in maximizing profit. Creating and strengthening customer loyalty must be a top priority of any business if it is to grow and prosper.

When you think about equipment that is used for measuring and test activities, you think about important equipment that is used to pass or fail product but may not necessarily see its correlation with a supply chain. However, this very equipment—whether it is calibrated in-house or off-site—does involve a supply chain one way or the other and therefore adherence to suppliers and supply-chain requirements is imperative.

If you outsource your calibration, you know that your calibration partners are your vendors. But when equipment is calibrated in-house, you may think there are no suppliers involved. However, even in this case, you probably still have to send the standard used for calibration to an outside calibration company that can provide traceability to National Institute of Standards and Technology (NIST) standards. So whether the calibration is done in-house or by an external company, calibration requires a thorough look into purchasing procedures and the supply chain.

Ten years after the Institute of Medicine released its influential report "To Err Is Human" (www.iom.edu/en/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx), hospital care still has many safety problems, and the quality of care remains lower than it should be in many institutions.

Hospitals could improve both quality and patient safety by using health information technology to standardize the processes of care and to ensure that vital information is available to clinicians when they need it. However, electronic health record (EHR) systems are multi-faceted and challenging to implement in acute-care settings, and few health care facilities have complete EHRs. As an initial step toward the automation of patient care, about 10 percent of U.S. hospitals have implemented computerized physician order entry (CPOE), which includes medication orders and orders for laboratory and imaging tests, as well as the ability to view test results and medication lists. While this falls short of a complete EHR, which also incorporates clinical documentation, CPOE, when it is properly implemented and utilized, represents a giant step toward better patient care.

It happens to the best of us. An upset client calls to complain about a product or service, and you’re completely caught off guard. How do you react? Do you fly off the handle right along with him? Or do you respond in a calm, thoughtful way that salvages and even strengthens your relationship? A high-pressure scenario doesn’t have to blow your client relationship sky-high—in fact, you can use it as an opportunity to truly connect with your client and keep him around for the long haul.

Conflict is a normal part of business, and we all need to learn how to deal with it in the right way. Some clients are just plain difficult. And yes, “easy” clients can also become dissatisfied for a variety of reasons. The good news is that there are effective ways to handle conflict and resolve issues—and these methods will actually strengthen your relationship.

Remember that quite often, unhappy clients will not even tell you that they have a problem. They simply move their business elsewhere. So, if a client thinks enough of you to give you the chance to repair a bad situation, take it. Play an active role in making your customer happy so that you can be sure to keep him or her on board with you.

In 2005, according to a BBC News report at the time, operating rooms all over the United Kingdom were thrown into chaos and operations canceled due to broken, missing, or dirty surgical instruments. The Royal College of Surgeons called for a national audit of decontamination units, following a report in the April 2008 Clinical Services Journal on surgery being canceled due to instruments being returned with visible blood and bone contamination. A report from the United Kingdom’s National Health Service (NHS) decontamination program revealed that 1,765 operations were called off at the last minute in 2005 and 2006 because of instrument problems.

This was a high-profile problem for the NHS and was taken very seriously, particularly because an audit eight years ago highlighted the need to upgrade and modernize decontamination facilities. Many hospitals have entered into contracts with commercial sterilization services, while others, such as the New Royal Infirmary in Edinburgh, have an in-house unit.

What if hospital leaders had an easier, more streamlined way to chart an improvement path for their organizations? Imagine a list of key processes that could—if implemented reliably—lower mortality,  reduce harm, lessen delays, create a better patient experience, and lower costs. This possibility is now within reach. 

For the past year, the Institute for Healthcare Improvement (IHI) and several scientific partners have been hard at work developing a tool that will offer an alternative to the current state of affairs in which U.S. hospitals must figure out how to juggle and work on nearly 1,500 quality indicators and long lists of requirements from organizations such as the Joint Commission, the Leapfrog Group, and the Centers for Medicare & Medicaid Services, and other payors. Plus, hospitals must participate in various quality assessment programs. While all worthy in their intent and specificity, this everexpanding list of expectations risks creating more frustration and confusion than improvement. 

In this case study of reverse engineering and rapid prototyping we will look at a company that developed an initial prototype of an anti-snoring device based on many years of research in the field of dentistry. The company’s main dental advisor is a pioneering dentist in the research and development of mandibular advancement devices to treat snoring and obstructive sleep apnea (OSA). He designed and created a functional device that comfortably and healthily helps cure snoring. 

The challenge came after the initial anatomical design and fabrication work was done, when modifications were needed to make the device more functional. The first version tested the shape and size, but the company wanted a way to quickly prototype different features into the base design. They also wanted to try different FDA-approved resins for improved functionality and comfort. And, as is typical for a one-of-a-kind prototype, the company did not have CAD files of the part. The development schedule allowed for flexibility, but the company wanted to move forward to get its anti-snoring device into production and on the market.