RM13000 - 8D Problem Solving Method
RM13000 - 8D Problem Solving Method
AESQRM000202312
SAE Industry Technologies Consortia provides that: “This AESQ Reference Manual is published by the AESQ Strategy
Group/SAE ITC to advance the state of technical and engineering sciences. The use of this reference manual is entirely
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Copyright © 2023 AESQ Strategy Group, a Program of SAE ITC. All rights reserved.
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Aerospace Engine Supplier Quality (AESQ) Strategy
Group
The origins of the AESQ can be traced back to 2012. The Aerospace Industry was, and still is, facing many
challenges, including:
The Aero Engine manufacturers Rolls-Royce, Pratt & Whitney, GE Aviation and Snecma (now Safran Aircraft
Engines) began a collaboration project with the aim of driving rapid change throughout the aerospace engine
supply chain, improving supply chain performance to meet the challenges faced by the industry and the need
to improve the Quality Performance of the supply chain.
Suppliers to these Engine Manufacturers wanted to see greater harmonisation of requirements between the
companies. Each Engine Manufacturer had Supplier Requirements that were similar in intent but quite different
in terms of language and detail.
This collaboration was formalized as the SAE G-22 Aerospace Engine Supplier Quality (AESQ) Standards
Committee formed under SAE International in 2013 to develop, specify, maintain and promote quality standards
specific to the aerospace engine supply chain. The Engine Manufacturers were joined by six major Aero Engine
suppliers including GKN, Honeywell, Howmet Aerospace, IHI, MTU and PCC Structurals. This collaboration
would harmonise the aerospace engine OEM supplier requirements while also raising the bar for quality
performance.
Subsequently, the Aerospace Engine Supplier Quality (AESQ) Strategy Group, a program of the SAE Industry
Technologies Consortia (ITC), was formed in 2015 to pursue activities beyond standards writing including
training, deployment, supply chain communication and value-add programs, products and services impacting
the aerospace engine supply chain.
AESQ Vision
To establish and maintain a common set of Quality Requirements
that enable the
Global Aero Engine Supply Chain
to be
truly competitive through lean, capable processes
and a
culture of Continuous Improvement.
i
The SAE G-22 AESQ Standards Committee published six standards between 2013 and 2019:
In 2021 the AESQ replaced these standards, except for AS13001, with a single standard, AS13100.
The AESQ continue to look for further opportunities to improve quality and create standards that will add value
throughout the supply chain.
Suppliers to the Aero Engine Manufacturers can get involved through the regional supplier forums held each
year or via the AESQ website http://aesq.saeitc.org/.
ii
AESQ Reference Manuals
AESQ Reference Manuals can be found on the AESQ website at the following link:
https://aesq.sae-itc.com/content/aesq-documents
AESQ publishes several associated documents through the SAE G-22 AESQ Standards Committee supporting
deployment of AS13100. Their relationship with APQP and PPAP is shown in Figure 1.
Figure 1: AESQ Standards and Guidance Documents and the link to AS9145 APQP / PPAP
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RM13000 - 8D Problem Solving Method
TABLE OF CONTENTS
5. FORMS OF 8D ........................................................................................................................ 13
5.1 A3 Excel 8D Methodology ....................................................................................................... 13
5.2 Two Page PowerPoint 8D Form .............................................................................................. 14
5.3 Three Page Word 8D Form ..................................................................................................... 16
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RM13000 - 8D Problem Solving Method
Figure 1 AESQ Standards and Guidance Documents and the Link to AS9145 APQP/PPAP ................ iii
Figure 2 Structured Problem-Solving Decision Tree ................................................................................4
Figure 3 Pareto Principle ..........................................................................................................................4
Figure 4 Problem-Solving Interrelationship Diagram ................................................................................6
Figure 5 Problem-Solving Methodology Roadmap ...................................................................................8
Figure 6 Excel 8D A3 Form ................................................................................................................... 14
Figure 7 PowerPoint 8D Format (Page 1) ............................................................................................. 15
Figure 8 PowerPoint 8D Format (Page 2) ............................................................................................. 15
Figure 9 Word 8D Form (Page 1) .......................................................................................................... 16
Figure 10 Word 8D Form (Page 2) .......................................................................................................... 17
Figure 11 Word 8D Form (Page 3) .......................................................................................................... 18
Figure 12 Case Study 1 Using Excel 8D A3 Form .................................................................................. 19
Figure 13 Case Study 1 Using PowerPoint 8D Form (Page 1) ............................................................... 20
Figure 14 Case Study 1 Using PowerPoint 8D Form (Page 2) ............................................................... 21
Figure 15 Case Study 3 How the Shaft Length (X) is Calculated ............................................................ 23
Figure 16 Case Study 3 Fishbone Diagram ............................................................................................ 23
Figure 17 Case Study 3, 5-Why Diagram for Direct Cause Example ...................................................... 24
Figure 18 8D Case Study 5 Why Detection Example .............................................................................. 25
Figure 19 8D Case Study Marking Check Sheet ..................................................................................... 26
Figure 20 AESQ 8D Interactive Tool Control Panel ................................................................................ 28
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RM13000 - 8D Problem Solving Method
1. INTRODUCTION TO PROBLEM-SOLVING
This reference manual has been created to support the requirements of AS13100 Section 10 and provides
information on the use of problem-solving methodologies to satisfy the requirements of this standard.
“A perceived gap between the existing state and a desired state, or a deviation from
a norm, standard, or status quo”
Business Dictionary
In this definition the “problem” can represent an improvement opportunity when addressing the gap between
the “existing state and the desired state” or an issue when addressing a “deviation from a norm or standard.”
ISO 9001, AS9100, and AS13100 require organizations to have a process to manage both types of problems
in Section 10 of their respective standards. ISO 9001 provides examples for improvement that include:
• Corrective action
• Continual improvement
• Breakthrough change
• Innovation
• Reorganization
This reference manual will primarily focus on managing problems associated with products and manufacturing
processes, although some may also be applied to other situations such as service issues and improvement.
AS13100 requires organizations to use the 8D methodology for customer escapes as described in Section 6.
Alternative approaches that meet the intent of this requirement may be used if approved by the customer.
The other material in this reference manual is provided as guidance for managing other types of problem-solving
with varying degrees of complexity.
2. PROBLEM-SOLVING APPROACHES
In every part of the business, there are issues that need to be managed.
However, not all issues will require an individual problem-solving investigation to be completed. There are two
main approaches to how problems can be managed:
2. Themed improvement
The following guidance aims to help clarify which approach should be selected.
Figure 2 illustrates the logic to consider when a new issue arises in deciding whether individual root cause or
themed improvement is most suitable.
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RM13000 - 8D Problem Solving Method
When the organization becomes aware of an issue, the priority is to assess it and determine the nature of the
problem. This is achieved through completing a detailed problem definition. If the issue is product related, then
the organization should also ensure that the customer (internal and external) is protected from any
nonconformance that may have been, or is suspected to have been, produced. This is referred to as
containment.
The organization should record all issues in a master database or similar so that the number of issues can be
measured and analyzed on an ongoing basis.
Once the issue has been defined and containment (if required) has been carried out, then the organization
needs to define the approach to best manage the issue.
If the issue is regarded as having a low impact, then one approach would be to perform a pareto analysis of
all the data to identify the key themes that can be managed through improvement activity.
Pareto of Themes
35
30
25
% of all issues
20
15
10
5
0
Theme 1 Theme 2 Theme 3 Theme 4 Theme 5
Themes
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RM13000 - 8D Problem Solving Method
Examples of where problem-solving is more effectively conducted on themes (i.e., a collection of issues) may
include:
• Process compliance issues (e.g., audit findings, process compliance check failures)
Using this approach does mean that for some issues, once recorded, defined, and contained will not be actioned
if it belongs to a theme that is low on the Pareto analysis. Clearly it is best if all issues are addressed and closed
out through a robust problem-solving investigation. However, it is recognized that it is important to focus
resources onto those issues that have the biggest impact to the customer and business performance.
If the issue is assessed as being of high impact, then the organization should conduct a focused root cause
and corrective action investigation using the 8D approach or similar. Typical high impact issues include:
• Repeat issues
• Issues that are complex in nature and require a cross functional team approach to fix them
Many customers will require a formal investigation for managing escapes from a supplier. Typically, they will
require an 8D investigation or similar.
Where the problem originates in an external supplier, then the requirements for managing the corrective action
should be flowed down by the organization. The organization will be seen as being responsible for the quality
and timeliness of the supplier’s investigation by the customer.
The organization should monitor the status of all problem-solving activity with the business to ensure that the
process is effective and timely.
Learning from investigations and improvement actions should be read across to areas that can benefit from the
insights gained. Wherever possible, the organization’s management system processes should be updated along
with the following documents as applicable:
• Design FMEA
• Process FMEA
• Control plans
• Work instructions
• Audit checklists
Records of the investigation and actions taken are required to be maintained by ISO 9001 and AS9100 (10.2.2).
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RM13000 - 8D Problem Solving Method
Problems that have impacted our external Customers typically will require completion of key problem-solving
steps against defined timescales. Some typical customer requirements are shown in Table 1.
Define Problem
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3. PROBLEM-SOLVING METHODOLOGIES
Many types of problem-solving methodologies have been established. They range from the very simple “Just
Do It,” to the comprehensive Eight Discipline (8D) investigation approach, to the broader DMAIC method.
The 8D approach is used to document external customer escape issues or internal high pain defect issues, to
very simple “find and fix” methods that deal with problems that are more local and not in need of an extensive
investigation. All methods have their origination from the “Plan, Do, Check, Act” approach developed by Walter
Shewhart and W. Edwards Deming back in the 1920s. Figure 4 shows some of the breadth of problem-solving
methods that have evolved overtime and how they overlap.
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RM13000 - 8D Problem Solving Method
While the purpose of this manual is not to go into detail in every problem-solving method, it focuses on a very
comprehensive method that focuses on root cause and corrective action investigations. The core of this
reference manual is based on the 8D investigation approach developed by Ford Motor Company in 1987. This
manual recognizes not every problem requires all the steps of 8D. Thus, attention is paid to shortened variations
of this model such as “4D” (medium type problems) and “2D” (very simple to fix type problems) to provide the
user problem-solving efficiency where the situation calls for it.
Table 2 illustrates the various problem-solving types all emanating from the 8D investigation steps. While the
illustration shows the nine steps of 8D being reduced to “4D” for medium type problems and “2D” for simple
type problems, even these shortened versions may require additional steps given the situation. For example, a
4D type problem may require a temporary action to be taken while a permanent solution is investigated. This is
adding D3 to the core 4D steps. The same can be said of a simple 2D problem.
Selecting the best approach is critical for the effectiveness of the investigation and the ability to prevent
recurrence. Each type of methodology is supported by a range of problem-solving tools that can be used to get
to the root cause and implement effective corrective actions.
Whatever methodology is used, the basic intent of any problem-solving process is to:
Many of the tools used in these methods overlap, as such there is a section on the common problem-solving
tools. These tools may be found in Section 7.
Table 2 shows the equivalency between the AESQ Eight Disciples (8D) per RM13000 and IAQG Nine Steps
(9S) per ARP9136. Companies may use either method.
D5 - Determine Permanent Corrective Action(s) S5 - Define and Select Permanent Corrective Action(s)
S6 - Implement Permanent Corrective Action and Check
D6 - Implement Permanent Corrective Action(s)
Effectiveness
S7 - Standardize and Transfer the Knowledge Across
D7 - Determine Preventative Action(s)
Business
D8 - Recognize the Team and Close Out Investigation S8 - Recognize and Close the Team
There is no significant difference between AESQ 8D per RM13000 and IAQG 9S per ARP9136. As such,
suppliers can use either method.
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RM13000 - 8D Problem Solving Method
The following roadmap in Figure 5 is used as a visual guide to select the most appropriate problem-solving
methodology based on complexity. It should be noted that there may be occasions where the nature of the
problem changes as the investigation progresses and hence the procedure may expand or collapse to meet the
needs for the change.
Since 8D is the core problem-solving investigation approach espoused by this reference manual, Section 6
provides detailed discussion of each of its nine steps thoroughly. The use of 4D and 2D is done using the
specific 8D steps per Figure 5 and their explanation would not bear repeating.
The 8D problem-solving process was established in the automotive industry in the early 1980s by Ford Motor
Company to standardize and improve the capability of problem-solving in their supply chain. It was launched
under the full title of Team Oriented Problem-Solving (TOPS) using the Eight Disciplines (8D).
This methodology was to be used as a standard tool for Ford suppliers where:
• It was suspected that the problem was complex with potentially several contributory causes
• A cross functional team approach was required due to the complex nature of the problem being investigated
This method has now been well established and has become the default problem-solving process in many
industries, including aerospace. It is well supported globally with training providers and consultants experienced
in it use.
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RM13000 - 8D Problem Solving Method
The AESQ adopted this approach in 2015 as the harmonized methodology for key problem-solving
investigations. Typically, it is required for all customer escapes although each customer may invoke it differently.
This section describes the expectations for meeting the requirements of AS13100 when 8D is required. When
required, the organization uses one of the 8D forms as described in this section and available from the AESQ
website. The purpose of this form is not to restrict the investigation approach but instead is designed to provide:
• A standard method of reporting the summary of the investigation to the customer. This is particularly useful
where an organization may have hundreds of suppliers who are required to submit investigation reports.
• Useful list of key questions to ask and evidence to gather at each stage of the investigation. This will help
to improve the rigor of the investigation. These prompts are based on learning from experience from
reviewing thousands of investigations by the AESQ member companies.
The correct training of 8D practitioners is key to the successful outcome of the process. It is expected that 8D
practitioners are trained by a training provider meeting the requirement of the “training syllabus” (see Appendix
B). One of the roles of the 8D practitioner is to ensure that the 8D report is complete.
Where a symptom is observed and there is customer impact, the organization takes immediate action to protect
the customer.
D0 should be completed and returned to the customer within 2 days of the problem being identified unless
otherwise agreed.
Actions:
b. Define and implement emergency response actions (sometimes referred to as immediate containment
actions). Check that the containment action works (provide evidence).
Ensure that:
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RM13000 - 8D Problem Solving Method
The organization forms a cross-functional team of people who have the knowledge, skill, experience, time,
authority, and work the problem at pace right through to a satisfactory conclusion. At least one member of the
team needs to be appropriately trained in the application of the 8D methodology and is to be accountable for
the application of this standard.
Actions:
• Identify a champion for the team that ensures actions are taken and any roadblocks are removed.
• Identify a team leader that can focus and motivate the team.
The organization defines the nonconformance to the customer requirement by identifying and describing in
quantifiable terms what is wrong. This statement is called the problem description.
Actions:
• Collect and analyze data to find out “what is wrong with what.” Develop a problem statement by describing
the problem in quantifiable terms. The description should address:
o Problem discovery point: Where is the earliest point within the process where the problem is observed?
o Problem manifestation: What are the indications that a problem exists? It is best if the problem can be
described in terms of customer experience.
o Problem impact: What is the impact in terms of quality, reliability, and productivity?
o Problem focus: Can the investigation focus be narrowed to speed convergence to the root cause?
• Review the problem description with the customer and affected parties.
The organization implements actions to immediately stop the symptoms from affecting the customer until the
problem can be resolved permanently.
Actions:
• Work with the customer, and the supplier if relevant, to determine the locations of affected product and the
responsibilities, methods, and timescale to contain that product.
• Check that the containment action is effective. Read across to other affected product as appropriate.
• Maintain records of containment as required by the customer (see Appendix D.9 and D.10 for an example
containment workbook).
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RM13000 - 8D Problem Solving Method
The organization’s aim is to find the root cause by identifying potential causes and selecting the ones which
explain the problem. The organization needs to find the generation points where the symptom was created and
the escape points where the problem should have been detected and contained.
Actions:
• Find the root causes of the problem of the escape and of the quality management system.
• Verify the escape point(s) and establish why they were present.
D5 - Identify Permanent Corrective Action for Root Cause and Escape Point
The organization identifies the corrective actions that permanently eliminate the generation and escape root
causes.
D5 is completed in a timely manner not to exceed 30 days of the problem being identified unless otherwise
agreed with the customer.
Actions:
• Verify that the corrective actions are effective and do not cause further problems.
• Define the actions required to fix the control system at the escape point so no further occurrences are
created.
The organization then implements and tests the corrective actions that fix the root causes and the quality control
system at the escape point.
Actions:
• Check that the actions are effective at fixing the root causes and result in no other product issues being
created.
• Implement the corrective actions that fix the quality control system at the generation and escape point(s)
ensuring that it detects and not releases the problem again.
• Remove containment measures when permanent corrective actions are proven to be effective.
• Update the appropriate quality documentation such as the process flow diagram, PFMEA, and control plan.
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RM13000 - 8D Problem Solving Method
D7 - Prevent Recurrence
The organization takes appropriate systemic action (modify policies, procedures, practices, standard work,
design manuals, etc.) to prevent recurrence of this problem and other similar problems and capture the lessons
learned.
NOTE: The team may not have the authority to implement systemic actions. In this case, they make
recommendations to the champion for implementation.
The champion ensures that recommendations are appropriate to the scale of problem and have responsibility
for implementation.
Actions:
• Identify further affected parties, products, processes, or systems for similar problems and read across
opportunities for improvement(s).
• Document the lessons learned in relation to the problem within the system so that the lessons are referred
to in order to maximize the value of the 8D effort and prevent any similar problems.
The organization recognizes the success of the team and formally closes the project.
Actions:
• Document the lessons learned from the 8D process and maintain all problem-solving records.
• Recognize the team for their contribution and celebrate the achievements.
4.2 4D Methodology
The 4D approach draws from the steps of 8D per Figure 5. The steps are:
• D2 (Define Problem)
Use these questions below to determine if the full 8D is required or if a shorter version would be appropriate.
Use the following set of questions to aid in that decision:
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RM13000 - 8D Problem Solving Method
If the answer is “yes” to two or more of the four questions above, it is best to utilize the entire nine steps of the
8D investigation process. Otherwise, start with the 4D shortened version and expand if needed as more
information becomes available. Examples of when a 4D is appropriate could be a problem contained to a
specific factory cell, such as a machine breakdown, part nonconformance, or yield issue where no defective
units left the station.
Note that no two problems are alike. A problem might start using the 4D approach and through the process the
team or team leader might realize that a temporary (interim) action is needed. In this case, step D3 is added
and a 5D investigation. This is very appropriate to do.
Everyday problem-solving does not require the level of documentation or steps such as an 8D investigation or
a 4D investigation. The following are some examples of everyday problems encountered such as a pencil breaks
then go sharpen it and the flashlight doesn’t go on. There is no need for a fault tree or 5 Why analysis to quickly
identify the problem and solution. The problem solver instinctively reaches for a new set of batteries and
replaces the ones in the flashlight, pushes the switch, the light goes on. The 2D approach draws from the steps
of 4D per Figure 5 with the steps being D2 (Define Problem) and D6 (Solve Problem). These two steps are
previously described above.
When should one recognize that they do not need to perform all the four steps of a 4D? Use the following set
of questions to aid in that decision:
If the answer is “yes” to the question set above, go ahead and implement a 2D type investigation.
5. FORMS OF 8D
There are three different forms provided here in this section that meet the requirements but are not required to
be used if a form is already in use that meets the 8D requirements. Customers may require a specific form of
the report.
This follows the same steps as for an 8D, but it is less prescriptive. This allows it to be a useful tool for non-
product related issues. In a work environment, it is good practice to print the A3 sheet and post onto team
boards to increase visibility of current investigation(s) and drive active engagement in the problem-solving
process.
Based on the prior discussion of 8D, the following incorporates additional 8D guidance when using the A3
format. Figure 6 shows a blank A3 form. Follow steps D1 through D4, D5/D6 and D7/D8 are combined.
D1. Form the Team - Pull together as many people that are familiar with the problem as possible. Process users
are particularly important as they understand the detailed steps and issues that occur. Ensure Subject Matter
Experts (SMEs) are drawn into the team.
D2. Define the Problem - Once the team is formed, define the problem. Once again stick to the facts of what
actually happened and don’t make assumptions. If necessary, walk the process with the team to really see what
is happening. See the 5W2H or SMARTI tool in Section 7.
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RM13000 - 8D Problem Solving Method
D3. Implement Containment - Once the problem is fully defined and understood by the team, determine what
the containment activity is to prevent the problem recurring while the root cause is investigated.
D4. Find the Root Cause - Recommend using tools from Section 5 to determine the root cause of the problem.
D6. Fix the Root Cause - Once the team has determined the root cause of the problem using the most
appropriate methodology, then the solution(s) to the problem should make itself clear to the team and should
be implemented. It is important not to walk away from the problem at this stage but ensure that the actions have
owners and they have the support necessary to implement the corrective action. The corrective action should
be reviewed to ensure that it is effective.
D7 and D8. Fix the System Issues, Read Across, and Recognize the Team - In this final step the team needs
to think about ways of preventing the problem from happening again. Also, the team should look at opportunities
of reading fixes across similar processes, other locations/components that may be affected by the same issue.
When this work is complete, it is important to recognize the good work that the team has completed in fixing the
problems and communicate to the local management the fix that has been implemented and the results.
This next form was developed as a two page presentation style problem-solving and report out tool. The layout
of the problem and solution is different but has all the elements of the 8D in a different format.
Page 1 (see Figure 7) covers the 8D Steps D0 through D3 where the problem is defined with the necessary
containment actions. There are two status indicators on this page as well. The first is a visual impact indicator
to be used to help bound the problem. It is located on the left-hand side of the page. It includes where in the
value stream between the supplier and customer the problem exists. There is a color coding scheme to indicate
the customer impact level. The second is an investigation status indicator (it is in the middle of right-hand side).
These boxes are filled in as the problem-solving process progresses with the status.
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RM13000 - 8D Problem Solving Method
The second page (see Figure 8) starts with determining root cause through the 3x5 Why method (Step D4) and
continues through Step D7 preventative action. The steps follow the direction of the standard 8D; just are
presented differently.
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RM13000 - 8D Problem Solving Method
This next form was developed as a three page working document style problem-solving and report tool. The
customer may require more diagrams or figures that could be attached or a presentation. This form summarizes
the 8D method.
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RM13000 - 8D Problem Solving Method
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RM13000 - 8D Problem Solving Method
6. CASE STUDIES OF 8D
The following three case studies are all real problems that were solved using the 8D methodology. Each case
is presented in a different format, all of which are acceptable. The common thread is the nine steps of the 8D
process.
Case Study 1 presents an example showing each step in the form. Case Study 2 provides some background to
the case and some summary thoughts on how the investigation was completed and then presents the
PowerPoint 8D form. Case Study 3 walks through the team’s thought process in detail using each of the nine
steps of the 8D methodology. Each root cause tool used is also demonstrated in the case study in the
appropriate step.
A quality issue was found at ACME Engine Assembly involving the XYZ oil pan bracket. It was discovered that
the holes were undersized resulting in the inability to assemble the bracket to the pan. An investigation was
launched to determine the root causes of the issue. Follow the case study in Figure 12 using the Excel 8D A3
form.
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RM13000 - 8D Problem Solving Method
ACME supplier took over manufacturing a disk from their customer Turbines, Inc. This disk was rough turned
and minimum and maximum thicknesses were defined on the drawing. The supplier determined the thickness
by calculating a difference between measurements obtained from opposing sides of the disk by using a
micrometer and sonic pin. Their initial calculations showed they were meeting the blueprint dimensions. The
part was further processed in the customer’s facility before assembling to the engine.
Two years after the first disk was made, a nonconformance was found at the customer during engine assembly.
Issued a stop build order form using all ACME disks P/N1234567 in assembly and subassembly. One hundred
percent inspection of all ACME disks to find any acceptable products.
Team (D1)
A team was created to investigate the issues relating to the nonconformance. This team was comprised of
members from ACME supplier and its customer Turbines, Inc. Team member expertise included customer
quality engineer, supplier quality engineer, statistician, customer quality manager, and supplier quality manager.
The P/N1234567 disk supplied by ACME supplier during the time period of January 2017 and January 2019
had potential nonconformances in the web thickness with maximum over thickness or under thickness. The
suspect population includes ~500 disks. The problem is found throughout the customer and supplier facilities.
This is shown in Figure 10.
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RM13000 - 8D Problem Solving Method
Incoming inspection was implemented immediately at Turbines, Inc. machining facility to ensure that any issues
were detected and reworked immediately.
The team conducted a 3x5 Why root cause analysis using the form shown in Figure 11. Below summarizes the
root causes they determined:
1. Generation Point (Direct) Root Cause: Over or under machining the part due to lack of accounting for
manufacturing variation.
2. Detection (Inspection) Root Cause: No Gage Repeatability and Reproducibility study (GRR) was completed
at First Article Inspection (FAI) (team feels GRR would have picked this up).
3. Systemic Root Cause: FAI did not have two independent measurement methods - only pinpoint micrometer
(sonic gauge).
The team developed several permanent corrective actions. Figure 10 has a summary table of the actions, their
owners, an estimated completion date, and status.
The team was recognized by the quality leader at Turbines, Inc. at his quality all-hands for their work.
Additionally, members of the team utilized this 8D investigation to improve their overall knowledge in quality.
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RM13000 - 8D Problem Solving Method
An aerospace component company who manufacturers shafts is required to physically mark the shaft length on
the part for the assembly operator to use at the next higher level assembly. A recent event occurred when the
actual dimension, which was within the engineering defined tolerance, was identified incorrectly on the shaft.
The recorded dimension on the shaft was outside the engineering tolerance which was caught by the assembly
operator who verifies this dimension on the shaft prior to its assembly. Given the marked shaft dimension was
out of tolerance, a quality notification was issued back to the component manufacturing site it originated at.
In response to the quality notification and given that this incorrectly marked shaft reached the external customer
assembly floor, an 8D investigation was required by the external customer. Following is the step-by-step
process used to document this investigation using the 8D process.
Given this problem was initially found by the shaft customer, the following immediate containment actions were
taken by the customer:
1. An 8D investigation was initiated by the customer Supplier Quality Engineer (SQE) assigned to that supplier.
The SQE began by preparing the 8D document as shown in Appendix A.
2. Contacted the supplier to inform them that three delivered shafts were received with dimensional markings
that were outside the engineering tolerance.
3. Supplier asked to verify if the out-of-tolerance markings matched the actual shaft length or if they incorrectly
marked each shaft.
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RM13000 - 8D Problem Solving Method
The SQE contacted the supplier who provided team members from inspection, manufacturing engineering,
quality control and assurance. The SQE worked with the supplier team members in establishing the following:
1. Meeting cadence.
2. Trained supplier in use of the AS13000 8D form to ensure clarity and understanding.
3. What the final customer’s expectations were (e.g., containment actions within 48 hours, use of root cause
analysis tools).
The team, using problem definition tools such as 5W-2H, defined the problem as follows:
“On April 15, 2020, the customer reported that the dimension marking on the shaft provided by the supplier -
which is nominally 935.40 mm ± 0.4 mm, is outside of limits on four of the shafts: S/Ns 120, 121, 122, and 123.”
The impact of failure was determined not to affect form, fit, or function. Engineering did require the marking be
corrected prior to installation at the next higher assembly since the shafts were not already assembled and
contained.
In order to help its customer and get its assembly line up and running, the Supplier took the following temporary
actions to provide conforming shafts:
1. Remarked all returned shafts from the customer with the correct dimensions.
2. Quality alert issued in shop floor with notification to all operators and inspectors.
3. Pulled all in-house incorrectly marked shafts found internally prior to shipping and reidentified them with the
correct dimension prior to shipping.
The initial investigation focused on how the subject shaft length dimension is calculated. Figure 15 illustrates
this feature.
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RM13000 - 8D Problem Solving Method
The team, per the problem definition, utilized a problem statement, fishbone diagram, and 5 Why analysis to
identify the causal factors and subsequent root causes of the problem. These causes are broken down into the
categories of direct, detection and systemic.
First, the team determined the causal factors for the problem definition using the fishbone diagram (see
Figure 16).
PROBLEM DEFINITION
Secondly, the team conducted a 5 Why analysis for the direct cause of the problem. This is shown in Figure 17.
Note the leading question “What is happening that shouldn’t be at the process generation point?”.
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RM13000 - 8D Problem Solving Method
5-WHY DIAGRAM
8D
8D
What is happening that shouldn’t be at the process Generation Point?
(HINT: Do not was te the 1 s t “why ” by res tating the problem; what is the failure mode or abs enc e of the requirement?)
“On April 15, 2020, the Customer reported that the dimension marking on
the shaft provided by the Supplier – which is nominally 935.40 +/- 0.4mm ,
is outside of limits on 4 of the shafts: S/N’s 120, 121, 122 and 123.”
Why is this happening?
Theref ore
Operator marked incorrect (out-of-
1 tolerance) dimension on shaft
3
spreadsheet
dimension manually, thus making that calculates
the error shaft length
2
Caution: Your last answer should be a cause you can correct and control
Note the use of the “Therefore” test as part of the 5 Why analysis. The 5 Why analysis needs to make sense
going from top-to-bottom asking “Why” and from bottom-to-top stating “Therefore.” This helps to validate the 5
Why analysis.
Third, the team conducted a 5 Why analysis for the detection cause of the problem. This is shown in Figure 18.
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RM13000 - 8D Problem Solving Method
Now the team worked to identify the needed permanent corrective actions for the problem that initiated the 8D
investigation. Note the brainstormed list of possible corrective actions from the 5 Why diagram. Also, a solution
selection matrix can be used if there is a need to analyze multiple possible solutions using typical criteria such
as speed to implementation, cost, ease of implementation, etc. Corrective actions at this stage address the
initial problem but the team may also look to see how they may deploy these corrective actions in a read across
manner which is part of D7. The permanent corrective actions for this incorrectly marked shaft length problem
are as follows:
1. Update the operator work instruction to include an inspection note to compare the recorded router
dimension with the drawing requirement. This is a permanent C/A.
2. Create an operator check sheet that includes a step to compare the recorded router dimension with the
drawing requirement. This check sheet will be called out by the work instruction in Item 1 above. This is a
permanent C/A.
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RM13000 - 8D Problem Solving Method
Drawing Revision
(図面のリビジョン)
年 月 日 OP-
(YYYY/MM/DD) (OP No.)
P / N S / N
9 3 5 . * * DBA L
The total length is within the range of 935.00 - 935.80.
(全長寸法は935.00 - 935.80 の範囲内であること。) Prepared Checked
(作成者) (再確認者)
3. Create a Microsoft Excel spreadsheet for the inspector to eliminate the need to manually calculate the shaft
length dimension. This spreadsheet is called out as a tool from the inspection plan. This is a temporary
action (D3).
4. Modify CMM program to inspect the shaft length dimension directly. This is a permanent action.
Next the team set up an implementation plan for the permanent corrective actions identified in D5. This will
include who is responsible to assure the C/A gets implemented, the expected dates for completion, validating
all C/As are deployed and effective. Determining effectiveness may mean monitoring the next sequence of
deliveries for the failure mode subject of the 8D investigation or completing an audit or both. Table 3 summarizes
the plan.
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RM13000 - 8D Problem Solving Method
D7 is about implementing corrective actions beyond the initiating event that drove the permanent corrective
actions. What other product could the failure mode become infected into? What future designed components
could contain potentially the failure mode if we do not update the appropriate QMS procedures, design manuals,
manufacturing planning standard work, etc.?
The team has addressed the D7 actions per the corrective action plan in D6 in the prior section. See Items 7
and 8.
The D8 step is about recognizing the hard work implemented by the 8D investigation team. This may be done
any number of ways such as an agenda item at a management staff meeting, a pizza party, an email from the
manager impacted by the investigation. This is truly up to the company how it will execute this step.
For this case study, the company decided to recognize the team at a staff meeting and made this one of the
meeting’s agenda items.
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RM13000 - 8D Problem Solving Method
The use of basic quality tools is strongly recommended as part of the problem resolution process no matter
what specific methodology is applied. Many problem-solving tools are available in the interactive 8D tool on
AESQ (https://aesq.sae-itc.com/supplemental-material) and on https://asq.org/quality-resources/seven-basic-
quality-tools with instructions on how to use for problem-solving tools and templates to use.
Figure 20 shows AESQ 8D interactive tool control panel. Each button is a hyperlink (when downloaded from
AESQ). The left-hand column of the panel is the four key actions: Immediate (D0-D2), Interim (D3-D4),
Permanent (D5-D6), and Preventative (D7-D8). The second column, Process Steps and Key Words, has the
step-by-step instructions to walk the user through the 8D process. The third column is the Tools Matrices. All
the possible tools and templates that would support an 8D investigation are in this column. The fourth column,
or right-hand column, is the key questions that should be answered during the 8D investigation. Additionally, in
the center of the control panel are links to all the 8D forms.
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RM13000 - 8D Problem Solving Method
The following checklist is designed to assist in assessing the quality of the 8D activity.
Review the following assessing questions during execution of each step and before proceeding to the next step.
D0 Assessing Questions
Are emergency response actions necessary?
Emergency Is a field action required as part of the emergency response?
Response How was the emergency response action verified?
Action (ERA) How was the emergency response action validated?
How well does the proposed 8D meet the application criteria?
Has the effect of the issue been quantified?
Have measurements been taken to quantify the symptom(s) demonstrated?
Does a performance gap exist and/or has the priority (severity, urgency, growth) of the symptom
8D Application warranted initiation of the process?
Criteria Is the cause unknown?
Is management committed to dedicating the necessary resources to fix the problem at the root
cause level and to prevent recurrence?
Does the symptom complexity exceed the ability of one person to resolve?
Other Will the new 8D duplicate an existing 8D?
Have all changes been documented (e.g., FMEA, control plan, process flow)?
Do we have the right team composition to validate the current step and proceed to the next?
Have we reviewed the measurable(s)?
Common Have we determined if field action is required?
Tasks Can we anticipate need for deployment of timely on-site support?
Have we reviewed all these assessing questions with the sub tier if the issue was caused by the
latter?
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RM13000 - 8D Problem Solving Method
D1 Assessing Questions
What have you done to make the room user-friendly?
When and where will the team meet?
What has been done to help team members build their relationships with each other?
Warm Up What has been done to help team members focus on the team's activity?
Has the purpose of the meeting been stated?
Has the team been informed of the agenda for the meeting?
Are the people affected by the problem represented?
How is customer’s viewpoint represented?
Does each person have a reason for being on the team?
Membership Is the team large enough to include all necessary input but small enough to act effectively?
Does the team membership reflect the problem's current status?
Do the team members agree on membership?
Product/Process What special skills or experience will the team require in order to function effectively?
Knowledge
Have the team's goals and membership roles been clarified?
Operating Does the team have sufficient decision-making authority to accomplish its goals?
Procedures How will the team’s information be communicated internally and externally?
and Working Do all members agree with and understand the team's goals?
Relationships Are team members’ roles and responsibilities clear?
Is a facilitator needed to coach the process and manage team consensus?
Has the designated champion of the team been identified?
Roles Has the team leader been identified?
Have all changes been documented (e.g., FMEA, control plan, process flow)?
Do we have the right team composition to validate the current step and proceed to the next?
Common Have we reviewed the measurable(s)?
Tasks Have we determined if a field action is required?
Have we reviewed all these assessing questions with the sub tier if the issue was caused by the
latter?
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RM13000 - 8D Problem Solving Method
D2 Assessing Questions
Symptom Can the symptom be subdivided?
Has a specific problem statement been defined (object and defect)?
Have “repeated Whys” been used?
Problem Statement What's wrong with what?
Do we know for certain why this is occurring?
Has Is/Is-Not analysis been performed (what, where, when, how big)?
When has this problem appeared before?
Where in this process does this problem first appear?
What, if any, pattern(s) is (are) there to this problem?
Are similar components and/or parts showing the same problem?
Has the current process flow been identified?
Problem Description Does this process flow represent a change?
Have all required data been collected and analyzed?
How does the ERA affect the data?
Is there enough information to evaluate and identify potential root causes?
Do we have physical evidence of the problem?
Has a cause and effect diagram been completed?
Type of Problem Does this problem describe a “something changed” or a “never been there” situation?
Has the problem description been reviewed for completeness with customer and
affected parties?
Review of Problem Should this problem be reviewed with executive management?
Description Should financial reserves be set aside?
Should any moral, social or legal obligations related to this problem be considered?
Have all changes been documented (e.g., FMEA, control plan, process flow)?
Do we have the right team composition to validate the current step and proceed to the
next?
Common Have we reviewed the measurable(s)?
Tasks Have we determined if a field action is required?
Have we reviewed all these assessing questions with the sub tier if the issue was
caused by the latter?
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RM13000 - 8D Problem Solving Method
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RM13000 - 8D Problem Solving Method
D4 Assessing Questions
Has the factual information in the problem description been updated?
General Is it consistent with the previously performed is/is not analysis?
What sources of information have been used to develop the potential root cause list?
Is there a root cause (a single verified reason that accounts for the problem)?
What factor(s) changed to create this problem?
What data is available that indicates any problem in the manufacturing or design process?
Root Cause How did we verify this root cause?
Does this root cause explain all the facts compiled at D2?
Does the root cause analysis address the system level issue?
Have appropriate Advanced Product Quality Planning (APQP) tools been considered (e.g.,
FMEA, control plans, instructions)?
Is there more than one potential root cause?
Does each item on the potential root cause list account for all known data?
Has each item been verified (used to make the effect come and go)?
Potential Root Cause How did you determine assignment of percent contribution?
If the level is achievable, has the team considered and reviewed with the champion the
benefit of developing a separate problem description (and, by definition, separate 8D) for
the one or more contributing potential root cause(s)?
If the level is not achievable, has the team considered and reviewed with the champion the
benefit of alternate problem-solving methods?
Does a control system exist to detect the problem?
Has the current control system been identified?
Does this control system represent a change from the original design?
Escape Point Has it been verified that the control system is capable of detecting the problem?
Is the identified control point closest to the root cause/potential root cause?
Is there a need to improve the control system?
Have all changes been documented (e.g., FMEA, control plan, process flow)?
Do we have the right team composition to validate the current step and proceed to the
next?
Common Tasks Have we reviewed the measurable(s)?
Have we determined if a field action is required?
Have we reviewed all these assessing questions with the sub tier if the issue was caused
by the latter?
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RM13000 - 8D Problem Solving Method
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RM13000 - 8D Problem Solving Method
D6 Assessing Questions
What departments are needed to implement the PCAs?
Are representatives of those departments on our team to plan and implement their roles
and responsibilities?
What customer and/or supplier involvement is needed?
Who will do the planning for the customer and for the supplier?
Do we have the necessary resources to implement this plan?
What is needed?
At what point(s) is this plan vulnerable?
What can be done to prevent these points?
How are we monitoring completion of the plan?
When will the ICA be removed?
How will we communicate this plan to those who have a need to know?
What training will be required?
What measurable(s) will be used to validate the outcome of the PCAs (both short term and
long term)?
Has the ICA been discontinued?
Has the unwanted effect been totally eliminated?
How can we conclusively prove this?
How are we continuing to monitor long-term results?
What is the measurable?
Is this the best way to prove the root cause is eliminated?
How have we confirmed the findings with the customer?
Have we updated all quality documentation pertaining to this issue (e.g., process flow
charts, Process control plan, work instructions, visual aids, etc.)?
Have all changes been documented (e.g., FMEA, control plan, process flow)?
Do we have the right team composition to validate the current step and proceed to the
next?
Have we reviewed the measurable(s)?
Have we determined if a field action is required?
Have we reviewed all these assessing questions with the sub tier if the issue was caused
by the latter?
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RM13000 - 8D Problem Solving Method
D7 Assessing Questions
What policies, methods, procedures, and/or systems allowed this problem to occur and escape?
What needs to be done differently to prevent recurrence of the root cause? Of the escape point?
Is a field action required as part of the prevention actions?
What evidence exists that indicates the need for a process improvement approach?
Who is best able to design improvements in any of the systems, policies, methods, and/or
Prevent Actions procedures that resulted in this root cause and escape?
(this problem and What is the best way to perform a trial run with these improvements?
similar problems) What plans have been written to coordinate preventive actions and standardize the practices?
Does the champion concur with the identified preventive actions and plans?
How will these new practices be communicated to those affected by the change?
Have we standardized all the practices that need standardization?
What progress check points have been defined to assess system improvements?
What management policy, system, or procedure allowed this problem to occur or escape?
Systemic Are these practices beyond the scope of the current champion?
Preventive Who has responsibility for these practices?
Recommendations Does the current champion agree with the team's systemic prevention recommendations?
Have all changes been documented (e.g., FMEA, control plan, process flow)?
Have all systems, practices, procedures, documents, etc., been updated?
Do they accurately reflect what we want to be done from here?
Do we have the right team composition to validate the current step and proceed to the next?
Common Tasks Have we reviewed the measurable(s)?
Have we determined if a field action is required?
Have we reviewed all these assessing questions with the sub tier if the issue was caused by the
latter?
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RM13000 - 8D Problem Solving Method
D8 Assessing Questions
Has the 8D report been updated and appropriately distributed?
Is the 8D paperwork completed and have other members of the organization (who have a need to
know) and the customer been informed of the status of this 8D?
Is the 8D report and its attachments retained in our historical file system?
Is there a complete list of all team members, current and past?
Were there significant contributions by individual team members?
What were they?
Are there opportunities to provide recognition from leader to team, team member to team
member, team to leader, team to champion?
What are some different ways to communicate the recognition message?
Are there any non-team members whose contributions to the 8D process justify inclusion at
recognition time?
Are all current and past team members being recognized?
Do the results achieved by the team warrant some publicity (e.g., company newsletter)?
D8 is intended to be positive. What are the chances that it might backfire and turn into a negative?
What have you learned as individuals and as a team?
About yourselves?
About problem-solving?
About teamwork?
How did the organization benefit by the completion of this 8D process?
Review each 8D objective.
What was done well?
What sort of things should be repeated if conditions bring them together again on another 8D?
Are there changes to the business practices that should be considered, based on the learning in
this 8D?
Have we reviewed all these assessing questions with the sub tier if the issue was caused by the
latter?
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RM13000 - 8D Problem Solving Method
The purpose of this syllabus is to define the minimum requirements that an 8D training course should cover to
meet customer expectations.
The training provider should check that the trainees have baseline understanding of:
Competencies of the trainees should be assessed with a written exam covering the content of the syllabus.
The training should review and explain the 8D process and customer requirement (see §1).
The training provider should plan specific tool training regarding each step of the 8D depending on customer
requirements.
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RM13000 - 8D Problem Solving Method
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RM13000 - 8D Problem Solving Method
ESCAPE POINT: The earliest point in the process where the problem should have been detected.
FAILURE MODE: The manner in which a component, subsystem, system, or manufacturing/assembly process
could potentially fail to meet or deliver its intended function(s) or process requirements.
GENERATION POINT: The point in the process where the failure mode was created.
INTERIM CONTAINMENT ACTION (ICA): Immediate temporary actions taken in order to eliminate or
significantly reduce the effect of the failure mode on the customer(s) until permanent corrective actions are in
place and verified.
PERMANENT CORRECTIVE ACTION (PCA): Long-term actions taken to address the problem from its root
cause(s) and fix it permanently.
PROBLEM: Description of an issue where a product does not meet the required standard.
ROOT CAUSE: The fundamental deficiency or failure of a process that when resolved, prevents or significantly
reduces the likelihood of recurrence of the problem.
SYMPTOM/FAILURE MODE EFFECT: Measurable events or effects that indicate the existence of one or more
problems.
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RM13000 - 8D Problem Solving Method
APPENDIX D - ACKNOWLEDGEMENTS
This reference manual represents the consensus of the members of the AESQ. The Team members who
developed this guidance and whose names appear below, wish to acknowledge the many contributions made
by individuals from their respective organizations.
Organization Representative
GE Aerospace Marnie Ham - Team Leader
IHI Jun Sakai - Deputy Team Leader
Safran Julie Fouquet
MTU Tobias Kranz
Rolls-Royce Sharron Magowan
Pratt & Whitney Peter Papadopoulos
GE Aerospace Vaclav Pisa
Honeywell Adam Rogers
Pratt & Whitney Peter Teti
GKN Roger Persson
Rolls-Royce Steve Roebuck
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RM13000 - 8D Problem Solving Method
Change History
Email: [email protected]
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