Re: $500 million for an error in a policy manual

["Peter Neilson" <neilson -at- windstream -dot- net>]

From my wife, the quality engineer...
"The correct procedure is incoming inspection for anything that can  
possibly be a critical material. There is a wide range of possibilities  
that must be covered. For example, I needed Vermiculite for a purpose very  
similar to the kitty-litter situation. The purchasing person found an  
"insulating material" that was much cheaper, and changed the PO. I caught  
that one before anything bad happened.

"On other occasions I have had arguments about removing incoming  
inspection to 'save a few bucks' and in each case if I lost the argument  
there was a catastrophe. One time a wall of a warehouse got blown out in  
the explosion. Another time purchasing substituted trichloroethane where  
trichloroethylene was required as a cleaning agent for manufacture of  
parts for xerography equipment. The customer discovered the resulting  
failure, which resulted in scrapping millions of dollars worth of product.  
The cost of incoming inspection on the trichloroethylene was less than  
$100 per year, but I could not get anyone to give me a sample."

The failure was that management did not correctly identify kitty litter as  
a critical material. This did not hinge on "tech writing" but instead on  
management of critical components. The kitty litter had not been a problem  
until the new wheat-based kind appeared. Perhaps there is a MIL spec for  
"hazardous spill" kitty litter, but nobody bothered to check.

Some of these problems stem from ISO9000, "Just-It-Time", and the belief  
that your supplier will give you what you need.

On Mon, 08 Dec 2014 12:07:09 -0500, Gene Kim-Eng <techwr -at- genek -dot- com> wrote: