Mistake-Proofing and Lean Methodology

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1 Mistake-Proofing and Lean Methodology JOHN R. GROUT CAMPBELL SCHOOL OF BUSINESS, BERRY COLLEGE MOUNT BERRY, GEORGIA

2 It s all about the process Introduction to Lean Mistake-proofing Process: a collection of interrelated work tasks, initiated in response to an event achieving a specific result for the customer and other stakeholders. 2

3 Value stream The value stream is the set of all the specific actions required to bring a specific product through the three critical management tasks of any business Problem solving: Information management: Physical transformation: concept design launch order taking scheduling delivery raw material Finished good 3

4 Muda: 7 wastes 1. Overproduction. (stop doing work early, decreasing length of stay) 2. Waiting (waiting rooms should shrink) 3. Transporting (Park Nicollett cancer facility) 4. Inappropriate Processing (over-treating (Brownlee) 5. Unnecessary Inventory (minimal inventory & shrinking storerooms) 6. Unnecessary / Excess Motion (lower shift distance walked) 7. Defects 4

5 Value? What exactly are you paying for? Driving to the airport Parking at the airport SLC to LAX to ATL Biscoff cookies Waiting for bags at baggage claim Waiting to be roomed Walking from one end of hospital to other? Nurse looking for a wheel chair or supplies Waiting to be discharged 5

6 Flow After waste is eliminated Create flow Everything should move immediately from one process step to the next uninterrupted (one-piece flow) Patients and materials should start to flow as if they were the only one in the hospital (or through the architectural firm). 6

7 Pull Have parts continually ready, in limited supply. Avoid or trivialize scheduling Avoid customer waiting Replace what is taken 7

8 Perfection 1. Doing the first 4 steps (value, value stream, flow and pull) reveals new more precise views of waste. 2. Since the pay off for eliminating waste is so high, and has been demonstrated to be an achievable goal 3. The newly revealed waste becomes low-hanging fruit for improvement. 4. Go to 1. Repeat. 8

9 MISTAKE-PROOFING: BUILT-IN TESTS OF SUCCESS 9

10 Mistake-proofing is The use of process design features to prevent simple errors or their negative impact. Also known as Poka-yoke, Japanese slang for avoiding inadvertent errors. Inexpensive & effective. Something already in use in healthcare, but more could be done. Examples: 10

11 11

12 Stairwells should not allow users to descend below the level of the exits without a strong cue 12

13 Visibility of process status helps improve satisfaction and efficiency. 13

14 Communicating with Linoleum 14

15 Broken seal triggers supply restocking 15

16 Standardized Head Wall 16

17 Example Way-Finding in Hospitals Colored lines or icons on the wall or floor show the way to various departments. 17

18 Q: (Wall Street Journal) How are you going to design restroom facilities In JFK International Terminal to reduce spillage?? A: (you pick) One of the following A) Hire an attendant to monitor and reprimand less hygienic users B) Periodically plot spillage area on a statistical control chart, perform root cause analysis when unusual variation occurs C) Double the size of the fixtures D) Etch the image of a fly on the porcelain 18

19 Interdisciplinary approach to design Engineering: Petroski says We rely on failure of all kinds being designed into many of the products we use every day, and we have come to depend upon things failing at the right time to protect our health and safety... We often thus encourage one mode of failure to obviate a less desirable mode. 19

20 Interdisciplinary approach to design Psychology: Norman recommends designing forcing functions into process: actions are constrained so that failure at one stage prevents the next step from happening. [they] rely upon properties of the physical world for their operation; no special training is necessary. Knowledge in the Head vs. Knowledge in the World 20

21 Interdisciplinary approach to design Medicine: a process that is designed to detect failure and to interrupt the process flow is preferable to a process that continues on in spite of the failure We should favor a process that can, by design, respond automatically to a failure by reverting to a predetermined (usually safe) default mode. Note that interruptions are themselves process failures Croteau & Schyve, Proactively Error-Proofing Health Care Processes, in Spath,P.L., Error Reduction in Health Care. Chicago: AHA Press,

22 Designing failures? Failure mode and effects analysis (FMEA) and other failure analysis methods now have TWO purposes. 1. Determine causes of undesirable failures, and implement preventive measures 2. Determine ways of creating benign failures, and use them AS preventive measures 22

23 Designing failures? Harmful Event Benign Failure OR P(harmful event)=.11 event)=.06 OR P(Benign Failure)=.051 AND P(C 1 C 2 )=.01 X Cause Cause Cause Cause #1 #2 #3 #4 P(F 1 )=.1 P(F 2 )=.1 P(F 3 )=.05 P(F 4 )=.05 Cause #4 P(F 4 )=.05 Cause #A P(F 1 )=.1 AND P(C 1 C 2 )=.001 Cause #B P(F 2 )=.1 Cause #C P(F 2 )=.1 Grout, Preventing Medical Errors by Designing Benign Failures. Joint Commission Journal on Quality and Safety Vol. 29 (2003), No.7, pp

24 24

25 5 stories high 25

26 Still Seeking Examples Manufacturing: 4 books with approximately 500 examples Healthcare: 1 book with 150 examples Architecture, engineering and construction: 0 books (1 manuscript in progress) with 100+ examples, mostly construction. 26

27 Send me examples like this: Color coded walls 27

28 Or this: Preventing the influence of mistakes 28

29 This would work too: Mistake prevention in the work environment 29

30 Even this would be deeply appreciated: Mistake prevention in future repairs 30

31 Here s another: Preventing the influence of mistakes 31

32 Send everyday examples that apply: Mistake detection 32

33 Or this: Metal sensing drill 33

34 Here is an example that was provided by a firm in Vermont: Mistake detection 34

35 But DO NOT send me this: What s wrong with this picture? 35

36 Thank You 36

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