Misguided Error Proofing?

A core Lean concept is “error proofing.” We use physical devices or processes that make it difficult or impossible for errors to be made. For a great resource on error proofing, check out John Grout’s Poka-Yoke page.

So let’s go back in time… let’s say it’s early in the 20th century (the era of black and white photos). You have a problem with false alarms with fire boxes, people are pulling the alarm, which wastes resources of the fire department and creates all sorts of risks.

So can you error proof this? You could, maybe, but would you want to? You might get a good chuckle about this one “solution” that was designed (and never took root). The punchline is at the link below:

Firebox Traps Pranksters

What are some obvious problems with this attempt at prevention?

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Mark Graban's passion is creating a better, safer, more cost effective healthcare system for patients and better workplaces for all. Mark is a consultant, author, and speaker in the "Lean healthcare" methodology. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent project is an eBook titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

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3 Comments on "Misguided Error Proofing?"

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  1. Peter P Patterson, MD MBA says:

    Problems? … well for one if the fire was close, the police might find only crispy critter remains of the alarm raiser. wouldn’t take long for people to be reluctant to turn in ANY alarms :-)

    OBTW, GR8 link to Dr. John Grout whose work I did not know, thanks.
    /Dr. Pete

  2. Mark Graban says:

    Exactly!!

    Grout’s work/site is great.

    He has a free pub on healthcare error proofing done through AHRQ, should check it out:

    http://www.ahrq.gov/qual/mistakeproof/

    LINK

  3. William says:

    I can only imagine the room of geniuses that came up with the idea to lock someone inside a burning building. I guess they thought there were more false alarms then real fires so statistically it was safe.

    How about squirting some ink on the person? Im messy but I am alive.

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