Here is a great example of error proofing that I’ve never seen before. It’s springtime, so my allergies have been killing me, especially after mowing the lawn on Saturday. I went and got a prescription for Allegra and received the…
This Is Broken – Hotel room warning I saw a large ad in the paper Friday that reminded me of this blog posting (link above). Be sure to click on the link to see a picture of what I’m talking…
I spend a good amount of time working in Excel, analyzing data and such. I often accidentally hit the “F1” key in a clumsy attempt to hit “Esc”. The keys are right next to each other and each key is…
Here’s the latest in the series on Everyday Lean. I love online bill payment. My bank and the web make it easy to view and pay bills while on the road, and eliminate a lot of paper that would otherwise accumulate…
www.mistakeproofing.com I love this website. There are 30+ examples of every day errorproofing. I wish my bank’s ATM had the error proofing function built in to the example shown. I drove off without my ATM card the other day… as…
A nurse on a telemetry floor had two orders to carry out. Forty milligrams of Lasix, to be given via IV. Two units of insulin lispro, given subcutaneously. At that hospital, every dose of insulin required a second nurse to…
Somebody on the r/nursing subreddit asked what the worst medication error was that people had seen or heard about. Almost six hundred replies came in. I’ve read the whole thing, and there are a few ideas I want to come…
Karen Martin has been on my Lean podcast five times over 12 years, talking through clarity, value stream mapping, whether Lean is dead, and mistake-proofing. For the 20th anniversary series, here are some of the moments from those conversations that…
On a factory table in Japan, in December 2019, there was a binder. White cover, the word KAIZEN in big orange letters, a photo of cherry blossoms underneath. Inside the front cover, someone had printed a word cloud — IMPROVEMENT,…
No. The claim that “Lean is for speed and Six Sigma is for quality” misrepresents both methodologies. Lean — based on the Toyota Production System — improves safety, quality, delivery, cost, and morale (SQDCM) together, with built-in quality (jidoka) as…
TL;DR: The eight wastes give you a lens for seeing problems — but Lean isn’t a scavenger hunt for waste. The real work is understanding why waste exists and building systems where people feel safe enough to point it out.…
Here’s the most famous example of root cause analysis in the Lean world, from Taiichi Ohno’s book on the Toyota Production System. You’ve seen it in training decks, conference talks, blog posts. I’ve shared it myself plenty of times. See…
