Mistake-proofing is not about blaming people or demanding perfection. It’s about designing systems that make errors less likely and make problems visible when they occur. This archive explores mistake-proofing as a leadership and system responsibility—across healthcare, aviation, manufacturing, and everyday work.
Through real-world examples, these posts show why signs, reminders, and “be careful” messages fail—and how better process design, learning, and respect for people lead to safer, more reliable outcomes.
I saw this at a hospital lab last year, a great example of true error proofing vs. just putting up warning signs. “Cautions” and “Warnings” are lazy engineering, in general, with product design. Signs are not good problem-solving in any…
Society of Manufacturing Engineers Catching up on some old links and articles I never did get around to publishing… here’s a good overview of error proofing (not “fool proofing” or “dummy proofing”) from the SME and their magazine. Please check…
This is an incredibly sad, and completely preventable, situation. Three babies are dead, and three more injured, because the wrong drug was administered to them at an Indianapolis hospital. Let’s keep in mind, first, this quote from the World Health…
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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…
