Error-Proofing, Mistake-Proofing, Poka-Yoke. Whatever name we want to give them, they all are methods that help operators avoid mistakes in their work. Devices and tools based on this premise have been utilized in virtually every industry to minimize / eliminate the ability of an operator to make a mistake and pass that mistake to the next step in the process – the elimination of human error. But, just how far should we take this?
We’ve all looked at processes, probably error-proofed them to a point, and then said, “everyone knows how to do that,” or “no one would be that…” figuring what could possibly go wrong. Well, it may turn out – a lot.
Take the making of a pot of coffee. It’s pretty intuitive to make a pot of coffee, especially once you’ve determined where the filters and coffee pack are. What could possible go wrong with this process? Well – take a look:
What’s missing from this picture? Oh yeah, the pot. The person gracious enough to make the coffee every morning forgot to put the pot on the burner. She said she came in, did her normal routine without thinking (she has made coffee perfectly for months), but just didn’t put the pot on the burner. She couldn’t remember if she was distracted, tired, or what, just that she didn’t do it (she not only felt awful, but was totally embarrassed by the situation). A simple proximity sensor that would not let you start the machine unless it detected a pot on the burner would have eliminated this from occurring.
True, the above example was ‘just coffee’ and installing proximity sensors on coffee machines may not be ‘cost effective’ – just make sure nothing important is in the path of the coffee as it flows to the floor. But, is there anywhere in your organization where failing to execute on something basic could have less than desirable effects?
Think about it.