Error Proofing

We are pleased to present this guest blog post by Heather Dunne, Digital Services Specialist for University Marketing and Communications at Michigan Technological University.

One of the common tools in Lean and continuous improvement is error proofing, or poka-yoke. Poka-yoke is a Japanese term that was developed and classified by Shigeo Shingo; that helps someone avoid (yokeru) mistakes (poka).

The concept is simple: Create countermeasures that guard against and prevent errors and mistakes from occurring in a process. If mistakes are avoided, the product quality is high, the customer is happy, and money is saved. Workers, engineers, and managers all must work together to write procedures and design devices to prevent errors from occurring at their source. Errors made within any process can lead to problems, including multiple wastes such as defects, overproduction, waiting, not utilizing people, transportation, inventory, motion, and excess processing.

Error proofing is implemented to prevent human error, but human error cannot be accepted as the cause of an error. The blame game does not apply. Humans make mistakes typically because there is a flaw in the process, itself. There are standard steps that can be taken when error proofing a process. First, take a first-hand look at the process, walking the gemba. Secondly, learn exactly where the error occurred. Then, conduct some problem solving analysis to uncover the root cause. Finally, develop countermeasures to prevent that error from happening again.

Some examples of real-world poka-yokes are the sensor in the gas nozzle that clicks when your tank is full, the ice maker in your freezer shutting off when the bucket if full, and your washing machine stopping when it is out of balance.

Michigan Tech’s Housing and Residential Life developed some poka-yokes for summer conferences:

  • A reference visual for staff who are setting up linens for a room.  It lists exactly what linens are needed and shows how they should be placed on the bed.  This saves staff time when gathering linens to distribute and reduces error in forgetting to place an item in the room.
  • Signage informing guests about areas they have access to and areas they do not. Limiting access to certain floors used the ERA principle–Eliminate Replacement Alternatives.  If the task that is creating the error is eliminated, then the error will disappear too.
  • A kanban board for management of the many groups that stay as guests. By arranging items, information, and people according to a sequence, they developed a good mistake proofing solution.

What are some ways you can apply this simple lean concept in your area?

Lean Olympics Take on the SWIM LANES

With the Rio 2016 Summer Olympics among us and being proud Americans, you probably can’t even go to the grocery store without something or someone blaring “USA! USA! USA!” amid chanting crowds. Can you blame us? We’re up to 83 medals in two weeks, and Hello! Katie Ledecky! Breaking a world record while winning a gold medal by *cough* ONLY 11.38 seconds! That’s pretty cool and yes, GO USA! However, moving passed the idea of the stripes and stars, I’m more interested in the arena Katie took her gold in, and that was in a swimming pool-the kind with swim lanes.

Swim lanes are a tool that is depicted through a diagram. How this tool works is to show the flow of a process or the crossing of many areas of a process and doing so visually. To aid in understanding the steps, an example represented by the progression of the tool will be shown below with a description of each step. This example shows a student who needs to get into a class that has already reached it’s maximum capacity and can’t register for it so they request an exception.

How a swim lane is kicked off is through identifying who touches the process. This “who” can be an individual, a group, a department, an object, or basically anything that physically touches the process. For our example, the who’s include the student, academic advisor of the student, and the professor of the class being registered.


Once the “who’s” are identified, the what’s need to be added. These “what’s” are the current processes that each “who” goes through and how each others processes relate to one another. This is also where you identify where each “who’s” process starts. The process for our example starts with the student and moves to the professor then to the advisor and back to the student.


The third step is where the “what” is examined and analyzed for where there is waste within the process or steps and that don’t add value. For our diagram, there is a waste of time between the time the student makes the request and actually hears back that they can register. This is a waste because it is waiting time. There is also waste for the student: once they are able to register they have to do it very quickly so that another student doesn’t register when they see an open or an “extra” seat. There’s also waste for the professor: they need to do re-work of their classroom to be able to accommodate an additional student.


Through the use of swim lanes you are made to focus on the basic steps to figure out what is actually happening in a process, and once that is done, you are able to then dive into the process and figure out where the defected or problematic areas are and can then get to the root cause. This aids you in being able to see the big picture. Often times we have a process that is “broken” and we become frustrated and redo the entire process just to find that it didn’t reduce the frustration. However, through the use of swim lanes you are able to see the whole process and establish what part(s) of the process is/are broken and can devote your time and energy into making improvements to that specific area without redoing the whole thing. So just like Katie Ledecky, if we take one [free-style] stroke at a time, we can come out in record time.

When The Going Gets Rough

We’re human. We can strive for perfection, like Lean dictates, but we’ll never be inherently perfect. As someone who has always been weighed on heavily by her potential, I have always been anxious to be perfect. I have to get good grades, I have to make my parents proud, I have to outshine the rest of my peers. With school starting up again in just a mere 17–I repeat, 17–days, the stress to be perfect is much more real than it has been all summer. After coming back from the Michigan Lean Consortium’s annual conference (which was awesome by the way) in Traverse City, MI, my life was quickly turned upside-down. This week has been a tough one, and I feel that I’ve been terrible in the sense of being a continuous improvement practitioner. I have found myself behind on my work, my bedroom a disaster, all my laundry dirty, and impending tuition payments on my doorstep–I’ll admit it, I kind of freaked out and bogged myself down…

But then I remembered something–Lean is a journey. I am still human. These things happen and setbacks are to be expected. I remembered how hard Lean was when I first started back in December; I couldn’t even really wrap my head around it back then. The culture confused me and the tools seemed to be described in a different language (unfortunately none of the ones I know). I was told it would be difficult and that there will be days where I would want to throw away all of my post-its and flashcards with random Japanese words on them… But here I am.  I have grown and learned more than I could have ever hoped to in this position in just a few months. I have networked, become more professional, and become part of the best team of practitioners a young lady could ever ask for. Lean is not about where you will get to, it’s about taking that next step that matters. You can’t expect to succeed without failing a few times and that has been one of the hardest lessons for me to learn–and continue to learn. Even though this week has been tough, and I am a bit disappointed in myself, I know now what I need to do to be better and will do so! Here’s to fixing what we broke, starting fresh, moving forward. We aren’t perfect, but we can certainly strive for it one baby step at a time.



Taking a LEAN of absence

Have you ever noticed how going on vacation is simple and coming back to reality is a challenge? There’s no weening into relaxation, you kick your shoes off and leap into a comfortable position, and that’s how you remain for your entire vacation. Yet, when it comes time to go back to your routine it takes some progressing.

This is a concept we are all familiar with, regardless of the length of our “vacation.” I am especially familiar since I just got back into the office last week from being a counselor at a girl scout camp. It was a wonderful week to simply be engulfed by songs, kids, and adventures, but it also took my mind away from being a lean practitioner for seven days. At first I tried to catch close calls, but with 100+ people I gave up pretty quickly and my lean mind was put in the shadows. Once Monday rolled in and I had to dive back into my usual routine, I found myself absolutely dumbfounded and bewildered. This was overwhelming and stressful because I felt as though I had lost my touch. Stepping away from a lean mindset didn’t only affect my work, it affected my everyday life beyond the office as well. This happened because I have been working on implementing lean into everything that I do and when my “core” was removed everything else felt as though it crumbled around me, which made me feel vulnerable, exposed, and distressed. Although I felt as though I lost my touch, I still had lean lurking in the shadows of my hibernating mind and I figured what better experiment then to see if lean really does work as well as it’s argued and to see how important sustainment is to the idea of continuous improvement. This became my first practice with lean since arriving home and I can say, yet again, I am in awe of the power of lean. Before I recognized that this could be an experiment, my apartment was a disaster and flipped upside down, my car became a “enter if you dare” zone, my notes from my classes were disorganized and irrelevant to the material, and my concentration at work was befuddled, all happening in a matter of three days. Now (only a week later), my apartment is no longer chaotic but rather rearranged AND labeled, my notes have been rewritten and deciphered, and my work is on task and on time.

From the start of my lean journey about five months ago, I could tell right away how powerful lean was, and I’ve shared this many times through previous blog posts. However, I hadn’t had enough time for my practices to fall apart and for me to appreciate lean for all that it is, nor did I really understand the importance of sustaining the changes or sustaining a mind to continuously make changes. I came into the Office of Continuous Improvement with no previous knowledge or comprehension of lean; I remember asking Nate what “kaizen” meant and him shaking his head. However, now lean is like the friends I made when I started college–one of the most important things in my life that has only been a part of it for a short period of time, but has made the largest impact thus far. Just like my new friends, I plan to continue to kindle my relationship with lean so that it will never burn out on me entirely.

Lean and Religion

In Zen Buddhism they have this concept known as “shoshin” or the “beginners mind”. The beginner’s mind is one of endless possibilities and connections to be made. It is the biases we learn over time that limit our ability to think outside the box.

I am currently in the beginning of my Lean journey and I want to always keep it that way. From here, I see an infinite set of paths to be followed that will lead me to success and the continuous improvement of both my professional and personal self. When striving to be successful, there are a lot of mental roadblocks that can get in your way. Fear and worry are natural occurrences, but it is what you do with these feelings that really matters. If you go forth with excitement, using these feelings as motivators instead of detriments, you will find yourself doing things you never expected to do (climbing that mountain, boarding that plane, nailing that proposal!).   The brain is something that can always be rewired, so if you spend your time going forth positively, new connections will be created and you will spend less of your time anxious about things that cause you more harm by overthinking about them than the actual task itself.

Growing up I was taught to live my life by the Wiccan principle known as “The Power of 3”. This is the concept that whatever thoughts/energies/ideas/actions you put into the world will come back to you threefold over time. Think outside of the box! If you put creativity out there, you will find yourself feeling more creative in the future. Put understanding out there and you will find yourself being understood (even if it needs a little explanation). If you find yourself always moving forward, you will find yourself leagues ahead of the competition.  Lean is a journey, as is life. If you’re always curious, always live in a shoshin-like state, new things will be discovered every day.


Justice for All


Above is a quote that I stumbled upon recently. When I saw it, I became aware of a change within myself. I couldn’t look at this simple statement from Tom Ford without feeling as though “lean” was leaping from each word.

With the recent holiday weekend at a close–a celebration of the United State’s independence from Great Britain–I found myself reciting the Pledge of Allegiance. The part that I’d like to highlight is the closing line, “with liberty and justice for all.” Liberty meaning that we are not to be enslaved by another nor are we to enslave another. Justice for all, meaning that each individual person is given an equal opportunity to succeed. I’m aware that the Pledge of Allegiance wasn’t written about or for lean, but I do know that it was written under the umbrella of structured common sense which happens to be a part of lean. These concepts along with the concept of striving for perfection have created (what I feel) to be an appropriate depiction of the lean culture.

Before taking on this job as a process improvement coordinator I would’ve classified myself into many variations of personalities, however, obsessive would not have been in the mix. I think that the reasoning may be due to a negative connotation regularly associated with the idea of being obsessed or “perfect.” I was no exception to this stigma until I began working here in the office of continuous improvement. I will say that I now would classify myself as having an “obsessive personality” simply because lean, continuous improvement, and the utilization of waste elimination has taught me that striving for perfection is not condescending, but rather commendable.

Without coincidence, I’ve found that all of the factors for this change are rooted from lean, whether it be from the abundance of tools, the endless room for growth, the “personalities” within lean itself, or simply the growth of a culture. These have all had an active role in how I view the world now compared to how I viewed it months prior. It’s irrelevant as to how I’d describe my personality traits, however, as I briefly mentioned before, lean also has a personality. To me this personality shines through in it’s encouragement of devotion, improvement, and above all it’s accountability regarding respect. These three areas are the specific root causes of why and how I have transitioned from the negative norm to thinking outside of the box to get whatever the day’s job is done in the most precise and efficient manner.

“PDCA Yourself, Before You Wreck Yourself”

… This is plastered on a sign taped to the front of my desk and they are words I live by. PDCA is a tool that every lean practitioner should use on a daily basis. Plan Do Check Act is used primarily when tackling projects or completing tasks in a timely, orderly fashion. However, I have recently found that it does wonders for your personal life.

I am a social butterfly. I pride myself in my ability to surround myself with genuine, caring, successful people… and a lot of them. However, sometimes it grows overwhelming to be this social all the time and I find that I spend less and less time caring for myself, because others tend to be more important to me. Eventually, I found that I was being walked on, that I wasn’t acting my normal happy-go-lucky self. PDCA saved the day! Now, I try to incorporate it into my daily routine to balance my tasks for the day. I plan my day out thoroughly and analyze each task, as well as how I am feeling, as I do them. After all of my necessary tasks are done (which now also includes thorough self-care) and I feel satisfied with myself, then I try to incorporate other people into the plan. At the end of the day I check how I am feeling again and go over the events of the day to see where things went wrong. Now I act by adjusting my plan for the next day, if need be!

So far this has been a great system of checks and balances for me. I highly recommend everyone PDCA all aspects of their life, not necessarily just professional. I myself am slowly learning that life will be more efficient and your time will be spent far happier if you pay attention to how you are feeling and adjust accordingly.Dont let the best youve done so far become the standard for the rest of your life

An Apple a Day Keeps the Problems Away

Lean is like eating an apple. There’s the skin that we all see-it has a color, a texture, and a stem. However, once you break through the skin with your teeth you see a different color, texture, and the core. This is the same principle in Lean and problem solving through the use of the five why’s.

You’re given a scenario (the skin), you see the results of the problem (the color), you see the repercussions of the results (the texture), and you may even see a sliver of the actual problem (the stem). Yet, until you sink your teeth into the scenario you won’t truly see what’s underneath. By taking a bite you slowly begin revealing a new color, a new texture, and eventually the core, or in this case the root cause.

For a moment let’s pretend that it only takes five bites to get to the core of the apple. Each bite represents one of the five why’s.

Imagine a woman who cuts off the ends of a ham before putting it in the oven. Her husband asks “Why do you cut the ends off of the ham before cooking it?” *Bite* She replies, “because it’s how my mother cooked it.” So the husband goes to his mother-in-law and asks, “why do you cut off the ends of the ham before cooking it?” *Bite* She replies, “because it’s how my mother always made it.” So the husband goes to the grandmother and asks why she cooked ham this way *Bite* here he got the same answer that he got from his wife, and his mother-in-law. Finally, he asks the great grandmother “Why have you always cooked your ham without the ends on?” *Bite* She replies, “so I could cook as much ham as possible,” the husband then asks, “why couldn’t you cook the whole ham at once?” *Bite* and she replies, “because the pan I had was too small.”

For generations, the women thought this was how they were supposed to cook a ham simply because their mother before them had cooked it that way, but not once did they stop to recognize that there may be an underlying method to their madness. Over the years this resulted in much ham, time, and money wasted for no real reason.

By asking ourselves five why questions we allow ourselves to get to the root cause. Now, if the husband had only asked four why questions, his last answer would’ve been, “so I could cook as much ham as possible,” this really wouldn’t have answered his question-it would’ve gotten him closer but not to the root cause. The same is true with eating an apple-by taking few too little bites you don’t ever see the core, all you recognize is the apple in your hand. However, if you take another bite you may just find the seeds, and your perspective and appreciation for the apple in your palm has changed.

*Note: The example of the ham is one that was introduced to me by Daniel Bennett of Public Safety and Police Services here at MTU.

What are some areas of waste around you? Have you properly identified the root cause? If not, try utilizing the ‘5 why’s” they may be able to help you find a problem you didn’t originally see.

I’ve been Ruined for the Better

I’ve been on board as a process improvement coordinator (PIC) for about three months now and believe me when I tell you I’ve been ruined… for the better. I truly had no idea what  I got myself into by taking this job, let alone any idea of how much it would change ME so quickly. I’ve always been a well organized person, but with three months of lean in my life I’ve gone a little over the top.

When it became undeniable that I had changed and will continuously change was after I learned how to make an A3. It all started because I’ve been working on a project with our database so that it can be ready to be used to create our updates and annual reports for the board of trustees. That being said, there’s a lot of little things that have been creating tremendous amounts of waste within our current system. To be able to get to the root cause(s) appropriately is where the A3’s came into play. An A3 is a structured problem solving and continuous improvement tools that is outlined on a piece of A3, or ledger, paper (an example of the outline is below). To kick start this project I created six A3’s total, a parent and five daughters. The parent has all of the vague information of what’s happening, where each daughter goes into detail on one or several of the problems identified on the parent. Currently revisions are still being made to the parent and daughters. Revisions help in thoroughly planning out the project and ensuring all of the details are correct before making changes.

A3 template

Going back to how lean has ruined me- I’ve recently moved into my first apartment and I’m noticing waste all around me. From clutter under the kitchen sink, to disorganization in my pantry and refrigerator, to how I store my shoes- there’s a lot of waste and unnecessary movement of things to get to what I actually want, causing a lot of wasted time. The moment that I noticed I was ruined was after my first draft of the database A3’s. I went home and noticed the waste of time, movement, space, and inventory. Having lean in my life I naturally began wondering where all of this waste was coming from, so what did I do? I created A3’s for myself and I’m on the road to improvement in my own environment. An example of one of my personal A3’s is shown below.

decluttering groceries

Feel Good with Lean

We are pleased to present this guest blog post by Lisa Hitch, Business Manager and Technical Communications Specialist, Department of Electrical and Computer Engineering at Michigan Technological University.

Our internal “Reward System” is a collection of brain structures that regulate our behavior by making us feel good when we achieve a goal. Everything necessary for the survival of our species–eating, mating, sleeping, and physical perseverance–is rewarded by a neurochemical called dopamine that makes us feel good. And the drive to feel good wins out over avoiding pain in most cases.

The problem is that we have evolved to the point that we are able to survive without our internal reward system. For example, we can just stop by a fast food drive-through on our way home from work to get our dinner–no big victory there. An inactive internal reward system can cause minor side effects such as procrastination, lack of organization, and missed deadlines. Moreover, low dopamine levels can also lead to serious conditions such as depression, attention deficits, anxiety, fatigue, poor concentration, and more.

Neuroscientific research shows that higher levels of dopamine might support the internal drive some people have to persevere while lower dopamine levels may cause others to give up. But dopamine can be harnessed and used as a prime motivating force to help us keep pushing and achieving our goals. The use of Lean tools and methods can actually help to create feel-good habits that increase our natural ability to produce dopamine.

Lean tools and methods help us to visualize our work, break tasks down to manageable pieces, stay focused, and–here’s the big one–finish our tasks, which rings the bell for our internal reward system. One such Lean tool is the Personal Kanban.

Image by NOMAD8

This image shows the basic concept of a Personal Kanban. Tasks are broken down and categorized into milestones or phases, such as “things to do,” “work in progress,” “waiting,” and “done.” Color-coded sticky notes help to separate the tasks between types of work we need to manage, “administrative,” “communications,” and “HR,” for example. The sticky notes can also be of different shapes and sizes to indicate levels of importance or flow of work. In any case, the movement of the task through the system and into the “done” column reinforces our internal reward system.

There are many other Lean tools and methods that can be found on Michigan Tech’s Continuous Improvement website. I encourage you to check them out and start rewarding yourself today!