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We recently came across a situation in a very long cycle time process. During the “automatic” process an operator is to check the status of the operation every 30 minutes and make any corrections for process deviations. Now that we are focusing on this process, we created a plan to poka yoke the system so that we don’t have to rely on an operator remembering to check every half hour, but it will take about 6 months to get the parts and install them to accomplish. In the mean time, having been historically a company driven by the 8D process from the Big 3, we decided to implement a sign off process for the operators that indicates they have made their check, similar to the McDonald’s bathroom check sheet on the backs of their restroom doors.
This was implemented because of the question from our leadership, “what is different today than when we discovered an operator’s deviation from standard.” The other operators were complaining about the change. “Why should the rest of us suffer because one person didn’t perform their job?”
Quite frankly, I agree with them because this type of thinking has been used against me before which has created non-value added activity. Particularly, someone in a corporation was found to be cheating on expense reports. Instead of dealing with the one deviation of thousands, a new tedious system of checks and balances was implemented and applied to the masses! Is this another huge disrespect for humanity?
Our team has spent much time discussing what other interim mistake proofs we could implement but so far haven’t found a non wasteful countermeasure. We have tried to problem solve the situation by asking why the deviation from standard occurred. So far the best we can come up with is the operator just didn’t do it that day for the first 3 hours.
Reflecting on what we have implemented, have we become the waste creating management that we so avidly complain about? Are we respecting people by implementing rigorous sign-offs because of one isolated incident? Should we just continue with the old system until we have truly poka yoke’d the process?
Much like Bruce thought about his past shadow boards, I have implemented hundreds of these type of 8D corrective actions thinking I have improved the process. Have I really just been creating waste? I shudder to think of the costs I have increased in the name of protecting the customer. Our team will continue to search for the “elegant solution” that Mathew May has written about, but in the mean time I’m still perplexed with our effectiveness.
Bryan
Filed under: Lean, Lean Manufacturing | Tagged: 8D, corrective action, countermeasure, error proof, gemba, hansei, mistake proof, poka yoke, respect for humanity |
Lean Is Good 
Bryan,
One way to demonstrate respect for people is to allow them to develop the countermeasures, rather than have you impose them from above. Have they been able to come up with any?
Dan, yes, the people are integral to the problem solving process. We have 3 operators as part of our A3 team. So far we don’t have a real “short term” poka yoke. We have implemented an improved andon to alert when we have a process variation until we can implement a truely mistake proof countermeasure.
I have had the same issue. In a past life, I worked in a couple of PSM, Process Safety Management sites, where a mistake can have lethal consequences. We worked with the employees to come up with the short term fix while sensors and meters were being installed. You know what we came up with? Two signatures on a piece of paper that became worthless after the process was complete. These are very dangerous processes that can affect people and the environment but I just couldn’t find a better way to do it while other controls were being installed. The other issue was that once they were installed and approved, it took us a couple of weeks to eliminate the added sign-offs.