Deming Article Operator Error
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TrainingSPC ConsultingSPC Knowledge BasePricing/OrderingAbout Us It is the Operator's Fault!November 2014It is the Operator’s fault! Have you heard that before? It is the operator’s fault!!! After all, he is doing the job. So, how can it be anyone else’s reducing human error in manufacturing fault? This month’s publication examines why mistakes occur and how to handle them.In this Issue:It is your fault!Everyone makes mistakesVariationThe challengeTypes of mistakesHow to handle mistakesSummaryHow many F’s are there?Quick LinksYou may download a pdf version of this publication here.It is Your Fault!You work in a distribution warehouse. Your job is simple. A customer order is printed. This contains the various items and quantities http://asq.org/quality-progress/2012/02/expert-answers.html the customer wants. The order ticket also contains where each item is located in the warehouse. You walk to each location, count out the number the customer wants of each item and put them into your cart. You then take the cart to packing where the order is packed and then shipped to the customer. So simple.It is Tuesday morning. Over the intercom, you hear https://www.spcforexcel.com/knowledge/variation/it-operators-fault the warehouse manager saying your name and that she wants you to come to her office. This is what the warehouse manager says:“I just got a call from Tom, our Vice-President of Sales. He just got off the phone with our major customer. The order you picked for them last week was not correct and they are very upset. Tom wants to know why I can’t hire people who can simply read and count! What happened? Why didn’t you fill the order correctly?”Poor you. You just stand there. You don’t even remember the order from last week – after all, you fill so many each week. But, for the warehouse manager (and the Vice-President of Sales), it is your fault.Of course, it is your fault. You are the operator – you are doing the work – you are closest to the process. Heard these reasons for why it is the operator’s fault?He didn’t follow our job work instructions. These are written out and the operator has been trained. The operator just didn’t follow those clear-cut instructions.He wasn’t paying close enough attention.The equipment is down because the operator didn’t run it correctly. And th
Other Podcasts VIDEOS Featured Videos YouTube Channel Video Podcasts BOOKS Books By Mark Graban Book Recommendations RESOURCES Healthcare Improvement Lean Blogs Lean Healthcare Blogs http://www.leanblog.org/2014/05/blame-human-error-occurs-even-if-were-being-careful/ Other Blogs Lean Resources SERVICES Speaking Workshops Consulting CONTACT View All http://www.srtorque.com/resource-box/error-proofing-by-guidance/ Audio Healthcare Leadership Kaizen Quality Patient Safety Deming Respect Books Video Blame Sports By Mark Graban May 11, 2014 15 Comments Read More → Blame: Human Error Occurs Even IF We're Being Careful I'm not sure why "error" was put in quotes since this seems like an actual human error error, not a quote-unquote error: Staff ‘error' blamed for chlorine leak at Louth's Kenwick Park Hotel which led to five being taken to hospital When people talk about human error, they often seem to miss the point. They think calling something human error is an excuse. No. Human error is GOING to happen, because we are fallible. That's why we for human error need good systems, tools, and processes and we can't just ask people to "be more careful" and we can't just blame them after an error occurs. As the article describes, a hotel employee was mixing chlorine and swimming pool chemicals something went wrong, releasing gas. This sent five people to the hospital, where all were expected to recover and be unharmed. Speaking at around 6pm yesterday, Mr Flynn said: "A member of staff got the mixture wrong in the plant room, releasing the chemical. "It was human error." It seems like a factual statement to say that the mixture was wrong… and that's about it. Ascribing it simply to "human error" often implies "well, there's nothing more we could have done… it was human error, don't blame the management or the organization… blame that individual. We'll punish that person and move on." However, if we ask "why was the mixture wrong?" (and keep asking why) there are possible systemic factors including (just guessing here): Unlabeled or poorly-labeled containers that led to the wrong chemical being used (a sys
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