A very commonly-implemented intervention when attempting to “mistake-proof” a process involving humans is the double-check.

Double-checks are, by their nature, waste.  Often, double-checks are put in place as temporary stop-gap measures while more effective, value-adding countermeasures are devised and implemented.  While a perfectly-implemented double-check does indeed improve error rate, it does not come close to serving as effectively as a prevention-based mistake proof device (poka yoke) and should therefore be considered a weak intervention.

The prevailing theory behind a double-check is that, while a person will occasionally err when undertaking a task, with probability A, the process will be made more robust by inserting a double-check of the work of the original person.  The presumption is that the person doing the double-check will also occasionally err, with probability B, but that the combined probability of error emanating from the double-checked task will be geometrically lower (improved).  For example if the error rates of the original person performing the task is 10% (A=0.10) and the error rate of the double-checker is 15% (B = 0.15), the combined error rate of the double-checked process is now (0.10)(0.15)=0.015, nearly an order of magnitude improvement.

Actual results of such interventions in practice rarely match the theoretical improvement.  By understanding the factors leading to gaps in performance of double-checks, we can set out to implement double-checks in such a manner that efficacy is enhanced.

Factors leading to sub-optimal performance of a double-check

Often, a double-check step is inserted into a process “on the fly” without thoughtful planning to eliminate possible failure modes of the check itself.  Following are some common situations to avoid when considering a double-check for your process.

• Lack of clear definition (standard work) of how the double-check is to be performed
• Ineffective training of staff who are to perform the double-check
• Failure to design an independent double-check; one that only involves the person originating the work has a high likelihood of error due to confirmation bias, which can blind the person performing a check on his/her own work .
• When a second person is assigned to perform the double-check, confirmation bias can blind this person.  This can be caused by specific information being passed from the first to the second person prior to validation, the second person subconsciously deferring to the authority of the first person, or simply trusting that the first person could not have erred.  Any of this leads to the second person missing errors.
• Creeping complacency, due to a person knowing that someone else is in place to catch any mistakes he or she will make
• Interruptions during the double-check
• Rushing the double-check

Related, and equally common, is the issue of nobody being tasked with examining errors caught during the double-check and using that insight to drive focused root cause analysis and interventions upstream to eliminate as many of these failure modes as possible.

What can you do?

1. Assess and analyze any double-checks you already have in place.  Look for evidence of any of the above issues.  Ask to see the data showing what errors are being found.  Investigate what actions have been initiated as a result.
2. Before assuming that a double-check is the strongest mistake-proof device (poka yoke) that can be designed and implemented for a particular task within a given value stream, challenge yourself and your team to seek out stronger interventions.  Estimate the relative strength between multiple intervention ideas.
3. Where a double-check is the only course of action, either for the short term or for a longer time period, infuse these design principles:

• independence of the check, separated by time and space if possible to mitigate risk of “contaminating” the checker with information about the person originating the work, inputs, outputs, calculations, and judgement applied
• to simplify and make visual the double-check, create a checklist showing the specific steps to be undertaken
• create a physical environment for the double-check that will be free from distraction and which will make the task simplest
• carefully document the standard work, train those involved, and assess skill/capability of those who will be performing the check
• avoid having the same two people serving as checkee-checker on a sustained basis
• periodically assess efficacy of the check, in a blinded fashion and provide feedback
• instrument your check and specify roles to include those who will prepare, analyze, and act upon the errors caught by the check

4.   Seek to continually improve, through successive cycles of mistake proofing, until you can evolve beyond the use of double-checking

With the objectives being to reduce stress on staff while meeting higher demands, being more responsive and lowering the cost of care and determining the technological advancements/innovation needed to support the new improved processes well into the future.

The end-to-end process in several areas will be assessed and redesigned in order to improve the flow of information, communication and the patient throughout the ‘system’.

The Lean Approach works to Increase Maintainable Profits and Decrease Risk

In determining the value of any business several factors need to be taken into consideration. Business strengths, weaknesses, opportunities and threats as well as value drivers, profit determination and risk factors all play a key role.  However, one of the most overlooked areas in any valuation is the evaluation of “maintainable profits”.

Many people simply think about profits when considering the value of their business, but by knowing the risk factors in any business, you have a much clearer picture of what the business is truly worth. Risk factors that affect profits, such as the role of the Owner, inconsistent revenue, non-value activities and cost of doing business all affect the multiple by which the dollar value of the business is determined.

By knowing and decreasing these risk factors, the multiple used to determine value can be higher resulting in the business being worth more in the marketplace.

Maintainable profits are the goal that any business seller should focus on to increase the value of their business to a potential buyer.  Maintainable profits and decreasing risks is where a Lean Business Value Assessment can play a critical role because Lean is a strategy and way of thinking that creates more value by eliminating activities that are considered waste. Any activity or process that consumes resources, adds costs or time without creating value becomes a target for elimination.  Lean methods are also critical when an owner or investors needs an accurate assessment of the current state and the true potential of any company.

The process used to increase the value of a business using a Lean Business Value Assessment starts with a fair market value of the business. A Lean Assessment is performed and a plan is built that indicates exactly how a company can increase profits and decrease risks. The owner/investor is then knowledgeable about the potential and future opportunity of the company, allowing them to make informed decisions about next steps.  A Lean Assessment also helps to decrease the business risks by improving the structure and the transferability of the business by creating more efficient, economic and effective business processes.

Did you know? Most companies have more waste activities than value. Removing the waste properly can add over 50% improvement in cost, quality and speed – resulting in a business becoming more valuable in a short period of time.