Monday, April 8, 2019

The Four Levels of Visual Management, Part 2

By Pascal Dennis (bio)

Last time I talked about making problems visible through the four levels of visual management.

I described Levels 1 and 2, which have comparatively low power.

Today, our topic is visual management Levels 3 and 4 – the most powerful:

Level 3 – Organizes Behavior

Home positions for tools & equipment are a good example.

In a surgery, home positions provide a nice visual confirmation that sponges, scalpels and other equipment are back where they belong – and not inside the patient!

In manufacturing, having a home position for, say, our torque wrench and gauges, ensures a) they’re there when we need them, and, as important, b) we know when they’re not there.

“Right, Bonnie is doing her daily 2:00 pm torque audit.”

Other good examples include the ribbed perimeters, and studded lane lines of many highways. You know at once if you’re on the median or straddling your lane. You quickly correct your behavior.

Recently, I saw a nice kaizen in the Oncology department of a children’s hospital. Infections are a major risk in such wards. How to encourage staff & parents to decontaminate their hands before they enter the room?

Move the hand decontamination unit to the point of entry. You can’t enter without seeing and using it, and compliance rates have spiked.

Level 4 – The Defect is Impossible

Lean thinkers will recognize the ‘pokayoke’ concept. We develop such a deep grasp of our process and its possible failure modes, that we install gizmos and practices that make them impossible!

Manufacturing is full of these: alarms on torque wrenches, electronic lights and safety mats that disable the machine if a team member enters the line of fire, gasoline nozzles that won’t fit diesel tanks and so on.

In Health Care, pokayokes on gas lines make it impossible to mis-connect oxygen and other gas lines.

As we get better at Lean, our visual management naturally progresses from Level 1 to Level 4.

Once we’re good at Level 1 and 2 visual management, we begin to think. “The same defect – here we go again! How do we prevent it?”

Who is the best source of Level 3 and 4 visual management?

Why, our front line team members, of course.

That’s why total involvement is critical. Alienate the front line and you lose all their insight & creativity. Problems mushroom!

But you already know that…

Best regards,


Monday, March 25, 2019

The Four Levels of Visual Management

By Pascal Dennis (bio)

Lean is about making problems visible, and visual management is a core methodology.

You can’t fix what you can’t see!

There are four levels. Here they are in order of increasing power:

Level 1 – Tells only

STOP signs are a good example. In our neighbourhood, people blow by them all the time.

(We call them ‘Hollywood stops’ – the driver slows by 5 miles per hour, takes a perfunctory look around & drives on through. Not exactly, Safety First!)

Level 2 – Something changes, which gets your attention

Traffic lights are a good example. “Hey, the light’s changed to Green. We can drive on.”

Level 2 has more power because, done well, it wakes people up.

Our regular readers may recall that Lean is about wakefulness…. ``Hey, we have a problem here. We should do something!

Sadly, visual management in many organizations gets stuck at Level 1.

In many Health Care organizations, for example, visual management amounts to signage telling people to do, or not do something.

This amounts to blaming the work, as W. Edward Deming observed a generation ago

Doing so, subtly shifts responsibility from senior management to front line workers. “Hey, I told them not to do it…”

A nice trick – “I’ll take the power, privilege and perks of power – but not the responsibility!”

This amounts to a 21st century variation on “Let them eat cake.”

Most of the time, the root cause is in the system - which senior leaders own.

Next time, Level 3 and 4 visual management.



Monday, March 11, 2019

Neither Too Rigid, Nor Too Loose

By Pascal Dennis (bio)

When it comes to fundamentals like Strategy, Management System, Standardized Work, Quality in the Process and the like, it’s easy to become rigid and even doctrinaire.

After all, these are the concepts that underlie TPS, the ‘world’s most powerful production system’. In the circumstances, we’re right to be doctrinaire, aren’t we?

“We have to have four mother A3s – one each for People, Quality, Delivery and Cost! We have to have strategy A3s and dashboards for everything!

Standardized work means Content-Sequence-Timing-Expected Outcome! Quality in the Process means detect the abnormality, stop the process, fix the immediate problem and develop countermeasures for root causes!”

No doubt, you’ve heard this sort of thing too.

In fact, as we apply these timeless ideas in areas further and further from manufacturing, finesse is of the essence, and rigidity, a recipe for failure.

The further from manufacturing we get, the more important it is the we translate the principles, and not insist, “This is how did things at Toyota, or Honeywell, or Proctor & Gamble or…”

This is a major challenge for ‘Lean’ practitioners in these times of tumultuous change. Who cares if your muffler manufacturing factory has the best SMED process in the industry?

Demand for mufflers is going nowhere but down, no? But the principles underlying SMED – separate internal & external work, convert internal work to external work etc. – transcend manufacturing.

SMED principles can readily be applied to shortening changeover times in healthcare, aviation, and software design.

The same applies to any ‘Lean’ principle. Principles are eternal, countermeasures temporary.

And this reflects the deeper challenge facing the Lean movement these days.

Is ‘Lean’ a principles-based profession, or a skilled trade? The distinction is important.

I don’t want to be misunderstood. I respect and admire skilled tradespeople. They’re an honorable and essential element of successful organizations.

But they’re insufficient if you want to transform an organization or an industry. For that you need principles.

Principles are harder to internalize than countermeasures. But principles are eternal, whereas countermeasures are temporary.

Which brings me to the title of this piece, which a wise old gentleman taught me many years ago. The old gentleman is gone, and I am his scarcely adequate proxy.

Neither too rigid, nor too loose, expresses reflects the subtlety and intelligence needed to apply principles in ever more complex situations.

It reflects the need to be humble and learn from quick experiments – because we don’t really know, and can’t really know what’s going on unless we study the situation.

As a colleague likes to say, “If your first hypothesis isn’t embarrassing, you’re not really trying.”

Good advice in a world where Value is often a vague shadowy thing, and changing with every new technological miracle.

Best regards,


Monday, February 25, 2019

Scatter - Our Nemesis

By Pascal Dennis (bio)

Big Company Disease has many causes.

One of the most subtle is our inability to ‘wrap our arms around’ the PDCA cycle.

Myriad improvement cycles begin – but they become fragmented:
  • Group A develops the Plan,
  • Group B deploys,
  • Group C checks the Plan, and
  • Group D adjusts it.

I call this Scatter, with a deep bow to the late, great Al Ward – friend, colleague & profound Lean thinker.

Al described this syndrome to me over lunch a decade ago, and then again in his splendid book Lean Product & Process Design.

Improvement, whether a Kaizen Workshop, Problem Solving cycle or Strategy A3, requires complete PDCA cycles

One person (or team) needs to wrap her arms around the cycle, and thereby develop the profound, sympathetic knowledge central to breakthrough.

Thereby, our entire brains start firing – Left, Right, prefrontal cortex etc.

The countermeasures we select are usually simple and clear.

There’s usually a sense of release. “Of course! Why didn’t we see it before!”

As opposed to the ponderous, countermeasure-by-committee stuff that blights so many report outs.

So how to reduce Scatter?

Lean fundamentals like visual management and Leader standard work are a good start.

Veteran Lean companies like Toyota have developed the Chief Engineer role in Design, and Key Thinker (aka Deployment Leader or Pacemaker) role in Strategy Deployment.

Their job is to oversee & manage broad PDCA cycles – and to record & share the learning.

There are all a good place to start in your never-ending battle with Scatter.

Best regards,