Tag Archive | Implementing solutions

Root cause analysis Rule #3


This week I’ve seen a problem that happens (sadly) all the time.

Imagine a company / department / team that has a problem (e. g. equipment failure that could impact the product quality). People who work at the work center and their immediate supervision meet at the gemba and agree how to investigate the problem. Some ask their managers if it is ok if they investigate, management says “of course, we believe in people, you are the experts, we trust you”. The team thinks, develops ideas, tests, learns together (e.g. “what are the equipment failure modes?”, “how could we detect them?”, “how can we know is this error has happened?”, “how can we prove our hypothesis right or wrong?”, “how can we evaluate if the product is still good?”). They discover the root cause of the problem and develop an action plan to avoid it in the future.

They call a meeting to share their learning with the site directors and then….. shit happened. I’ll list the sad list of problems:

  • Directors came to the meeting with their own root cause analysis (of course, none of them had been at the work center or had spoken with any of the workers). It was a nice PowerPoint Ishikawa.
  • Directors developed their own action plan. It was a wonderful MS Project file.
  • The first time a team member talked at the meeting was 15 minutes after the meeting had started.
  • The team’s improvement ideas were ignored. No director asked about their analysis or improvement action plan. The team had spent more than 20 hours in 2 days doing their investigation.
  • Most of the meeting time was used by management to show why their ideas were great. 2 team members tried to talk and make a point about their ideas, but they were ignored. The team stayed in silence the rest of the meeting.
  • One director finished the meeting asking: “But, what do you think about this?” Another one said she was very happy to see the team working together. Nobody else said a word.
  • When leaving the meeting, one worker said “I’ve learned something. Never think by yourself.”

Meeting minutes:

always right 2

Director actions were implemented and the problem happened again 3 days afterwards.

This story is an example of one of the most important questions about problem solving: “what is the role of management in problem solving?” The tricky part is to see the difference between “supporting” and “doing somebody else’s job”. Remember rule #3: Problems must be solved by those who do the job. How can we do this? Let’s listen to the experts:

Management must move from “telling what to do” to “asking questions that provoke the right thinking”. Telling people what to do takes away responsibility from the person. Management main goals are a) find and frame problems by observing (at the gemba) front line learning and b) challenge, enable and remove obstacles for front line while they are solving problems.

Daniel T. Jones, Lean Conference 2014

The most important question from the management side is “What are your problems?” Management work is not to solve problems by themselves, but to develop problem solvers. Otherwise, you’ll become a manager like this:


Innovation: Overcome psychological inertia


Our brain works in a way that helps us understand the world quickly. We are good at finding patterns, applying proved solutions and learning from experience. Our brain and the way it thinks is an evolutionary advantage that has made us progress. However, sometimes the way it functions is a problem. Innovation is one of those moments. Let’s see an example:

Psychological inertiaIn this picture we find two very different tasks from our brain’s point of view:

  • The left column shows a task our brain LOVES doing: finding a pattern in mispelled words. Past experience and known solutions work great here, piece of cake for our brain.
  • The right column shows a task our brain HATES: reading the word’s color instead of reading the written word. Past experience does not work here; even worse, past experience is a wrong solution. Our brain has to do things differently, which is tiring and frustrating. Unfortunately, innovation work must be disruptive and, therefore, looks pretty much like this type of task.

Our brain likes “doing the same things the way we have always done them”. This is called psychological inertia. Innovation needs disruptive thinking, which does not get along well with psychological inertia. This mental inertia prevents us from seeing unconventional solutions and is a great obstacle for breakthrough results. It is a wall between business as usual and innovation.

Experts define 3 main types of mental presumptions:

  • Functional fixedness: Tendency to perceive an object as having a specific function, leading to inability to imagine new possibilities (e.g. a brick is used for building houses, but it can’t be used as a flower pot)


  • Structural fixedness: Tendency to view objects as a whole. It makes difficult to imagine how the product could be reorganized differently (e.g. a regular bike vs. a folding bike)


  • Relational fixedness: Tendency to view relationships and dependencies of a product or situation as static and permanent. One overlooks the possibilities of changing these dependencies to create new configurations (e.g. a rain umbrella used as a beach umbrella)


Combined with “Ideal Final Result” techniques (learn more here), innovation work benefits incredibly if we actively try to overcome the psychological inertia of our development team. The typical process is:

  • Discuss the innovation challenge with the team.
  • As a team, list the assumptions about the product of service that the team is analyzing (e.g. bricks are for building houses, cars need a park place…). This will create consciousness about our presumptions and prejudices.
  • Challenge assumptions: think how can I eliminate the barriers, contradictions and limitations. Choose a “HCI” (how can I) or “WI” (what if) question and think how to eliminate the problem (e.g. how can I use bricks if building a house is not an option? How can I eliminate the need of a park place?)

This mental exercise can be very powerful. It opens our mind making obvious our assumptions and prejudices, and prepares our brain for the fight against standard solutions. Maybe, who knows, you will never look at your product / service in the same way.

Picture from: www.psychologyconcepts.com



Experts say that innovation is “the effective implementation of new ideas for simple solutions to address relevant customer needs in order to generate value“. Innovation and Lean are different things, but they like working together. Innovative thinking is a common building block of Lean work. Additionally, lean tools can be used or adapted for creative thinking and innovation. In fact, there are very interesting initiatives going on working in the relationship between Lean and new product design (like Lean Startup by Eric Ries, http://theleanstartup.com/) or generating new business models (like Strategyzer by Alex Osterwalder, Tecnhttps://strategyzer.com/). Some might think that “innovation just happens”: new ideas show up suddenly generated by that limited group of people who are good at inventing new things. Well, there is some truth here (creative thinking is not 100% controllable, some people are more skilled than others) but there are many factors to consider that affect innovation:

  • The S-Curve of innovation
  • Innovation is not linear
  • It is key to understand customer needs
  • The importance of the environment
  • The importance of execution
  • It is all about the process

Innovation means “jumping the S-curve”. In other words, innovation is revolutionary, not evolutionary.  New ideas and technology follow a performance/effort curve with an “S” shape. The first step is “experimentation” where a new success pattern emerges (“make it work”). After this, the “learning” phase (“increase efficiency”) shows a very rapid growth in performance and profit, apparently infinite. Suddenly, we reach the “maturity” phase (“minimize cost”) and performance stays constant or even declines . This is the moment to jump. True high-performance companies are able to jump repeatedly the S-curve, because before they reach the top of one “S-Curve” they are already getting ready for the next “S-Curve”. Research shows that 60% of the companies fail doing so and disappear after the first technology revolution.


Jumping S-curves

Innovation follows a development pattern similar to PDCA. It starts understanding your customers needs, feeling their life with tools like interviews, focus groups, or the empathy map. We must always go to the gemba and see customers interact with the product or service we are studying. The process keeps going with the generation of innovative ideas (e.g. using SIT): create prototypes (something physical or not) and experiment with them to learn. These prototypes are often called Minimum Viable Product (MVP), defined by Eric Ries as “that version of a new product which allows a team to collect the maximum amount of validated learning about customers with the least effort“. Finally, connect with stakeholders to develop a business model (e.g. with a business model canvas) and validate assumptions (e.g. with a validation board). Now that you know more about your ideas, what things work and what things don’t (you will have many of these because approx. 99% of innovative ideas fail) it’s time to refine the prototype and start again if needed.

Innovation S-shape

Innovation is a process

Don’t forget:

  • The only important thing is the learning process, not the tools. “Learning” means understanding what the customer needs/likes/wants. The tools mentioned before are just suggestions: always use the tools and methods that work best for you. Experiment and learn.
  • The process is not linear, so it is perfectly ok to move back and forth as many times as needed as long as you are learning.
  • Your customer is the key part here. Understanding the customer and validating the prototype (MVP) is critical. Starting the idea generation phase without having understood the customer needs is a great and common error. Investing money in anything that has not been validated with the customer might be fatal.
Innovation customer

King of innovation

It is important to keep in mind certain innovation killers that can make the difference between success and failure

  1. The environment: it is critical for innovation. Everybody fails the first time. We all need time, support and patience for some trial-and-error until we reach something that works. A place that encourages thinking differently and provides a safe place for testing-failing-learning has the highest probability of success.
  2. Implementing: Understanding the customer and generating ideas are important, but they are useless without robust implementation. The world is full of great ideas that fail because they are implemented wrong. Pay attention to business models and execute seriously.
  3. Talent and process: Innovating needs creativity AND a process. It is wrong to think that pure and simple talent is enough to make it work. Yes, talent is critical, but talented people helped by a great process will be unstoppable.

This is a summary of the post, enjoy!

Innovation summary

Innovation summary


Voltaire, détail du visage (château de Ferney)

Voltaire, détail du visage (château de Ferney)

Voltaire once said “Le mieux est l’ennemi du bien“, perfect is the enemy of good.


If you think, it is not a bad description of how PDCA works. Try a solution that makes sense, sounds reasonable or can help you learn. It does not matter if it is not perfect, just try it and see what happens. If you wait for the perfect solution before you start doing, you’ll probably wait forever.

Making actions visual


One of the “Lean management” pillars are the daily accountability processes, when assignments and tasks are reviewed and results (positive or not) are shared.

This is a draft of a very simple task board: one row for each person and a column for task status:

  • Scheduled (column 1): tasks to do, not started yet.
  • In progress (column 2): tasks that are being implemented but not finished.
  • Waiting (column 3): tasks in progress, waiting for other people’s work.
  • Finished (column 4): tasks finished, their effectiveness is being evaluated.
  • Actions (column 5): additional actions needed during the effectiveness check.

It can be completed with additional features like capacity management (make each sticky note or magnet bigger or smaller depending on how many working hours are needed to complete the task), capacity control (do not allow anybody to have more than 3 actions in progress), task status (color magnet to show if tasks are progressing ok or not) and many more.

The most important thing to remember is that quality is much more important than quantity: do not start hundreds of actions at the same time, hoping that some of them will work. Select carefully a few of the most critical ones and then implement fast so that you can quickly learn from the results and feed your PDCA cycles.

Old-fashioned solutions


One of the best ways of applying lean is using the simplest solution possible. In these days it looks that IT and automation must be part of the perfect solution, but it’s not always the case. In this brand new modern restaurant they have decided to use a simple system to link customer-table-food. Nice, visual and cheap.

Don’t take me wrong, I have nothing against computers, they are powerful and make our life better. However sometimes they make the process objectively worse: more complicated, difficult to use, difficult to learn, information is hidden, problems are difficult and expensive to solve. And all that is waste.