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# Benchmark Six Sigma - War Room

Everyone makes their attempts at solving problems. Working professionals like to do it systematically using their favorite theory or method for problem solving. While training people ever the years, I have come across mistakes which seem to be common irrespective of the method used. This is the focus of the week’s story.

Scene – Problem Solving Training Session
Situation – I have found Banta, a gregarious, optimistic, outspoken, and enthusiastic participant who proposes to be part of every role play in the training session. He has been invited to play the role of problem solver for the benefit of all participants.

Me: Banta, have you ever seen people pressing the wrong button outside a lift?
Banta (Instantaneously): Yes, I have noticed that this happens quite often.

Me: Do you think this misuse of lift is a worthwhile problem that should be solved? Does it seem to be a problem that deserves our time and energy?
Banta (Does not seem enthused by my comment at all): It is not that big an issue. Having said that, I think it does create a bit of inconvenience for the commuters.

Me: Imagine that you live and work in high rise buildings. Can you guess the average time loss per day due to people pressing the wrong button outside your lift?
Banta: (Grimaces)

Me (Noticing a lack of interest in Banta, I decide to change the scene for him): Imagine you are in a multi storied hospital building and you observe an emergency patient being taken from the tenth floor to the basement for a surgery. The lift stops on every alternate floor because of someone pressing wrong buttons.
Banta (Lights up and says enthusiastically): There is absolutely no need to continue any further. I got your point with just half the story. This problem can lead to waste of time and may be crucial at times.

Me: Great point Banta! If you had to solve this problem for public buildings, how would you proceed?
Banta: Well, I will not allow you to catch me on the wrong foot this time. I need just about ten minutes to answer this perfectly.

Me: Banta, we are now breaking for tea and you have not ten but fifteen minutes with you. (To everyone) Folks, we shall resume in exactly 15 minutes. And Banta can seek advice of others around here.
Banta: I might think of bouncing some ideas around with others but (winks) the final decision will be mine.

During the break, Banta is seen seeking suggestions from others which is a good sign for me.

Me (After the break): Welcome back, everyone. Banta, are you ready?
Banta (Eagerly): Yes. The problem solving sequence is clear to me. The first thing I will do is to find the root cause of the problem. To this effect, I have already done a survey and found the most likely root cause.

Me : Good, this means we are progressing really well. What is the root cause?
Banta (Confidently): The root cause is – (pauses and smiles to enjoy the attention) – Many people are unaware of the correct use of buttons. People think that they need to call the lift from where it is and not direct the lift to where they wish to go. I can explain this thinking in detail of you wish.

Me: You have made a valid point and it has been well explained well in your sentence. This is the one reason that most people consider as the root cause. Banta, do you think this is a cause that can be reasonably addressed?
Banta: Education! We need to educate people on usage of lifts. We need to tell them this – (loudly) – TO GO UP, PRESS UP. TO GO DOWN, PRESS DOWN. (Smiles as if acknowledging the applause)

Me: Great statement! Banta. How practical does this seem to you?
Banta: hmmm. Let me imagine. (Starts mumbling) People are being educated by teams before they reach an elevator in all public buildings in India. (Loudly) My heart says it can be done and should be done. But my mind says NO. Not practical. Not actionable.

Me: We shall stop here and understand part of our definition for root cause(s). The root cause(s) of a problem should be actionable.
Banta: With that perspective, let me analyze all causes in my priority list. I shall write them on the white board.

ONE – Lack of awareness – Not actionable.
TWO – Intentionally pressing both buttons or wrong button (for reasons like – finding good company on another floor) – Actionable.
THREE – Not paying attention while pressing button (for example – being on a phone call) – Not actionable.
FOUR – The lift panel and the system design (including the up and down arrows) – Actionable
FIVE – Lack of an effective visual – Actionable

Banta (Points towards what he has written on the board): Two of these causes are not actionable.

Me: Thanks for systematically tracking these. One important point here – Lack of something should not be considered as a root cause.
Banta: Okay, I remove number FIVE and reduce the list to four. Also, I think number ONE should be changed from “Not actionable” to “Actionable”. Actually, we can write or display something outside the lift to make sure people are aware about the function of these buttons.

Me: Agreed. That makes it actionable again. Do you think people will read and follow it?
Banta: If it is in their language, they will. In addition to English and Hindi, we may have to use Punjabi in Punjab, Tamil in Tamil Nadu, Telugu in Andhra, Malayalam in Kerala, Marathi in Maharashtra etc. Wait a minute, people may travel, we will need all languages in all places. A big board outside each lift with all major languages. Problem solved!

Me: Do you think people will read and follow it?
Banta: If my memory serves me right, you have asked this question earlier and I have answered it already.

Me: Banta, Do you see “Push” written on one side of some glass doors and “Pull” written on the other side? People do..
Banta: (Impatiently): I must say that I have captured what you are going to explain next. Even in school I was always ahead by one step. Just writing an instruction does not mean people will follow. So many people intuitively push or pull without giving a damn about what is written on the glass door.

Me: Brilliant! This brings us to the next part of the definition of root cause. The root cause is one which when acted upon, prevents the problem from occurring in future or minimizes the occurrence to a very large extent.
Banta: For the lift, I can imagine people pressing the button first before reading the message. Many of them may not observe it at all. So, while this cause is actionable, it may not be sufficient to solve the problem.

Me: That matches my thought but we are not ruling this out. We may still have to try this one and see the extent of impact.
Banta: Does this mean verification of this cause being root cause depends on result of a trial?

Me: Yes, you are right. What is the next cause in your list now?
Banta (Checking his list): Number TWO -Intentionally pressing both buttons or wrong button. We can design the logic in such a way that if two buttons are pressed simultaneously or with a very small time gap, the second action will not register.

Me: Feasible. Will it address the problem?
Banta: Not to the extent we want. I want to drop this one. I want to change this from actionable to partly actionable.

Me: What is next?
Banta: Number THREE is not actionable. Number FOUR – The lift panel and the system design should be actionable.

Me: Design elements in a lift are certainly actionable. Let us look at some feasible actions –

• If we consider the presence of confusing arrows as root cause, there is a lift design which has floor numbers on the panel outside and no such buttons inside.
• If we consider the presence of two arrow buttons as root cause, there is a lift design by Hitachi that carries only one arrow button on one side. In this design, the lift on the left side of the building only goes up. And the one on the right side only goes down.

Banta: You must be joking. On the left side of the building, the lift only goes up and never comes down?
Me: Yes, you are right. Let me show a video. Here it is!

Banta: hmmm. Comes down from other side. So, you are saying these two are solutions.
Me: Wait, we cannot conclude that. I said that these are two examples of designs that might reduce the occurrences of pressing wrong buttons. None of these were designed to solve the problem that we are discussing and I do not have data related to our problem for any of these designs. If we consider the panel with floor numbers outside as a solution, it creates other problems that were never seen with the earlier designs. As an example, a miscreant on any one floor can create trouble for everyone on all floors by pressing all buttons outside. It is good to anticipate new problems that our solution can create before an enthusiastic implementation.

Banta: Got your point. I think we learned a lot and I wish to summarize our learning so far today. Root cause of a problem is the one which is actionable and if actioned, shall reasonably resolve the issue or completely prevent the problem in future. I understand that there can be multiple root causes instead of a single root cause. Also, to add, unless we get data to verify, our trials cannot be called as successes. It is also possible that our solution solves one problem and creates others. Ideally, we should do such validation much before implementation, instead of doing it at the end. The root cause analysis and selecting final solution shall need subject matter experts who know deeply about the problem, product, customers and the technology.
Me: Very good, Banta! Everyone, let us have a round of applause for Banta’s final summary.

The common mistakes people make while solving a problem are mentioned in the story. They are –

• Not verifying if the identified problem is really worth solving and if solved shall have benefits worth the effort.
• Not talking to people who experience it or not observing the problem carefully.
• Stating causes as the “lack of something”.
• Discussing causes that are not actionable.
• Looking for just one root cause while there could be a group of root causes.
• Not verifying if the actionable cause should be considered the root cause (Not testing the significance of impact of cause on the problem.)
• Not using trials/data to validate if the problem really gets solved and is sustained with the proposed solution.
• Not systematically checking if the solution creates other problems.

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