Inefficiency With the Best of Intentions

by Jay Allen

As quality professionals, we are all familiar with lean thinking. We have spent years, sometimes decades, trying to find waste and eliminate it. But did you ever wonder how the waste got there? I believe inefficiencies occur—at least in part—with the best of intentions.

How can this be? Do the people doing the job really think creating waste is good for the enterprise? A recent experience has led me to believe the answer may be yes.

Our company had a large fulfillment order, which we handled during off hours using temporary help to supplement our regular staff. Our goal: to receive, pick, pack and ship 8,000 new videogames before the launch date on Monday.

To meet this goal we would have to triple our capacity on a temporary basis. We worked on the problem for weeks, setting workstations, figuring walk distance and optimizing handoffs. We identified a few bottlenecks but were confident they wouldn’t significantly slow down throughput.

One of the identified bottlenecks was the printer that produced the shipping label. The scanning process, which fed the labeling process, was about three times faster. Since we knew we couldn’t speed up the labeling process with the existing timeframe, we assigned the scanner additional duties to balance the throughput. We were ready, but to quote Robert Burns, “The best-laid schemes of mice and men often go awry.”1

What Went Wrong?

Production day came, and things began smoothly. Orders were picked, wrapped and sent down the conveyor to the scanning and labeling station. The orders were scanned, labels applied, and all was good. But as the label program began adding more and more files to its database, it began to slow down dramatically. It went from printing one label every one to three seconds, to printing one label every six to 10 seconds.

Packages began to stack up behind the labeling station. The scanner was still able to scan about 30 packages per minute, so the pile on the labeling station began to grow. Eventually, we moved the scanning operator to another assignment upstream to let the labeler catch up.

After a couple iterations, an interesting phenomenon began to occur: The labeler appeared to be keeping up better than he had been in previous hours. The backlog at the labeling station was considerably less. Had the label maker sped up? Had the production efficiencies increased?

The answer was no. What had happened was the scanner, seeing the frustration of the labeler, began adding extra steps to the scanning process, slowing it down. The scanner would scan nine boxes at a time and then stack and feed them to the labeler. When the backlog got down to three boxes to label, the scanner would repeat the process.

What the staff did intentionally or unintentionally was to balance the labeling and the scanning by making the scanning process less efficient. They did this not for any malevolent reason but because they were friends and the labeler was getting frustrated at not being able to keep up.

Adding Wasteful Steps

I call this QWERTYing the process, named after the first six letters on a typewriter. Urban legend has it that when the typewriter was invented and the keys were in alphabetical order, the typists of the day were too efficient, causing the keys to jam frequently. The QWERTY keyboard was designed to slow down the keystroke process and prevent jamming. Making one process inefficient to improve another—QWERTYing.

The scanner was QWERTYing, or adding wasteful steps, to help a friend. Neither recognized what they were doing, and neither did it intentionally. What they both really wanted was to have the labeling process sped up to keep pace with everything else. What they also really, really wanted was to feel good about what they were doing. So they instinctively balanced workload with that intention in mind. Their goal was not to slow down the system or add waste, but to eliminate pain—their pain.

That got me thinking—how many other instances of QWERTYing could I find? It turns out a lot. Now, as I look for opportunities to make processes more efficient and eliminate waste, I’m mindful of the conditions that may have unintentionally added inefficiencies in the first place. Has the process been QWERTYed? If the original process caused pain or frustration for the people using it, I need to make sure I don’t recreate that pain or, even worse, increase it.


  1. Robert Burns, “To a Mouse,” 1787. Trans-lated from Gaelic.

JAY ALLEN is the VP of operations and Six Sigma Black Belt for One World Distribution in Mobridge, SD. He earned a bachelor’s degree in political science from Goddard College in Plainfield, VT. Allen is a member of ASQ and a certified quality manager and auditor.

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