The Human in the Loop

W. Edwards Deming espouses a “system of profound knowledge” as the way to manage complex systems. The key points are:

  1. Appreciation for a system. (Systems thinking)
  2. Knowledge about variation. (Knowing the difference between variation inherent in the system and variation with an attributable cause.)
  3. Theory of knowledge. (Understanding how the organization learns – summarized as PDCA)
  4. Psychology.

This last point – psychology – is the one I want to discuss.

The common view of business and production systems is a technical one. We look at things that can be easily disaggregated and analyzed – production processes, financial models, defect rates. Even when we consider the role of people it is in terms of “heads” and labor hours; absenteeism, payroll, labor costs.

Then we turn around and talk about “corporate culture” as though it is an abstract thing that can be analyzed as well, and that conversation all too often turns into commiseration and a blame game where things would be great “if only they….”

Reality, however, is even messier than that. The culture of a company emerges from how people interact with each other, and with the work environment. The work environment itself is also the product of interactions between people. People also interact with the processes themselves. Every second of every day, it is the people who are sensing, assessing, and deciding how to respond to what they see, hear, feel, perceive, believe.

If we truly want to construct a work environment where people make the best possible decisions, it behooves us to rid ourselves of decades old stereotypes and convenient beliefs about why people decide what they do.

Those stereotypes were largely established in the 1930’s and 1940’s. Since then, however, we have learned a great deal about psychology. Further, we are now (finally) beginning to make the connections between what happens in the mind – how people think, feel, perceive, behave – and what happens in the brain – the neuroscience behind the feelings.

How We Decide is a layman’s overview of those linkages.

As I was reading it, I found many topics that link directly to business and the workplace, and stuffed my book full of sticky notes.


Deming famously said “Management is prediction.” We also know this in the context of PDCA and the scientific method. We make observations, collect facts, and make a prediction. “Given what I know, if I do x I should see y.” Or “… if I observe x happening then y should follow.” These are predictions. By making them, we set ourselves up to either be proven correct, or confront something that surprises us. In either of those situations, we learn either by reinforcing the prediction for next time, or by examining what was not understood and trying to understand it better.

Well – as much as we like to imagine this is a logical process, it isn’t. This is pure emotion, which in turn is driven by changes in the level of dopamine in the brain as we have these experiences. In fact, our emotions learn to predict a vague situation before our logical brains catch on. “I don’t know why, but this feels right” – except that if you think through it that much, you will likely get it wrong.

Lehrer cites a number of scientific studies, but what they all have in common is immediate positive or negative consequences. Without those consequences, the emotional mind is never engaged, and the people never develop that “gut feel” for the situation.

Now before anyone jumps all over the word “consequences” let me be really clear on this point. This has nothing to do with punishment or “accountability.” Indeed, neither of those is immediate enough for this kind of learning to occur. Rather, it means that there is a situation where the person has immediate feedback and knows whether he made a good or bad choice.

What is more interesting is when these experiments were conducted with people who were neurologically impaired to the point where they could only engage in logical thought – they experienced little or no emotion. They failed, totally, at detecting the subtle patterns of success and failure in the experiments. The dopamine driven emotional part of the brain “gets it” and the logic part follows.

So – if we want a person to learn to correctly carry out a subtle process, and develop a good feel for how it is going:

  • They need practice.
  • They need immediate feedback.
  • They need safe opportunities to get it wrong.
  • They need emotional support for continuing to try. (More about that later.)

Now think about this in the context of how your people are trained to perform tasks that require skill or developing a “knack.” How well does your work environment provide a safe place to practice?

Another factor that plays a huge role in learning is reflection. Again, this is something that we all know at a logical level, but do we structure our situations to actually do it… or rely on happenstance? Worse yet, do we try to avoid focusing on things that went less than perfectly in our desire to focus on the positive?

Leher’s next key point is that, except in trivial cases, practice is not simply repetition. It is equally important to be good at it – to know how to practice. Reflection plays a huge role in this. He uses the example of a master game player – chess, poker, backgammon. Bill Robertie plays these radically different games at a world class level.

Leher describes how Robertie learned to play backgammon.

Robertie bought a book on backgammon strategy, memorized a few opening moves, and then started to play. And play. And play. “You’ve got to get obsessed,” he says. […]

After a few years of intense practice, Robertie had turned himself into one of the best backgammon players in the world. “I knew I was getting good when I could just glance at a board and know what I should do…The game started to become..a matter of aesthetics.”

Leher is describing the process of training the dopamine receptors in the brain to give a positive emotional response to thoughts of the right move, and a negative emotional response to thoughts of a bad move. That is what happens in the brain of someone who is playing by instinct.

But, he goes on:

But Robertie didn’t become a world champion just by playing a lot of backgammon. “It’s not the quantity of practice, it’s the quality,” he says. According to Robertie, the most effective way to get better is to focus on your mistakes. In other words you need to consciously consider the errors being internalized by your dopamine neurons. After Robertie plays a chess match, or a poker hand, or a backgammon game, he painstakingly reviews what happened. Every decision is critiqued and analyzed.

Actually this kind of reflection can be found behind pretty much any world-class performance you might see. Professional sports teams review the films. The U.S. Army does “after action reviews” in training. The opposing force commanders and the unit being trained first discuss and reconstruct what really happened, and then drill in on cues that might have revealed missed opportunities. By consciously learning from their mistakes in a practice environment – with blanks and lasers – they make far fewer mistakes when the bullets are real.

What about business? If you are a regular reader (meaning you are interested in this stuff), you likely know that “reflection” is a critical part of policy deployment, otherwise known as hoshin kanri. That reflection is the same process – examining the original intention and prediction, and then seeking to understand why things went differently (better or worse) than anticipated. By understanding the why behind the deltas, the leaders are better able to make better and better plans. That might look like they are leading by instinct, but just like Robertie’s backgammon game, that instinct is honed deliberately by a process of learning.

Likewise, when organizations try to learn “problem solving” and “A3” I see them start with big, complicated problems. But in my experience, it is far better to start off on small ones that are easy to solve. There are a couple of good reasons for this. First, it gets leaders down to the place where the work is done and shows that they actually care. This is all well and good, but it isn’t the primary reason.

The main reason is so they have an opportunity to practice seeing and solving problems in an environment where they can do it a lot, get immediate feedback, and contain the effects of their mistakes. In other words, it is an environment where:

  • They get practice.
  • They get immediate feedback.
  • They have safe opportunities to get it wrong.

    Unfortunately, what many senior leaders fail to give to themselves or to each other is that last point – an emotionally safe environment to make mistakes. And that links to the next key point that Leher makes.

    He describes research by Carol Dweck, a Stanford psychologist, on the role of making mistakes in learning. In her classic research, she gave groups of school children puzzle tests that were relatively simple for them. All of the kids did well. Two groups, selected at random (the total population was over 1000) were alternatively praised for their intelligence (“You must be very smart”) or their effort (“You must have worked really hard.”)

  • To cut to the chase, in follow-up tests, the group that was initially praised for their intelligence avoided subsequent challenges, gave up on tough puzzles more easily, and sought out opportunities to see that they had done better than others.

    The group that was praised for their effort, on the other hand, sought out tougher challenges, worked harder on those tougher puzzles, and sought out opportunities to understand why others had done better than they had. In other words, they were driven to learn.

    To be clear, the only difference between the groups was the initial praise. Throughout the remainder of the experiment, each group sought to self-validate the single compliment they had been given – one group by selecting tasks that allowed them to look smart, the other group by selecting tasks that allowed them to work hard.

    At the end, they were all given a final set of puzzles. Guess which group had learned more about how to tackle them? In short, the kids who were praised for their efforts got better results because they worked hard to learn how to learn.

    Now, this is with little kids. But what we all learn as kids are the things which drive us throughout our lives. Each of us seeks to renew the conditions that got us the most acceptance and praise.


    Let’s look at how to apply all of this when we are trying to transform an organizational culture.

    First, what are we trying to achieve?

    If we are trying to instill a culture of problem solving and kaizen, then we want people to try hard to solve the problems they are confronting, are willing to experiment (and make mistakes), realize they have to discover (rather than already know) the answers, and support others in doing the same.

    So what are the best conditions to learn how to do that, and do it well?

    • Practice.
    • Immediate feedback.
    • Safe opportunities to experiment.
    • Emotional support for continuing to try.

    If I go back and look at the learning environment described in Learning to Lead at Toyota by Steven Spear, I actually see these characteristics being deliberately put into play. And not simply for the benefit of the senior executive who is the main character, but for the team leaders in training as well.

    Think about how much more effective this gradually building hands-on practice and experience is than sitting people through a three day classroom based “Lean Overview?” Just like you can’t learn backgammon (or infantry tactics) in a lecture, neither is it possible to really understand what kaizen is about. You have to play, and play, and play. You have to reflect, which means you have to know what you expected, know what actually happened, and study the differences.

    No matter what you think people’s motivations should be, let go of your judgments, and look at what we know about how people really learn. Use that information to create the best possible space to do it in.

    The next section covers the neurological and psychological aspects of what Deming calls “tampering” – why we are tempted to do it – and the psychology behind relying on hope and luck as a risk management plan. Pretty interesting stuff.

    4 Replies to “The Human in the Loop”

    1. Hello Mark, thank you for another great article. While preparing a three days course for 5S and reading your article i know i have to change my training programme. For whatever reason, the psychological aspects in spreading the knowledge of eliminating ‘waste’ crossed my mind for a couple of months ago. I didn’t know how to do it, other than explaining the tools i made for doing so (problem-effect-solution). Again you opened my eyes, knowing i have to integrate some psychology in training.
      Read you soon!
      Regards, Edwin.

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