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Pointing and calling

Pointing and calling, known in Japanese as shisa kanko (指差喚呼), is an occupational safety technique that involves workers physically pointing at key objects, signals, or indicators while verbally announcing their status to confirm observations and actions, thereby reducing errors through multisensory engagement of the brain, eyes, hands, mouth, and ears.^[1] This method heightens focus and prevents oversight in routine tasks by transforming silent checks into deliberate, audible affirmations, such as a train conductor pointing at a speedometer and calling out "speed check, 80 kilometers per hour."^[2] The practice originated in Japan's railway system in the early 20th century, when a steam locomotive engineer with declining eyesight began verbally calling out signal statuses to his fireman for confirmation, a habit that evolved into a formalized protocol and was codified in a railway operations manual by 1913.^[1] It became a cornerstone of Japanese rail safety, contributing to one of the world's safest transportation networks, which handled approximately 24 billion passengers annually before the COVID-19 pandemic.^[3]^[4] A 1994 study by Japan's Railway Technical Research Institute demonstrated its efficacy, finding that the combination of pointing and calling reduced error rates by 85%, from 2.38 mistakes per 100 actions without the method to just 0.38 with it, as the dual actions activate broader brain regions for improved attention and memory retention.^[5] Beyond railways, pointing and calling has been adopted across various Japanese industries, including manufacturing, where it fosters mindfulness and error prevention in high-stakes environments.^[2] Internationally, it has influenced practices in aviation cockpits, New York subway operations (resulting in a 57% drop in berth-related errors within two years of implementation in 1996), and even medical education to enhance procedural accuracy.^[1] As of 2021, transit authorities like Canada's Metrolinx have incorporated it into GO Transit door operations to ensure platform safety, underscoring its enduring role in promoting vigilance without compromising efficiency.^[3]

Overview

Definition

Pointing and calling, also known as shisa kanko (指差喚呼) in Japanese, is a visual and verbal confirmation method employed as a safety technique to prevent errors in operational tasks. It requires individuals to physically point at an object, piece of equipment, or signal while simultaneously vocalizing its observed status, such as "Signal is green, all clear," thereby reinforcing attention and enabling early detection of discrepancies. This approach integrates deliberate physical action with auditory feedback to heighten awareness during routine procedures.^[5]^[6] The core mechanics of pointing and calling involve a sequence of sensory engagements: first, visually locating the target; second, extending the arm to point directly at it using a finger or an outstretched hand; and third, articulating the confirmation aloud to activate multiple cognitive pathways. This multi-sensory process—combining sight, kinesthetic touch through the pointing gesture, and sound from self-vocalization—serves to anchor the worker's focus and mitigate risks associated with human error, particularly perceptual oversights where subtle anomalies might otherwise go unnoticed, or habituation in repetitive environments that leads to complacency.^[5]^[6] Variations in the technique adapt to different contexts while preserving its foundational elements. The standard form entails full pointing and calling by a single individual, but abbreviated versions may limit it to pointing alone for quick visual checks or calling alone when physical gesturing is impractical. Group implementations, such as "pointing and saying out loud together," involve multiple participants simultaneously pointing and vocalizing to build collective verification and team cohesion.^[5]^[6]

Core Principles

Pointing and calling, known as shisa kanko in Japanese, operates on a psychological foundation that leverages multi-sensory engagement to bolster cognitive control and mitigate autopilot behaviors. By integrating visual fixation through pointing, kinesthetic feedback from the gesture, and auditory reinforcement via verbalization, the technique activates the brain's supervisory attentional system, facilitating the retrieval and activation of task rules from working memory.^[7] This multi-modal approach enhances orientation of visual attention and strengthens information encoding, countering habitual actions that lead to inattention by drawing on principles of dual-task interference, where concurrent motor and verbal demands disrupt automatic processing and promote deliberate awareness.^[7]^[5] Operationally, pointing and calling converts passive monitoring into an active verification process, fostering accountability in environments where oversight can have severe consequences. The core sequence involves identifying a critical element, physically pointing to it for spatial confirmation, verbally articulating its status to reinforce comprehension, and listening to one's own utterance for self-auditory validation.^[5] This structured ritual ensures that operators externalize internal checks, transforming routine observations into intentional acts that align perception with action and reduce reliance on memory alone.^[7] The technique's error reduction theory aligns with established human factors models, specifically targeting slips—unintentional execution errors—and lapses—failures in memory or attention—common in automated, skill-based performance. Pointing and calling interrupts autopilot modes by enforcing verification through explicit cues, thereby minimizing inadvertent deviations without overburdening cognitive resources.^[5] This proactive intervention addresses the root of performance slips by slowing action sequences to allow for accuracy checks, as opposed to reactive corrections.^[5] Implementation guidelines emphasize repetitive practice to embed the technique as a habitual response, adaptable to both individual and team contexts. Training typically involves simulated scenarios where participants repeatedly perform the identify-point-confirm-call sequence until it becomes reflexive, leveraging motor learning principles to integrate it into procedural memory. In solo settings, it serves as self-verification; in collaborative ones, it promotes mutual accountability through audible calls that invite peer confirmation, ensuring scalability across high-reliability operations.^[5]^[6]

History

Origins in Japan

Pointing and calling, known in Japanese as shisa kanko (指差喚呼), originated in the early 20th century within Japan's railway system as a method to enhance vigilance and reduce human error among operators.^[8] One widely recounted anecdote attributes its inception to Yasoichi Hori, a steam-train engineer during the late Meiji era, who reportedly began the practice to counteract his deteriorating eyesight during night shifts, thereby ensuring he verbally confirmed signals and track conditions to maintain alertness.^[8] This technique addressed prevalent issues such as signal misreads that contributed to accidents in the expanding rail network, which had begun modernizing since the 1870s but faced challenges with manual operations and increasing traffic.^[8] The practice was formalized shortly thereafter, appearing in official Japanese railway manuals by 1913 as a standardized procedure for train drivers and signalmen.^[9] By 1917, it had become an integral part of training protocols across railway companies, emphasizing physical pointing at indicators combined with vocal confirmation to reinforce attention and prevent oversights like missed stops or collision risks.^[10] Shisa kanko aligns with Buddhist principles of mindfulness to foster focused awareness in high-stakes environments.^[1] Following the privatization of the Japanese National Railways (JNR) into the JR Group in 1987, the technique continued as a core safety practice in Japanese railways.^[8] Initially confined to railway contexts, it focused on critical tasks such as verifying switch positions, speed limits, and departure signals among crew members.^[8]

Global Adoption and Evolution

The technique of pointing and calling first gained international exposure in the West during the 1980s through studies of the Toyota Production System (TPS), where it was integrated as a safety practice in manufacturing to minimize errors by combining visual, physical, and verbal confirmation.^[9] As TPS principles spread globally via joint ventures like the New United Motor Manufacturing Inc. (NUMMI) plant in 1984 and subsequent lean manufacturing adoption, the method influenced safety protocols beyond Japan, particularly in automotive and industrial sectors seeking to replicate Japan's low-error rates.^[9] By the 2010s, pointing and calling saw targeted adoption in North American rail transit systems, often as part of broader safety enhancements. The Toronto Transit Commission (TTC) implemented an adapted version in July 2014, inspired by Japanese practices, where operators point and verbally confirm door alignments and platform clearances to reduce oversight errors during high-volume operations.^[11] Similarly, Metrolinx introduced Shisa Kanko to GO Transit Customer Service Ambassadors by March 2021, training nearly all staff to point at indicators and call out statuses like "clear left, clear right" before door operations, adapting the verbal components to English phrases for local workflows while maintaining the multisensory engagement.^[3] In the 2010s and 2020s, the practice saw limited adoption in aviation, such as cabin crew pointing during briefings and suggestions for pilots to use verbal confirmations in pre-flight checks and taxi procedures to heighten focus; a 1994 Japanese railway study demonstrated error reductions of up to 85% with the method.^[12]^[1] Healthcare applications emerged around the same period, particularly in Asian facilities before initial Western pilots, where nurses use it for medication verification and patient handoffs to prevent errors, with ongoing research exploring sensor-based detection systems to automate compliance monitoring.^[13]^[14] Evolutionary adaptations have shifted from purely manual methods to tech-assisted variants, such as wireless sensors on arms to track pointing gestures in nursing environments, enhancing verification without altering core principles.^[14] Cultural barriers, including language differences, were addressed through localized verbal scripts and training programs, as seen in Canadian implementations where Japanese-inspired calls were simplified for non-Japanese speakers to ensure accessibility.^[3] Japanese firms like JR East have supported internationalization via global railway projects that incorporate the technique in safety standards, facilitating its transfer to overseas operations.^[15]

Usage in Railroads

Asia

In Japan, pointing and calling, known as shisa kanko, serves as a nationwide mandate in all rail operations, standardized as a core safety protocol since its formalization in the early 20th century and rigorously enforced across the country's extensive network.^[16] This practice is integral to preventing errors in high-volume transit, where workers point at critical elements like signals, gauges, and platforms while verbally confirming their status, contributing to Japan's exceptionally low accident rates. For instance, Tokyo Metro staff employ it during platform safety checks, pointing along edges and calling out clearances to safeguard passengers in crowded urban environments.^[17] Similarly, on the Shinkansen high-speed lines, drivers and conductors use pointing and calling for signal verification, pointing at track indicators and announcing conditions to maintain precision at speeds exceeding 300 km/h.^[3] The technique has spread to other Asian rail systems, particularly in eastern Asia, where it supports error reduction in complex networks. In India, Central Railway's Mumbai Division has implemented pointing and calling as part of safety protocols, with seminars emphasizing the technique for motormen to manage overcrowding and improve vigilance during peak hours as of October 2025.^[18] Regional variations reflect local contexts, incorporating native languages and cultural norms to ensure accessibility. Training in Southeast Asia frequently involves hands-on apprenticeships, where new staff shadow veterans to master pointing gestures and calls tailored to local rail dynamics, as seen in Indonesia's adoption of Japanese-style protocols in Jakarta's commuter trains around 2015–2016 by PT Kereta Commuter Indonesia.^[19] Challenges in Asia often stem from extreme urban density, requiring adaptations like enhanced pointing for visibility in tight spaces. In Hong Kong's MTR, the method is applied to pedestrian and platform signals, with staff pointing at barriers and calling statuses to navigate high passenger flows and prevent falls, integrated into daily operations for urban safety.^[20]

North America

The adoption of pointing and calling in North American rail systems began with early adaptations in urban transit, drawing inspiration from Japanese practices to enhance operator awareness and reduce errors. In the New York City Subway, conductors have been required to point at black-and-white striped "zebra boards" at station platforms since September 1966 to confirm proper train alignment before opening doors, a procedure rooted in Japanese shisa kanko methods and refined for North American use.^[21]^[22] This visual confirmation helps ensure platform edging safety and signal verification by alerting operators to their position relative to the platform edge. In Canada, the Toronto Transit Commission (TTC) formalized pointing and calling for subway operations in July 2014, requiring guards to point at colored markers (such as green circles or orange triangles) on station walls as part of a four-step process: standing up, opening the window, pointing to the marker, and then opening doors.^[22] This adaptation, directly inspired by Japanese techniques, aimed to prevent door-related incidents by confirming train spotting, reducing reported issues from 14 in the 26 weeks prior to implementation. The TTC's approach emphasizes urban subway safety, focusing on precise door operations in high-density environments. Key implementations have expanded to commuter rail, with Metrolinx integrating shisa kanko into GO Transit operations starting in March 2021. Customer service ambassadors in accessibility coaches point at spotting locations and call out "good spot," then scan platforms by pointing and announcing "clear right, clear left" before opening or closing doors, enhancing freight-passenger interface safety on shared corridors.^[3] This sensory-engagement method has been trained across nearly all ambassadors without affecting on-time performance, prioritizing vigilance in mixed urban-rural settings. Similar practices have appeared in U.S. freight rail, such as Norfolk Southern's "Point, Call, and Trace" protocol introduced in June 2025 for track inspections and equipment checks, and BNSF Railway's team briefings using multi-sensory pointing since April 2025.^[23]^[24] Regulatory integration in North America is guided by industry standards rather than federal mandates, with the American Public Transportation Association (APTA) endorsing pointing and calling in its September 2021 Recommended Practice for Defensive Rail Operations (RT-OP-RP-030-21) as a voluntary tool to boost train operator focus and error reduction in rail transit agencies.^[25] Training often occurs through rail unions and operator programs, emphasizing procedural adherence in English with localized phrases, such as abbreviated calls like "clear left" to accommodate North American workflows. Adaptations include acronym-based verbal confirmations, for example, pointing to switches and calling "locked" during inspections, though visibility challenges in adverse weather like snow can complicate pointing in outdoor corridors.^[3]

Applications in Other Industries

Healthcare

Pointing and calling, known as Shisa Kanko in Japanese, has been adapted to healthcare environments to mitigate human errors in high-risk procedures by combining physical gestures with verbal affirmations, thereby enhancing cognitive focus and verification processes.^[26] This technique, originally from industrial safety protocols, promotes conscious attention during task execution, making it suitable for patient-facing activities where distractions can lead to adverse outcomes.^[27] Initial applications emerged in the early 2020s, with introductory studies highlighting its potential integration into clinical workflows to support broader patient safety efforts, such as those emphasized in the World Health Organization's 2024 World Patient Safety Day theme on improving diagnosis.^[27]^[28] In surgical and procedural contexts, pointing and calling is applied during checklists to verify critical elements, such as pointing to surgical instruments or blood products while calling out confirmations like patient identity, blood grouping, or sterility status, which helps prevent mismatches in transfusions or operations.^[27] For medication administration, practitioners point to drug labels, patient identifiers, and dosage instructions while verbally stating details—e.g., "Medication: insulin, dosage: 10 units"—to ensure accuracy and reduce dispensing errors.^[27]^[29] A 2024 cross-sectional study at Sarawak General Hospital demonstrated high acceptability among nurses and pharmacists for this use, with mean scores indicating strong perceived effectiveness (4.64/5) in boosting vigilance during busy shifts, though concerns about added workload were noted.^[29] These applications extend verbal-visual cues to procedural verifications, aligning with existing safety protocols without requiring new technology. Training for pointing and calling in healthcare emphasizes low-cost, practical methods like workshops and simulations to build habit formation.^[13] For instance, sessions at Sarawak General Hospital incorporated risk prediction exercises and hands-on practice, enabling staff to integrate the technique into daily routines such as the TWED checklist for clinical decisions.^[27]^[29] This approach facilitates broad adoption, as the method relies on behavioral reinforcement rather than infrastructure changes, making it accessible for diverse clinical teams. Outcomes in healthcare include significant error reduction through heightened situational awareness, with the technique shown to decrease mistakes in medication safety by promoting active confirmation over passive reliance on memory.^[29] The verbal-visual elements provide dual cues that help avert procedural lapses, such as in wrong-site verifications where pointing to marked sites during time-outs reinforces correct identification.^[30] A 2025 study on integrating pointing and calling into paramedic training emphasized its simplicity, low cost, and potential effectiveness across healthcare settings, including both low- and high-resource environments.^[31]

Manufacturing and Aviation

In manufacturing, pointing and calling has been integrated into lean production systems to enhance quality control and reduce errors during assembly processes. Originating from Japanese practices, this technique was adopted by Toyota in its global plants starting in the 1980s as part of the Toyota Production System, where workers point to components and verbally confirm their status, such as calling out "defect-free" to verify proper installation and minimize production mistakes.^[9]^[32] This method synchronizes visual, tactile, and auditory senses, helping to heighten focus on critical tasks like part verification on assembly lines, thereby contributing to overall operational safety and efficiency in high-volume manufacturing environments.^[33] In aviation, pointing and calling is employed for operational safety during pre-flight inspections and maintenance procedures, with endorsements from aviation safety resources emphasizing its role in error prevention. Aviation safety resources have promoted its use since the 2010s for human factors training, with flight instructors recommending pilots and ground crew point to gauges, controls, and indicators while verbally stating readings or statuses to confirm correct configurations before takeoff.^[12] This practice extends to in-flight operations, including taxiing, where pilots point to runway signs and call out identifiers to mitigate risks like incursions.^[34] Variations of pointing and calling adapt to specific contexts in these industries. In manufacturing, team-based applications involve coordinated calls during inventory checks, where groups point to stock items and collectively confirm quantities or conditions to ensure accuracy in supply chain processes.^[35] In aviation, solo pilots use aids like mirrors to point at hard-to-reach areas during solo pre-flight walks, verbally noting observations to maintain vigilance without external confirmation.^[12] By 2025, integrations with virtual reality (VR) training have emerged, simulating pointing and calling scenarios in manufacturing assembly lines and aviation cockpits to build muscle memory and error detection skills in controlled environments.^[36] Challenges in implementation include environmental factors and regulatory demands. In noisy factory settings, amplified calling devices or standardized hand signals are often required to ensure verbal confirmations are audible over machinery, preserving the technique's effectiveness without disrupting workflow.^[32] In aviation, adaptations must comply with International Civil Aviation Organization (ICAO) guidelines on human performance, which stress standardized procedures to align pointing and calling with global safety protocols while accommodating diverse cockpit layouts and crew compositions.^[37]

Effectiveness and Research

Empirical Evidence

Empirical evidence for the effectiveness of pointing and calling primarily stems from controlled experiments and longitudinal implementations in high-risk industries, demonstrating significant reductions in human error through enhanced cognitive control and attention. A landmark 1994 study by Japan's Railway Technical Research Institute examined the technique in simple signal-checking tasks among railway workers, finding that pointing and calling reduced mistake rates by nearly 85% compared to silent observation alone. This reduction was attributed to the multisensory engagement of visual pointing, verbal articulation, and auditory feedback, which reinforced task verification. Subsequent research in human factors has validated these findings through experimental methodologies, including comparisons of pointing-and-calling conditions against baseline tasks without the technique. For instance, a 2012 study published in the International Journal of Industrial Ergonomics used a task-switching paradigm with 20 participants performing binary decisions under mixed-rule conditions; it reported significantly faster reaction times and reduced preparation intervals for rule retrieval with pointing and calling, though accuracy remained comparable, indicating the method's role in bolstering supervisory attention without increasing cognitive load.^[7] Longitudinal data from operational settings further supports efficacy; the Toronto Transit Commission implemented pointing and calling in 2014 for subway train operations to ensure proper stopping before doors open, resulting in a 50% decrease in critical safety incidents within seven months, a trend that persisted through subsequent years.^[11] Cross-industry applications reveal consistent error reductions when adapted to context-specific tasks. In healthcare, a 2015-2016 Plan-Do-Study-Act (PDSA) implementation at United Christian Hospital in Hong Kong trained over 1,100 nurses in pointing and calling for high-alert medication administration via infusion and syringe devices; audits showed 98-100% compliance, and the incident rate for inaccurate device settings dropped from 0.21 to 0.13 per relevant period, representing a substantial decline in errors.^[38] In manufacturing, the technique has been integrated into lean processes at companies like Toyota, where it contributes to overall error-proofing (poka-yoke) strategies, with general studies indicating up to 85% reductions in procedural mistakes similar to those in rail contexts.^[32] Factors influencing results include training intensity and procedural integration, with studies emphasizing the need for repeated practice to achieve high compliance and sustained benefits. The Hong Kong healthcare trial, for example, required initial workshops followed by ongoing audits, yielding near-perfect adherence and measurable error drops only after full rollout. Pre- and post-implementation comparisons across these studies consistently show 50-85% relative reductions in errors or near-misses, underscoring the technique's reliability when embedded in routine workflows.

Limitations and Criticisms

While pointing and calling has demonstrated efficacy in error reduction, its implementation faces several practical and cultural challenges that can hinder widespread adoption. In fast-paced environments such as high-speed rail operations, the technique's requirement for deliberate physical and verbal actions can introduce minor delays, potentially conflicting with the need for rapid task execution. Additionally, repetitive use of the method has been associated with increased worker fatigue, as greater frequency of pointing and calling correlates with higher reported exhaustion levels in manufacturing settings. Visibility constraints in low-lighting or remote operational areas further complicate its application, as effective pointing may be impaired without adequate illumination to confirm targets accurately. Cultural barriers significantly impede adoption outside Japan, particularly in individualistic societies where the overt gestures and vocalizations are often perceived as awkward or embarrassing. In Western contexts, the technique has proven resistant to export. Inconsistent training programs exacerbate this, resulting in variable adherence that undermines the technique's safety benefits.^[39] Research on pointing and calling remains predominantly Japan-centric, with most empirical studies originating from or focusing on Japanese industrial contexts, limiting generalizability to diverse global industries and cultures. Long-term data on its sustained effectiveness beyond initial adoption phases is scarce, particularly in non-rail sectors like healthcare and manufacturing. To address these limitations, emerging improvements include hybrid digital adaptations, such as monitoring and feedback systems that use sensors and apps to automate verification while retaining core verbal elements, thereby reducing manual burden and enhancing compliance in varied settings. Strategies to mitigate fatigue from repetitive application, such as rotating emphasis on pointing during shifts or combining it with brief mindfulness breaks, have also been proposed to maintain long-term usability without compromising safety gains.^[40]

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