Navigating complexity with checklists (a book review)

Atul Gawande’s latest book, The Checklist Manifesto: How to Get Things Right is an incredible book that I highly recommend to anyone that works in a complex environment, especially if that involves working with multi-discipline teams. And most especially if this involves frequently working with people you have never worked with before.

I picked the book up not really knowing what I was in for. Talking about checklists, I thought maybe it would be a discussion of how to document and implement best practices, or something similar. Boy was I wrong.

At the surface, the book is the story of how Gawande, as part of a World Health Organization initiative to reduce surgical complication rates around the world, discovered the power of checklists to help avoid “avoidable failures.” Looked at more closely, it is a study of the importance of team building, team work, and communications between team members as they tackle the complex problems we all face today.

The first chapter, titled “The Problem of Extreme Complexity”, sets the stage. Later chapters build on this problem statement and uses examples from many diverse fields including aviation, construction,  and the operations of corporations and government. The common thread through each of these examples is the checklist – the lowly, simple checklist.

The challenges face by Gawande and the WHO team were (are) two fold: figuring out how to take what worked in these other industries and translating it into the needs of the surgical community; and getting past the culture of surgery and surgeons. The former was a relatively simple matter of trial and error, see what works and give it a try (in simulation first, where possible). The latter, on the other hand, remains a significant issue.

Part of the resistance is, according to Gawande, a misconception about what checklists are and the purpose they serve. This is a lesson he learned as he worked with engineers from Boeing in trying to understand what makes a good checklist:

It is common to misconceive how checklists function in complex lines of work. They are not comprehensive how-to guides, whether for building a skyscraper or getting a plan out of trouble. They are quick and simple tools aimed to buttress the skills of expert professionals. And by remaining swift and usable and resolutely modest, they are saving thousands upon thousands of lives.

As a systems engineer I recognize many of the issues, challenges, and solutions that Gawande discusses in the book. I was (am) quite appalled at how little of this systems type thinking seems to exist in the world of surgery and am quite hopeful that the idea of checklists catch on at all hospitals. If I ever have to go in for surgery, one of the first questions I ask the surgeon and his team is going to be, “Do you have a checklist prepared for this procedure?”

Perhaps the greatest insight about checklists in the book is that checklists – a lowly, simple, well crafted checklist – can take a group of individual experts and quickly turn them into an expert team.

All you have to do is use it.

Update: For more on the book, links to various media interviews, and some examples of effective checklists, visit Atul Gawande’s website.

Advertisements

Management : Efficiency :: Leadership : ??

When talking about management, what most people are thinking about is efficiency, maximizing output per unit of input. Many (most?) people talk about the need for leadership in addition to, or even instead of, management.

But what exactly do we get from leadership? What is its purpose?

The first word that comes to mind is “effectiveness”. But most measures of effectiveness are based on a desired end-state, which to me makes this just a different way of measuring efficiency.

Is leadership just another way to get people to do what you want them to do so you can accomplish your own goals? Or is it something different, something more?

<break title=”flight to phoenix”>

</break>

Some thoughts:

When you “manage” something / someone, the best you can hope for is what you ask for. When you “lead” someone, there is no way to know ahead of time what you will end up with.

Maybe the question is better addressed in the context of the Cynefin framework:

Management : Simple :: Leadership : Chaotic

(and possibly disorder), with a sliding mix of the two being appropriate in complicated or complex situations.

Of course, I’m not the first person to consider this question. There are many (many many) more thoughts on this question out there, as you can see in the Google search results for leadership vs. management.

Cynefin, concept work, and the role of deliberate practice

Over the past week or so there have been several blogs that have helped me pull together a bunch of things I’ve been trying to connect in my mind for a while.

First was Harold Jarche’s post Working Together, in which he looked at Shawn Callahan’s ideas on group work against the backdrop of Tom Haskins discussion of the Cynefin and TIMN frameworks. Next was Tony Karrer and Ken Allan‘s discussion of the role of deliberate practice in the development of skills less than that of an expert, based on Tony’s question:

Any thoughts on how deliberative practice relates to becoming something less than an expert.  It seems it should be applicable to all levels of achievement, but everything I’m reading is the study of becoming an expert.  Is that just aspirational, or is deliberative practice also studied for quick attainment of proficiency?

Read Tony and Ken’s posts, along with the comments, for all the discussion including my comment:

…the application of deliberate practice is not the most efficient way to achieve basic proficiency, even though it would be effective. As proficiency turns into literacy and then mastery, I think that deliberate practice becomes not just the most effective way but the most efficient as well.

After some thought, and several pages of scribbles, scratches, and doodles in my notebook, I put together the following table that pulls together several different topics using Cynefin as a guide.

cynefin-concept-work

The first two columns come directly from the definition of the Cynefin framework. I had just a bit of trouble in the third column, primarily in trying to figure out what the best term would be to carry out “simple” work tasks.  I’m not completely happy with the term “assembly line”, but I think it gets the idea across. I am open to any suggestions to improve this.

I was also not quite sure about the use of the terms in the “Skill Level” column, specifically the order of “fluency” and “literacy”.  Again, I’m interested to hear your thoughts on this.

The heart of the table, especially as it applies to the original question that Tony asked, is the column “How to Achieve”.  Various levels of deliberate practice could have been included in each row, but in looking at each level of complexity as a stand-alone level it seems to me for the “simple” and “complicated” tasks that deliberate practice, at least as defined by Geoff Colvin in “Secrets of Greatness” and the more in-depth Talent is Overrated, is overkill. And probably an unreasonable expectation to have of people who just want to do their job and go home, which is more typical of those performing this type of work.

It is once you move into the area of complex and chaotic work that the benefits gained from deliberate practice are needed, in fact necessary.  Not only must you be able to apply what is already known in ways that have already been identified, you need to be able to learn new things and figure out how to apply them in new ways. That is the nature of mastery, and the ultimate result of deliberate practice.

The Cynefin framework and the global economic crisis

With all the talk about the ongoing global economic crisis and the desire to find out what caused it and how to “fix” it, I found myself wondering if this is something that we actually can figure out, especially while we are still in the middle of the situation.   I turned to the Cynefin framework to help me try to make sense of what kind of problem this is that we are facing.

Graphical depiction of the Cynefin framework

This is most definitely not a simple problem, in which the relationship between cause and effect is obvious.

I also don’t believe this is a complicated problem, in which the relationship between cause and effect requires analysis and/or the application of expert knowledge and the approach to solve it is characterized as Sense-Analyze-Respond.  I do, however, think the decision makers early on in this situation treated this as a complicated problem.    The sensing part came from the realization that their was a problem, an analysis (quickly and crudely conducted) showed that the problem was liquidity (they thought), and the response was to funnel nearly a trillion dollars to various people in the hope that this would improve said liquidity (they hoped).

Over the past couple of weeks, the decision makers seem to have gone into a chaotic state, grasping at straws because there is no apparrent  relationship between cause and effect at the “system” level of the economy.  They seem to be using the Act-Sense-Respond approach to trying to solve the problems; they try something to see if it works and then respond with another action so they can see if that works.  Of course, you could just as easily say that they have been acting in a state of disorder, with no clue of what type of causality exists and simply making decisions based on what has always worked for them.

Which leaves complex, where I think this problem actually belongs.  In a complex system, the cause and effect can only be perceived in retrospect, which is why I wonder if we will be able to figure out the cause while we are still enmeshed in the problem.  However, just because we can’t yet determine how we got to this point doesn’t mean that we can’t find our way out of it.  Using the approach of Probe-Sense-Respond, those making the decisions can get an idea of what’s going on and what effect possible actions would have before taking action to understand the emergent practice(s) that can help us get to the point we need to be.

One of the reasons I think it is taking a while – and will take a bit longer – for people to accept this as a complex problem is that, from a political perspective, it does not present a quick fix.  It doesn’t even present the illusion of a quick fix.  Even worse, those in a position to fix this have to admit (gasp!) that they don’t know how we got to this point.