The Hero in the Age of Checklists

A new step in our synchronized reading.  According to our reading calendar, today is time for chapter 8.

Why aren’t checklists more common in our world nowadays? If Gwande is right, anyone could improve by adding a checklist to their working routines. But then, besides aviation, restaurants, and more recently, surgery, checklists are mostly missing.

This is the main subject for this chapter, and Gawande argues that the main reason for that is how checklists are at odds with our myths about creative work. We still believe that human achievements are mostly the result of lonely geniuses, inspired by the muses, which are able to go beyond the view of the majority and perform astounding actions. Can you imagine Picasso, Neil Armstrong or Michael Jordan ticking boxes of a checklist? No, we expect them to have “the right stuff” to deal with the unexpected, guided by the superhuman abilities, and their grit.

The chapter describes how easily investing would benefit from using a checklist and then, how atypical they are.  Even when the amazing Warren Buffet, which is almost a cult figure in the finance world, has argued that he uses mental checklists to decide whether to invest in a company or not, checklists in investing are the exception, not the norm.

But this chapter also focuses in another key aspect of checklists: how they can be used to avoid biases. Interviewing a professional investor that uses checklists, Gawande states:

Yet no matter how objective he tried to be about a potentially exciting investment, he said, he found his brain working against him, latching onto evidence that confirmed his initial hunch and dismissing the signs of a downside. It’s what the drain does.

“You get seduced,” he said. “You start cutting corners” (p. 164)

 

So this person made a list of all the mistakes he has done and devised a matching series of checklists to be sure that he’ll never commit those mistakes again.

He then describes the modus operandi of another professional investor, which is also based on checklists. An even more methodical one. For example, he had a “Day Three Checklist” which he and his team reviewed at the end of the third day of considering an investment. (p. 166)

But still, the professional investors that use this checklist approach are very few; even considering a relevant study that Gawande describes in which Geoff Smart analyses the styles of different venture capitalists. He clearly showed how venture capitalists that use checklists are much better investors and managers. For example, he showed that those using a checklist:

had a 10 percent likelihood of later having to fire senior management for incompetence or concluding that their original evaluation was inaccurate. The others had at least a 50 percent likelihood. (p. 172)

And still…

The most interesting discovery was that, despite the disadvantages, most investors were Art Critics or Sponges -intuitive decision makers instead of systematic analysis. (p. 172)

 Then he goes in some detail to analyze how in 2009 the plane crew was able to make a crash-landing in the Hudson river and were able to save the passengers. The press rapidly hailed the pilot as a hero, but as details unfold, one sees that real hero of the story is the checklist, that helped both pilot, co-pilot and the crew to become a team and be able together to make a successful crash landing. 

But the press didn’t like the story of a successful team using a checklist, and continued with the fantasy of a single hero. They probably imagined that following checklists makes you rigid and unimaginative but the fact is that the opposite happens: checklists help us not to worry about the boring -but essential details- and “focus on the hard stuff (Where should we land?)”

Gawande then explains how  so much money is spent  in medicine on technology, and how little in getting all these components working together in a feasible way. He argues for creating something akin to the studies that National Transportation Safety Board undertake when there is a plane accident, no tracking of how well a hospital is doing, no checklists to assure that all these technologies and equipment are used in the most meaningful way.

We have a very useful tool that is only used in a few disciplines, despite its potential to be applied to hundreds of others. The main reason is how checklists can be embarrassing when one tries to show up as an expert, a genius, able to improvise and not following plans, and specially, not boring checklists.

But, as Gawande says, maybe we have to update our idea of what a hero is.

 

 

Soft Robots

Here is a review of the state of the art in this very interesting and promising field of robotics full of links for further information:

http://www.theverge.com/2014/4/16/5617290/soft-robotics-is-booming

Among those links I’d like to highlight this two videos:

For sure there is a lot of hype in the field but I cannot help thinking that robots of the future are much more likely to look in this way than like C-3PO.

Bach revisited

It is with emotion and reverence that I remember the discovery of Gödel, Escher, Bach (thank you David) a long time ago. A mind opening, fascinating and entertaining masterpiece about the mind, the conscience and a thousand other things.

I recently recommended it to a friend of mine (Werner) while we were sitting in a bar watching a soccer game on TV. The noise was so high that I had to shout the title of the book several times to be understood. I don’t fully understand how you can end up talking about Gödel’s theorem in such a place but sure you know by now that the Lord works in mysterious ways.

Anyway, Werner began reading it and sent me back a lot of links to those image annotated Bach pieces that you can find in Youtube. And I have to admit that they can help to improve the experience of reading the book.

When I read it (it was the early nineties) I had no Internet access and practically no way of listening to all the musical references that Hofstadter offered. Moreover, my limited musical skills didn’t allow me to follow most of the intricacies of Bach’s music even if it were available. This kind of visual approach makes everything easier and provides a gateway to the musically ungifted of the world to grasp the genius of JSB.

Reading Antifragile

We are nearing the last chapters of The Checklist Manifiesto in our Reading Calendar and we have to plan for next readings.

We are enjoying a lot reading again TCM. It is a mind changing masterpiece. The only question of using such a book in a collective reading experiment is that

a. There is no discussion in the interpretation because everything it says is so clear and well explained that everybody understands it.

b. There is no discussion about the value of it because it is so powerful and convincing that we all agree and surrender to it.

So, next book is not going to be like that.

We are going to re-read Antifragile, beginning on May the 15th. After all it was its publication that inspired us to create this blog. You can find the detailed timeline in the Reading Calendar, as usual.

The Checklist Manifiesto: The Test

Following the schedule of our Reading Calendar

After studying in detail the aviation industry approach to checklist development, Atul Gawande’s team work hard to redo their safe surgery checklist following the principles they had learned:

1. Not to include too many things so that it may be practical

2. Not to forget really important thinks so that it may be useful

3. To foster team building, to help react against the unexpected.

Big parts of their initial failed checklist are removed after iterative modifications and surgery simulations using the proposed checklists.

When a final consensus is reached, the result is a 19 point checklist divided in 3 stopping points: before anesthesia, before incision and before taking the patient out of the operations theater. A pilot study is devised to check its utility analyzing surgery complication rates in 8 hospitals around the world before and after the introduction of the checklist use. The hospitals are selected in such a way that reflect a broad spectrum ranging from affluent and high technology centers in rich countries to poor rural hospitals in third world countries.

Further changes in the checklists have to be added to meet local particularities of each hospital. The nurses are given the authority to conduct the checklist routine.

After 3 months, the results come and they are shocking:

the rate of major complications for surgical patients in all eight hospitals fell by 36 percent after introduction of the checklist. Deaths fell 47 percent. (…) Using the checklist had spared more than 150 people from harm- and 27 of them from death

Three months later this findings are published in The New England Journal of Medicine as a rapid-release article. Public health authorities around the world became interested in applying the procedure.

Rebuilding technology from scratch

I haven’t read it,but The Knowlege, how to rebuild our world from scratch sounds very intriguing to me.
From the Amazon website:

How would you go about rebuilding a technological society from scratch?

If our technological society collapsed tomorrow, perhaps from a viral pandemic or catastrophic asteroid impact, what would be the one book you would want to press into the hands of the postapocalyptic survivors? What crucial knowledge would they need to survive in the immediate aftermath and to rebuild civilization as quickly as possible—a guide for rebooting the world?