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and heat rises. At the time, though, the lieutenant made none of those connections consciously. All of his thinking was going on behind the locked door of his unconscious. This is a beautiful example of thin-slicing in action. The fireman’s internal computer effortlessly and instantly found a pattern in the chaos. But surely the most striking fact about that day is how close it all came to disaster. Had the lieutenant stopped and discussed the situation with his men, had he said to them, let’s talk this over and try to figure out what’s going on, had he done, in other words, what we often think leaders are supposed to do to solve difficult problems, he might have destroyed his ability to jump to the insight that saved their lives.

In Millennium Challenge, this is exactly the mistake that Blue Team made. They had a system in place that forced their commanders to stop and talk things over and figure out what was going on. That would have been fine if the problem in front of them demanded logic. But instead, Van Riper presented them with something different. Blue Team thought they could listen to Van Riper’s communications. But he started sending messages by couriers on motorcycles. They thought he couldn’t launch his planes. But he borrowed a forgotten technique from World War II and used lighting systems. They thought he couldn’t track their ships. But he flooded the Gulf with little PT boats. And then, on the spur of the moment, Van Riper’s field commanders attacked, and all of a sudden what Blue Team thought was a routine “kitchen fire” was something they could not factor into their equations at all. They needed to solve an insight problem, but their powers of insight had been extinguished.

“What I heard is that Blue Team had all these long discussions,” Van Riper says. “They were tying to decide what the political situation was like. They had charts with up arrows and down arrows. I remember thinking, Wait a minute. You were doing that while you were fighting? They had all these acronyms. The elements of national power were diplomatic, informational, military, and economic. That gives you DIME. They would always talk about the Blue DIME. Then there were the political, military, economic, social, infrastructure, and information instruments, PMESI. So they’d have these terrible conversations where it would be our DIME versus their PMESI. I wanted to gag. What are you talking about? You know, you get caught up in forms, in matrixes, in computer programs, and it just draws you in. They were so focused on the mechanics and the process that they never looked at the problem holistically. In the act of tearing something apart, you lose its meaning.”

“The Operational Net Assessment was a tool that was supposed to allow us to see all, know all,” Major General Dean Cash, one of the senior JFCOM officials involved in the war game, admitted afterward. “Well, obviously it failed.”

4. A Crisis in the ER

On West Harrison Street in Chicago, two miles west of the city’s downtown, there is an ornate, block-long building designed and built in the early part of the last century. For the better part of one hundred years, this was the home of Cook County Hospital. It was here that the world’s first blood bank opened, where cobalt-beam therapy was pioneered, where surgeons once reattached four severed fingers, and where the trauma center was so famous — and so busy treating the gunshot wounds and injuries of the surrounding gangs — that it inspired the television series ER. In the late 1990s, however, Cook County Hospital started a project that may one day earn the hospital as much acclaim as any of those earlier accomplishments. Cook County changed the way its physicians diagnose patients coming to the ER complaining of chest pain, and how and why they did that offers another way of understanding Paul Van Riper’s unexpected triumph in Millennium Challenge.

Cook County’s big experiment began in 1996, a year after a remarkable man named Brendan Reilly came to Chicago to become chairman of the hospital’s Department of Medicine. The