The Checklist Manifesto_ How to Get Things Right - Atul Gawande [29]
The checklists work.
4. THE IDEA
There is a particularly tantalizing aspect to the building industry’s strategy for getting things right in complex situations: it’s that it gives people power. In response to risk, most authorities tend to centralize power and decision making. That’s usually what checklists are about—dictating instructions to the workers below to ensure they do things the way we want. Indeed, the first building checklist I saw, the construction schedule on the right-hand wall of O’Sullivan’s conference room, was exactly that. It spelled out to the tiniest detail every critical step the tradesmen were expected to follow and when—which is logical if you’re confronted with simple and routine problems; you want the forcing function.
But the list on O’Sullivan’s other wall revealed an entirely different philosophy about power and what should happen to it when you’re confronted with complex, nonroutine problems—such as what to do when a difficult, potentially dangerous, and unanticipated anomaly suddenly appears on the fourteenth floor of a thirty-two-story skyscraper under construction. The philosophy is that you push the power of decision making out to the periphery and away from the center. You give people the room to adapt, based on their experience and expertise. All you ask is that they talk to one another and take responsibility. That is what works.
The strategy is unexpectedly democratic, and it has become standard nowadays, O’Sullivan told me, even in building inspections. The inspectors do not recompute the wind-force calculations or decide whether the joints in a given building should be bolted or welded, he said. Determining whether a structure like Russia Wharf or my hospital’s new wing is built to code and fit for occupancy involves more knowledge and complexity than any one inspector could possibly have. So although inspectors do what they can to oversee a building’s construction, mostly they make certain the builders have the proper checks in place and then have them sign affidavits attesting that they themselves have ensured that the structure is up to code. Inspectors disperse the power and the responsibility.
“It makes sense,” O’Sullivan said. “The inspectors have more troubles with the safety of a two-room addition from a do-it-yourselfer than they do with projects like ours. So that’s where they focus their efforts.” Also, I suspect, at least some authorities have recognized that when they don’t let go of authority they fail. We need look no further than what happened after Hurricane Katrina hit New Orleans.
At 6:00 a.m., on August 29, 2005, Katrina made landfall in Plaquemines Parish in New Orleans. The initial reports were falsely reassuring. With telephone lines, cell towers, and electrical power down, the usual sources of information were unavailable. By afternoon, the levees protecting the city had been breached. Much of New Orleans was under water. The evidence was on television, but Michael Brown, the director of the Federal Emergency Management Agency, discounted it and told a press conference that the situation was largely under control.
FEMA was relying on information from multiple sources, but only one lone agent was actually present in New Orleans. That agent had managed to get a Coast Guard helicopter ride over the city that first afternoon, and he filed an urgent report the only way he could with most communication lines cut—by e-mail. Flooding was widespread, the e-mail said; he himself had seen bodies floating in the water and hundreds of people stranded on rooftops. Help was needed. But the government’s top officials did not use e-mail. And as a Senate hearing uncovered, they were not apprised of the