The Checklist Manifesto_ How to Get Things Right - Atul Gawande [74]
So who was the hero here? No question, there was something miraculous about this flight. Luck played a huge role. The incident occurred in daylight, allowing the pilots to spot a safe landing site. Plenty of boats were nearby for quick rescue before hypothermia set in. The bird strike was sufficiently high to let the plane clear the George Washington Bridge. The plane was also headed downstream, with the current, instead of upstream or over the ocean, limiting damage on landing.
Nonetheless, even with fortune on their side, there remained every possibility that 155 lives could have been lost that day. But what rescued them was something more exceptional, difficult, crucial, and, yes, heroic than flight ability. The crew of US Airways Flight 1549 showed an ability to adhere to vital procedures when it mattered most, to remain calm under pressure, to recognize where one needed to improvise and where one needed not to improvise. They understood how to function in a complex and dire situation. They recognized that it required teamwork and preparation and that it required them long before the situation became complex and dire.
This was what was unusual. This is what it means to be a hero in the modern era. These are the rare qualities that we must understand are needed in the larger world.
All learned occupations have a definition of professionalism, a code of conduct. It is where they spell out their ideals and duties. The codes are sometimes stated, sometimes just understood. But they all have at least three common elements.
First is an expectation of selflessness: that we who accept responsibility for others—whether we are doctors, lawyers, teachers, public authorities, soldiers, or pilots—will place the needs and concerns of those who depend on us above our own. Second is an expectation of skill: that we will aim for excellence in our knowledge and expertise. Third is an expectation of trust-worthiness: that we will be responsible in our personal behavior toward our charges.
Aviators, however, add a fourth expectation, discipline: discipline in following prudent procedure and in functioning with others. This is a concept almost entirely outside the lexicon of most professions, including my own. In medicine, we hold up “autonomy” as a professional lodestar, a principle that stands in direct opposition to discipline. But in a world in which success now requires large enterprises, teams of clinicians, high-risk technologies, and knowledge that outstrips any one person’s abilities, individual autonomy hardly seems the ideal we should aim for. It has the ring more of protectionism than of excellence. The closest our professional codes come to articulating the goal is an occasional plea for “collegiality.” What is needed, however, isn’t just that people working together be nice to each other. It is discipline.
Discipline is hard—harder than trustworthiness and skill and perhaps even than selflessness. We are by nature flawed and inconstant creatures. We can’t even keep from snacking between meals. We are not built for discipline. We are built for novelty and excitement, not for careful attention to detail. Discipline is something we have to work at.
That’s perhaps why aviation has required institutions to make discipline a norm. The preflight checklist began as an invention of a handful of army pilots in the 1930s, but the power of their discovery gave birth to entire organizations. In the United States, we now have the National Transportation Safety Board to study accidents—to independently determine the underlying causes and recommend how to remedy them. And we have national regulations to ensure that those recommendations are incorporated into usable checklists and reliably adopted in ways that actually reduce harm.
To be sure, checklists must not become ossified mandates that hinder rather than help. Even the simplest requires frequent