Airlines are good at safety not because liability charges are astronomical, they are good at safety because of an enormous set of not too unreasonable regulations.
Liability is a very bad substitute for regulation when risks are comprised of high damage at low incidence. That's why you have speed limits instead of responsible self-determination and potentially rich surviving dependents.
> Airlines are good at safety not because liability charges are astronomical, they are good at safety because of an enormous set of not too unreasonable regulations.
Agreed. Checklist proponents in this thread oversimplify the issue. In a 2007 article, Atul Gawande, author of the 2009 book Checklist Manifesto, discusses how Peter Pronovost trained his hospital to better follow known surgical procedures,
> The new rule made it clear: if doctors didn’t follow every step on the checklist, the nurses would have backup from the administration to intervene. [1]
So, he didn't just use a checklist. He convinced staff they were making mistakes. The administration changed hospital rules. Then, Atul says,
> They calculated that, in this one hospital, the checklist had prevented forty-three infections and eight deaths, and saved two million dollars in costs.
He claims the checklist is what saved people's lives. He continues saying so for the rest of the article and in his book. It's an oversimplification and misleads the public into believing medicine is simple. The result is the comments you see in this thread. Training people is not simple. Everyone forgets things, even with checklists.
Atul himself later says so,
"It turns out to be much more complex that just having the checklist in hand." [2]
People want to hear about simple solutions. They disengage when a problem is described as complex.
This is why the Lean healthcare movement (and Lean in general) is so great.
It takes procedures into account, like checklists and workflows and all that, but more importantly it takes into account the human psychological factors in the workplace that prevent success on even the simple solutions.
However, this could not be more perfect an explanation:
> People want to hear about simple solutions. They disengage when a problem is described as complex.
This is where true leadership is required to breach the barrier of complexity and lead systems thinking across a (naturally) complex organization. Any organization. It's extremely difficult to get people to look outside their bubble or change the way they think, and that's required to manage any complex system with any success. This leadership is the main barrier to improvement in any org.
Lean sounds cool, I didn't know about that movement. I'd support that over the checklist movement any day.
I like that it's based on Toyota's core principle of respect for people. Toyota is a great example of how to inspire people to work smarter and harder. Their core values were initially based on how Ford ran his factories.
Actually, that's false. The principles of Toyota are rooted in statistical quality control, passed down by Walter Shewhart and W. Edwards Deming directly to the Japanese after WWII.
Sure, indirectly, Henry Ford made strides in both scientific management (alongside but not directly associated with Taylor), and moreso, respecting his workers. But the holistic management philosophy that Deming pushed forward was as much a revolt against Ford-era factory ideas as it was based in them; similarly, you might say the core values of Agile were initially based on how IBM ran their software development—nothing but a distant relative.
> They therefore revisited Ford's original thinking, and invented the Toyota Production System. [1]
Both Ford and Toyota made contributions to each other's processes at different times.
Also, Ford showed a healthy respect for people. This influenced other businesses to compete for talent. Ford doubled wages, increased productivity, etc. in the first half of the 20th century. Toyota made its own contributions later when Ford began to lag. Neither can be discounted from the equation.
Liability is a very bad substitute for regulation when risks are comprised of high damage at low incidence. That's why you have speed limits instead of responsible self-determination and potentially rich surviving dependents.