I recently read Gawande’s The Checklist Manifesto. (You can read my review of the book here and my notes on the book here.) The book made me think harder about failure and how to prevent it. Here’s a result of that thinking.
We fail because we don’t know or because we don’t execute on what we know (Gorovitz and MacIntyre). Of the things that we don’t know are things that no else knows either—they are beyond humanity’s reach for now. Ignore those for now. This leaves us with things that “we” know but the practitioner doesn’t.
Practitioners do not know because the education system has failed them, because they don’t care to learn, or because the production of new knowledge outpaces their capacity to learn. Given that, you can reduce ignorance by 1) increase the length of training, b) improving the quality of training, c) setting up continued education, d) incentivizing knowledge acquisition, e) reducing the burden of how much to know by creating specializations, etc. On creating specialties, Gawande has a great example: “there are pediatric anesthesiologists, cardiac anesthesiologists, obstetric anesthesiologists, neurosurgical anesthesiologists, …”
Ignorance, however, ought not to damn the practitioner to error. If you know that you don’t know, you can learn. Ignorance, thus, is not a sufficient condition for failure. But ignorance of ignorance is. To fix overconfidence, leading people through provocative, personalized examples may prove useful.
Ignorance and ignorance about ignorance are but two of the three reasons for why we fail. We also fail because we don’t execute on what we know. Practitioners fail to apply what they know because they are distracted, lazy, have limited attention and memory, etc. To solve these issues, we can a) reduce distractions, b) provide memory aids, c) automate tasks, d) train people on the importance of thoroughness, e) incentivize thoroughness, etc.
Checklists are one way to work toward two inter-related aims: educating people about the necessary steps needed to make a decision and aiding memory. But awareness of steps is not enough. To incentivize people to follow the steps, you need to develop processes to hold people accountable. Audits are one way to do that. Meetings set up at appropriate times during which people go through the list is another way.