Showing posts with label incident management. Show all posts
Showing posts with label incident management. Show all posts

Wednesday, October 28, 2009

Mindfulness and fighting wild fires, and the value of simulations for training

Professor Karl Weick at the University of Michigan has written extensively on the need for "mindfulness" in emergency situations, such as, literally, fighting forest fires.

A mindful crew or crew-chief will be aware that they are operating on a mental model, and that model may be incorrect, so they must be alert to even very small signs that they have completely misconstrued the situation.

There are lessons here, on a longer time scale, for every leader, civilian or military.

Here are some public documents on the subject.

http://www.wy.blm.gov/fireuse/2009mtg/presentations/HROs-mindfulness.ppt

Teaching Mindfulness to Wildland Firefighters (Fire Management Today, Spring 2008, Dave Thomas)

For the last 3 years I have taught half-day workshops, conducted 1-hour lectures, and provided general awareness speeches about the Weick/ Sutcliffe model of High Reliability Organizing as described in their book Managing the Unexpected: Assuring High Performance in an Age of Complexity.

This article is a series of musings, conjectures, and recommendations pulled from this teaching experience. My intent is to pass on some of the lessons that I have learned teaching High Reliability Organizing, and to pose recommendations for further study...

Today, however, mainly due to the heating of the Earth through global warming and a build up of fuels -firefighters are working within an environmental framework of weather and fuel never experienced before. Errors that we might have "got away with" in the past could more easily become catastrophic today....

Next, I explain the irrationality (mindlessness) of always learning our primary safety lessons through trial and error. It is our job to be better at anticipating errors before they occur, before a brutal audit forces us to notice the discrepant events in the fire environment. The following quotation, which reinforces this view, is taken from French disaster expert Pat Lagadec:

"The ability to deal with a crisis situation is largely dependent on structures that have been developed before chaos arrives. The event can ... be considered an abrupt brutal audit: at a moment's notice, everything that was left unprepared becomes a complex problem, and every weakness comes rushing to the forefront."...

High Reliability Organizing

NEW! France-USA High Reliability Organizing in Incident Management Teams Project
Just like NYPD detective "Popeye" Doyle, who traveled to Marseilles in the 1970s hit movie “the French Connection” so too, did a Forest Service NIMO team this past December. Only it wasn’t for crime busting this time. It was a landmark match-up between two French and American Incident Management Teams to capture what makes these teams so successful in complex, rapidly changing, stressful situations. It is hypothesized that they exhibit many of the behaviors that directly align with high reliability organizing (HRO) concepts and principles.

( More to come)


More information:

The France-USA HRO Project (French Web Site, from Bouches du Rhone with video)
http://hro-fires.com/exercices_live.html

High-Reliability Organizing - Roberts, with Weick and Sutcliff:
http://www.wildfirelessons.net/HRO.aspx

Center for Catastrophic Risk Management, Berkely CA
http://ccrm.berkeley.edu

Communication and Information technologies:
New tools for DISASTER management
Jean-Michel DUMAZ (1)
Bouches-du-Rhône Fire Department – MARSEILLE - FRANCE
2nd International Conference on Urban Disaster Reduction
November 27~29, 2007

The Bouches du Rhône
Fire Department


Wade

Saturday, October 24, 2009

Hypnotized in high places - Northwest Flight 188

( picture of vulcan cockpit from u07ch on flickr -- Click for larger view.)

So, yesteday, it seems that a Northwest flight #188 overflew its destination city as the FAA attempted desperately to reach it. According to the NY Daily News,

Crew members aboard Northwest Airlines Flight 188 told the Federal Aviation Administration they were distracted during an intense discussion over airline policy and lost track of their location in the bizarre Wednesday night error.

I wrote a comment to ABC News, after reading the other 200 or so comments, as follows (spacing put back in for clarity and ease of reading).

====
There are always multiple levels of contributing factors, from personal to procedural to crew interaction to cockpit design to job design to corporate policy to FAA policy.

For safety, versus lawsuits, it's worth looking at each level of that nested hierarchy of contexts to seek ways to reduce the odds of this type of thing recurring. If we do that, we don't need to know for sure what happened -- only what might have happened that we are now aware of is a gap in our current system that is relatively easy to fix without side effects.

I think the context of the discussion could be expanded in two ways, both of which involve asking "What other events is this event like?" in a much larger framework.For example, I note an uncanny resemblance between this situation and the behavior of CEO's and government regulators as the nation financial situation flew up to the red line, and past it, while thousands of people screamed and called for attention below, and those above seemed to be ... asleep? ... arguing?... out to lunch?

This is not just situational unawareness, it is unawareness or a shared-delusional-mesmerized state that cannot be broken into by repeated efforts from outside and below, in the corporate and governmental boardrooms.

I'm not saying that just to b####, although b####ing can be fun -- I'm saying that human beings, even those with superb qualifications in isolation, can manage, collectively, to get themselves set up so that those "above" are completely and thoroughly "cut off" from input and flying blind or simply not flying at all anymore.

Again, not as legal blame for this accident, but as a route to understanding "what goes wrong with human interactions", this event could spur us to look at that much larger question, asking seriously, "No, seriously, how could THIS KIND OF THING ever actually happen?"

The truth is, socially, it happens A LOT.

There is something structurally seriously wrong with our mental model of how a hierarchical command structure ACTUALLY functions versus how we IMAGINE it to function.The lives destroyed and lost on a corporate and national level from THIS KIND of error are far more than the lives lost in this latest incident (zero).

Wade_AA

====
(picture by aeneastudio on Flickr)

Other observations I've made about structural blindness and delusional-mesmerism in high places:

Why we have so much trouble seeing

Why are so many flights delayed? The circle of blame


Model induced blindness and FEMA

It's a year since Katrina made it obvious that people watching CNN knew more about what was going on top government officials.

We have to ask how that is even possible. It defies our intuition, although not our experience, which is interesting.

While the "blame-game" remains in high-gear, Systems Thinking leads us to discount the obvious "bad people" and look for deeper root-causes in the social structure. FEMA Director Brown has been replaced, but the systems problems are harder to see and may still be there....
The power of delusion

It is an astonishing fact of life, which the Times article reveals, that the desire for life to be simpler is so powerful that it can cause 10,000 "trained" scientists, with PhD's, to take 30 years to finally collectively observe what others outside their mutual-blindness-field already knew.

As I've said, textbooks such as "Feedback Control of Dynamic Systems" are in their 5th editions in Control System Engineering, but biologists, and much of public health's biomedical research community, discount that literature to the point of invisibility and effectively treat it with contempt. To them, this literature does not exist. When seen, it "comes as news to them", and is promptly forgotten, because it conflicts with the shared myth of their culture, and cultural myths always win out over boring contrary evidence.

The Way Things Are (The "Yarn Harlot" tells it like it is, beverage alert!)


There are some truths. Things that just are the way they are, and no amount of desperate human optimism will change them. Allow me to demonstrate.
The guys showed up with the new stove. I went out front to meet them....

OK, Seriously... WHY didn't we see it coming?


High-reliability human systems have been studied extensively, from Chernobyl to The Bay of Pigs to Challenger to aircraft cockpit teams to hospital surgical teams to the US Army Leadership Field Manual. The answer always comes down to the same thing -- dissenting views need to be heard, and dissenters need what Harvard Professor Amy Edmondson calls "Psychological Safety" or they will wilt and become ineffective. This is how humans always behave and unless steps are taken it always breaks along this fault line.

The right question then should be, who is going to take charge of seeing that those steps are taken and that level of social literacy achieved?

I can't emphasize enough how much more important this is than more math and science, in the absence of this. As T.S. Eliot said, we repeatedly get burned "dreaming of systems so perfect that no one will need to be good, but the man that is will shadow the man that pretends to be."

Much of my weblog is about what we really need to do to avoid such errors in judgment.

====
Various related posts:

My 40 page multilevel structural analysis of
the Crash of Comair 5191 crash in Lexington KY. August 2006
with extensive links to source materials

related webpost with links to Comair 5191 cockpit voice recorder transcripts.


Information on the investigation of the crash of Continental flight 3407 in Buffalo, NY Feb 13, 2009, from the Buffalo News.

On Thursday, Feb. 12, 2009 at 10:20 p.m., Continental flight 3407, en route from Newark, N.J., spun from the sky and crashed into a home as it made its approach to Buffalo Niagara International Airport. All 49 people on board the plane were killed, as was one man in the house in Clarence Center. It was the worst aviation accident in Western New York history.

...A moment later, the co-pilot, Rebecca Lynn Shaw, complained of her own inexperience.

"I've never seen icing conditions," she said. "I've never de-iced. I've never seen any. I've never experienced any of that. I don't want to have to experience that and make those kinds of calls. You know I'd 've freaked out. I'd have like seen this much ice and thought oh my gosh we were going to crash."

Moments later, the crew lowered the plane's flaps and landing gear, and the plane quickly encountered trouble.

Things we have to believe to see

Why men don't ask for directions

Pisa/OECD - Why our education stresses the wrong way of seeing

Failure is perhaps our most taboo subject (link to John Gall Systemantics)

Active strength through emergent synthesis

US - Economy of arrogance (and blindness)

Virtue drives the bottom line - secrets of high-reliability systems

High-Relability Organizations and asking for help

Secrets of High-Reliability Organizations (in depth, academic paper)

High-Reliability.org web site

Threat and Error Management - aviation and hospital safety

Failure is perhaps our most taboo subject (link to John Gall Systemantics)

The importance of social relationships.

Houston - we have another problem (on complexity and limits of one person's mind)

Institute of Medicine - Crossing the Quality Chasm and microsystems (small group teamwork)

Here's a few quotations from MIT Professor John Sterman's textbook "Business Dynamics".

Many advocate the development of systems thinking - the ability to see the world as a complex system, in which we understand that "you can't just do one thing" and that "everything is connected to everything else." (p4)

Such learning is difficult and rare because a variety of structural impediments thwart the feedback processes required for learning to be successful. (p5)

Quoting Lewis Thomas (1974):
When you are confronted by any complex social system, such as an urban center or a hamster, with things about it that you're dissatisfied with and anxious to fix, you cannot just step in and set about fixing things with much hope of helping. This realization is one of the sore discouragements of our century.... You cannot meddle with one part of a complex system from the outside without the almost certain risk of setting off disastrous events that you hadn't counted on in other, remote parts. If you want to fix something you are first obligated to understand ... the whole system ... Intervening is a way of causing trouble.


IN reality there are no side effects, there are just effects.

Unanticipated side effects arise because we too often act as if cause and effect were always closely linked in time and space. (p 11)

And, this crucial comment by Sterman, reflecting the same observation by persons such as John Maynard Keynes.

Most of us do not appreciate the ubiquity and invisibility of mental models, instead believing naively that our senses reveal the world as it is (p16).
My additional note on this crucial insight. The reality is that the world, as it shows up on the mental TV screen we watch, is NOT the world that is actually out there. It has been more than rose-tinted by our brains. It has had entire chunks of the scene edited out entirely, and other chunks that "should go there " put in their place. A whole set of things that have given us pain or conflict in the past have been summarily removed, without so much as a place-holder left where they were. A set of things we hope might be true have been "helpfully" added to the scene. People's behavior, where it deviated from what we expected, has been "corrected" to show us them acting "the way we KNOW the are", not the way they actually are.

We are, in other words, flying almost entirely blind. We have papered over the front and side windows of our cars with pictures of the way we WANT the road to be, and are driving and turning the steering wheel based on those internal delusions.

Throughout evolution, this has been useful to reduce the immense fire-hose of data to a smaller set we can live with -- and, if we do a bad job of managing it, heck, we just die off and don't reproduce and others who do better jobs have children and go on. No big deal.

The problem comes when those living in such delusional and self-confirming, often self-congratulory worlds are given the power to rule our communities, our corporations, or our governments and they continue onwards believing that what shows up on their mental TV screens IS in fact what is going on out there, and believing, therefore, that those voices of dissenting views are, in fact, some kind of misguided or enemy action that should best be suppressed, shut out by locked cockpit doors or isolated fortress war-rooms, etc.

I'm not saying that solving this problem of filtering the fire-hose of complexity down to a size we can comprehend and use as a guide for steering is an easy one -- but I am saying that it is the kind of hard, complex problem that can yield its secrets to methodical research and study, and it is THAT research we desperately need at this time in our lives on Earth.

This is where it is breaking.

This is where we need to fix it.

Well, at least, that's what MY internal mental TV is showing me right now as the "obvious truth".

Wade

Saturday, November 15, 2008

A different model of what's wrong

Mental concepts or models of life are ways of throwing out most information to focus on a few bits that seem more important to insight than all the others. Different models give different answers to questions such as
  • What's wrong?
  • Why doesn't this work?
  • Where is it broken?
  • Where should we intervene?
  • If we intervene there, should we push or pull?
  • If we did that, what effect would we expect to see and when?
It's miserably cold and rainy out, with snow coming this way, so I'm staying inside this morning and working on something more abstract, while I eat breakfast -- such as what a model of the nature of Life and Evolution would suggest is "the problem" in our economy.

Might as well, nothing else seems to be working, and the models used by the government seem to change daily. Meanwhile, they argue over what it will take to stop GM going bankrupt, which again depends on what you think is wrong. Different camps point to:
  • too many government regulations
  • too few government regulations
  • health care costs
  • unions -who make unreasonable demands
  • management - which makes unreasonable demands
  • consumers - who make unreasonable demands
  • "the economy"
  • Housing and mortgage defaults
  • Nuclear above-ground testing
  • Ozone
  • Godzilla
  • Unfair competition from larger companies
  • Unfair competition from smaller companies
  • Hedge funds and banks
  • tree-huggers
  • commies and socialists
  • liberals or conservatives
  • lawyers
  • dentists
  • side-effects of anti-depression meds
  • Not enough team collaboration and consultation
  • Too much team collaboration and consultation
  • Too much decentralization
  • Too little decentralization
  • Alien invasions, UFO's, and demon possession
  • breakdown in the moral fiber of our nation
  • God's punishment for [ pick your sin and sinner ]
Given that range of diverse opinions about what is "obviously" "the cause" of the current problems in the industry, it seems there is room for one more.

You don't have to "buy" this - just consider it as yet one more possible model, and see where it leads. In particular, see if it leads to an idea we haven't tried yet that seems affordable and that won't interfere with other initiatives underway.

So, my new model of the day looks at the nature of Life - which is clearly and unambiguously organized in a kind of hierarchical and overlapping fashion. Cells are alive, but cells form multicellular thingies that are themselves alive in a whole different way, such as cats and dogs and people and you.

Individual instances of any type of thing collectively form "a species", which itself has many properties of living things, including being the abstract object that really evolves over time. (Individuals don't evolve, at least very much in terms of DNA arrangement, once they are born.)

There is a running argument in biology as to whether genes evolve, and animals are a side effect, or animals evolve, and genes are a side effect, or species evolve, and both genes and individual animals are side-effects.

In my model, they are all evolving, in inter-related but partly independent fashions.

The key feature of this particular multi-level model of life is that each level of Life has its own, largely independent, existence and rules of life and Life. Each level can forget, most of the time (but not all the time) that the other levels exist at all.

You can forget that your body is made of cells, unless your behavior, such as consuming some chemical, affects how the cells work, and then suddenly it matters and un-becomes invisible.

Similarly, management of a company, say GM, or of a country, say the US, lives in its own world with its own rules, and can easily forget that the cell-equivalent (workers / citizens / "consumers") matter -- until some behavior suddenly damages them (or bankrupts them) and they become un-invisible to "the economy".

These actors,however, are all still "people". Just as there are living structures smaller than "people" (such as cells), there seem to be (by this model) living structures that are larger than people, namely corporations and nations.

Smaller, in this sense, means things that make up something, and larger means, things made up of something.

But, our bodies are not "just" a pile of chemicals, or ten trillion cells - they have unique features that only make sense at a person level - such as going to the dentist. Much of "our" lives we spend dealing with issues "mortgage refinancing" that simply have no equivalent at the cellular or atomic level. If we could talk to our cells, it would be a very short and frustrating conversation, pretty much what one gets when management and labor sit down together.

So, let's assume for the moment that Corporations (with a capital C) are themselves life-forms that are dimly aware of their environment, dimly aware of the people who make them up, and yet exist independently (mostly) doing their own things that are similarly unintelligible to us.

We have, in other words, created a new level of multicellular life, called Corporations, which have their own life of struggling with each other, their own rules, and their own economy that is often entirely decoupled from the economy individual humans live in.

What has changed, in a baffling way to these corporations then, is that the health of "the consumer" has suddenly changed. Before this level was a reliable source of income or labor and as invisible as illegal immigrants to our food-processing company stockholders, and now, suddenly, the problems of individual humans have intersected the problems of the corporate world.

The US government is struggling to fix the problems of corporate life forms, because, at their scale, these are the only ones that matter or are even visible. Corporate life forms are trying to stay afloat by laying off 20% or more of their workers, because that always used to work, but it doesn't any more, not once EVERYONE is doing the same thing at once.

Intersecting all this is the confusion and confounding of "management" of a company and the company or industry itself. If there is no such thing as a corporate life form, other than an extension and echo of the top manager, then the company and the leader are the same thing.

However, most of our corporations and industries exist and continue to function even though the top management may be dysfunctional or absent entirely, or entirely engaged in internal power struggles. The plane continues, for a while to fly, even though the crew is having a huge fistfight.

So one thing we need to distinguish, when possible, is the survival of the current pilot and crew, versus the survival of the airplane. In many cases, the two seem to have diverged, and the crew is more interested in stripping the plane and bailing out than in saving the plane.

But the question here is where "the problem" is. Where is this whole multi-level system of cells, humans, corporations, and government breaking down?

This gets to the crux of the matter. Is it the humans at the top who are blind to any world except their own, a fact that is obvious from below but invisible from up there? Or is it that the higher life form, the corporation or nation, is insufficiently well formed to understand how important its constituent people are to its own existence?

In other words, assuming that most of what we see at a national level is a struggle of corporations and Corporate life forms, do they grasp that trying to survive at 'the expense of" their own cells is a losing strategy?

There is a lot of evidence that this fact is not evident. Congress is obsessed with trying to bail out or save the Corporate life forms, at the expense of the individual composite cells (ie, us.)

It is not surprising that humans at the top of such corporations or government become blind to the realities of cellular-level life. This is no longer where they operate.

If corporations are an independent living species, then the problem we face is that this level entity is too stupid to realize what it depends on.

And the solution that suggests is to make corporations more, not less, capable -- if that can be done in such a way that they don't destroy the entire planet that they also rely on in the process.

In other words, imagine that Corporations are "mostly alive", and "dimly aware" of what depends on what, and what part of individual humans and the earth's ecosphere they rely on to survive, which used to be invisible before there were so many Corporations sucking so much out of us and the planet.

Then, an intervention point, in that model, if we could find it, would be to make the Corporation brighter at perceiving long-range, long-term consequences of decisions IT makes, where the humans in it are mostly just there for show, acting as if they are making the decisions, kind of the way humans think they are making decisions that their bodies and brains made minutes earlier, as MRI studies now show.

This gets to the core question of how emergent, synthetic, multi-level life forms perceive the world, and learn about it, including what is connected to what.

Surely the basic laws of cybernetics apply to such learning. Things that have immediate consequences are easier to learn. Things with distant or delayed consequences take longer to learn.

The model says we're struggling with the wrong thing, trying to figure out WHO should be the humans at "the top" of meta-organisms that don't really rely on "the top" for leadership or guidance any more. The thinly veiled secret of those at the top is that they are also clueless and not in control of what's going on, despite their massive marketing effort to persuade everyone that they are just crucial and should be paid massive sums for their invaluable contributions.

We should take some time, remove the individual humans from the equation, and look at how the overall system is organized, and self-organizing to perceive the world around it and to improve its own ability to perceive and act and make alliances and adapt. Such seeing has to extend downward to humans and cells and plants and the ecosystem, as well as upwards to nations and planetary composite life forms that Corporations are themselves cells within.

This seems abstract, but it may be very real. It is certainly outside the normal box!

A few points in closing.

One is the key assumption that collections of things do not just have 'emergent properties", but that the emergent properties themselves take on a persistent, self-perpetuating "life of their own" that no longer depends directly on the collection of things that initially made it. Life has, in some sense, like an electromagnetic wave, been radiated outwards and no longer depends on the existence of the broadcast antenna. In fact, the corporate entity may turn on its founding fathers and expel them and go off its own direction, and often does.

The huge mental barrier to this concept is the idea we have of "life" being a property of collections of cells that are touching in a more or less fixed arrangement, although even that breaks down if one includes blood and white blood cells, etc.

To "see" or visualize the type of "life" I'm talking about, you may need to just follow the feedback loops and see what aspects of things are self-regulating, self-perpetuation, self-repairing, self-defending, DESPITE the efforts to go a different way by the employees ,management, stockholders, regulators, etc.

It is, ultimately, not DNA or proteins or genes, but the existence of these abstract "feedback control loops" that seem to be the universal property that defines something that behaves as if it were "alive". If we look at it from that point of view, this includes all biological life, but now includes as well ecosystems, the planet, corporations, major religions, etc. as living things.

This would also suggest that the key aspects of information transfer, the web and Google, for example, are at the core of the thinking neurons of this meta-being that has taken shape, or is taking shape around us even now.

That in turn suggests that the place to look for successful new product innovations for Google or Web-3 systems is beyond collaboration into synthesis of smaller-scale living units, something akin to "teams" but way beyond them, as well as synthesis of dyads of people that have a life beyond that of each of the two separately.

What structure, system, framework, boost, database, service, etc. would catalyze the emergence of such multi-human life forms, detect them, make a space that nourishes them and makes them bright enough to surround us safely instead of destructively?

That may be the question some people should be asking. That may be the gap. It's not just a question of groupware and collaboration and working-together, or of fixing 'broken" relationships or marriages. It's a question of what the positive side is, what levels of emergent life we can make with and out of our interactions with each other.

What kind of network service would detect and facilitate the closure and stability of such closed, feedback loops between individual agents -- the substrate of Life itself?

NOW you're talking "market share" and pent-up demand.

Wade














Wednesday, December 19, 2007

Clergy take on US Mortgage Mess


Martha Graybow, from Reuters, looks at what the US Clergy think about the mortgage mess in today's Washington Post. I agree wholeheartedly that there are "spiritual solutions to economic problems" but don't see them mentioned in that article.

One characteristic of spiritual solutions is that they tend to look at the bigger picture, in all three dimensions of space, time, and social scale. Like great health care, the solutions are proactive, preventing the car crash in the first place, not miraculously repairing the damage and deaths following it.

The solutions involve what seems to be a lost art these days - understanding the actual causes of outcomes, and the consequences of our own actions, and then, gasp, altering our behavior so we don't get into trouble next time.

The USA has made the news lately for the poor state of health here, and I'm not talking about insurance but simply the physical health of people. The upper quarter of white American males, for example, are less healthy than the bottom quarter of white males in England.

Why? Compare the strategies. England, with universal care, tries to prevent health problems and helps people eat well and stay fit and not do dumb things. The USA tries to have the most astoundingly heroic rescue and repair service so we can smoke, drink, and do dumb things, and then not have to face the consequences, sometimes. Of course, the culture of abandon of self-control is spread widely, and the access to repair-services is restricted, which makes for many sick poor people. What's less recognized is that even the rich end up worse. No doctor can make you better after a heart attack and transplant than you would have been if you'd stayed fit in the first place, either physically or psychologically.

With airplanes with those T-shaped tails, with the small wings ("elevators") up high on the tail, there is a design issue. If the plane descents at the wrong angle, turbulence ("stalling") from the body of the plane surrounds the tail, which loses the ability to change the angle of the plane. If you get into this condition, typically, the plane will descend into the ground before the airport. Not good.

Pilots have a question: "What do you do when you get into this condition?" and the answer is "Don't get into that condition."

And here is the difference between a novice learning lessons too late, and professionals. Professionals figure out what it takes so they don't end up in that condition, and what kind of training they need to do that, and build it into the training program so they can, in fact, "not do that." Social wisdom from other people's experience is built into everyone's training or retraining. That works, going forwards. It doesn't fix the past, of course.

So, when we look at an equivalent question to the mortgage mess, such as "What would it take to get young people not to drive too fast on icy roads?" the answer that comes to mind is "It would take a miracle."

Precisely.

It would take maturity, training, a social ethic of responsibility, a social ethic of competence, and an ability to overcome the impulse to rush and damn the consequences. All of these things are possible for people, and some people can do all of those.

The "miracle" isn't that the people wake up one day and are suddenly good drivers, but that they have the social support system that, over a long period of time, gives them the internal capacity to master skills, to survive the short-term costs of responsibility, to overcome temptation and the short-run impulses to cheat, etc.

What's "miraculous" is that this "bounce-shot" works, when you can't sink the pool ball in the pocket directly. If you try to do this activity on your own, you'll generally fail. It's hard, and it involves persistence and local costs for some distant future benefit, and you'll run out of steam regardless how well intentioned the start is.

This "steam" to keep on going is crucial. We aren't taught about this in school, sadly, despite the fact that everyone knows about it and I believe it would stand up to rigorous experimental designs and tests.

Where does this "steam" come from? What gives young people the ability to say "No!" to drugs or speeding or ill-advised sex, or the ability to stay in school, or the ability to say "No!" to a dangerous mortgage, or the ability to rise above ego and consult with others and avoid putting their foot in that mortgage bear-trap in the first place?

Some kind of larger scale, persistent social structure is needed to hold this learning and navigational advice, and some kind of practice and habit is required to develop the strength to "obey" or "submit" to that outside higher authority when the inside impulses all want to go the old way.

For pilots, professional organizations and ethics may be enough, although federal standards help somewhat. Great pilots are far above what standards require, because they use outside social support to keep themselves in line.

For most of us in daily life, we need some kind of equivalent. Organized religion has historically served this role, when it doesn't get lost in itself and lose its own way.

So, while the government's "abstinence only" method of birth control is demonstrably broken and ineffective, the reason is not that abstinence may be a good practice for teens (and others), but that it is simply not possible for fragmented individuals, on their own strength, to carry out that practice and survive temptation.

In between the chaos of everyone repeating every mistake over and over, and the rigidity of dead dogma controlling every aspect of everyone's lives is a sweet spot that can provide make good pilots or drivers of us all.

These kind of problems are not healed by prayer after the crash, but by organized activity long before the crash designed to prevent it from ever happening.

Like Mr. Rodney Dangerfield, prevention "don't get no respect." It works, it can work, it has worked, it will work - but it's an organized social activity, not something an individual does for or to themselves.

In the mix of making it happen are deeper spiritual issues of identity, motivation, purpose, awareness, externally-based stability and power, and "steam".

God, we all could use more "steam." We just wish it was free.

It's not free, but it is affordable. It's something we can do for each other that requires no huge government program and, in fact, would probably choke and die if the government tried to run it.

At this point, most people look, sigh, and turn sadly away saying "They'll never do that."

I'd like to see what would happen if the 3 hours a day of TV indoctrination encouraged social responsibility with eyes open, instead of discouraging it and encouraging blind yielding to whatever impulse the advertisers or politicians can create in us at that second.

I think the change would indeed justify the term "spiritual" sufficiently to use that word even in an academic sense. Actually, I think the reconnection to the larger "us" goes deeper, but even if it only went this deep, it would be worth investigating.

And I'm confident that, like discovering the planets, if we charted out all the known effects and watched behaviors, we'd see patterns of unexplained variation that would cause us to look even deeper for something else going on.

It's a fascinating question. Meanwhile, short term, there are solutions to our problems but we refuse to accept them, wanting, I don't know, something more glamorous or short-term.

Being able to say "yes" to saying "no" is enough of a miracle to pray for daily.

We're still trying to build some sort of moral-Rambo model, where we have internal strength that doesn't require external support -- a GPS that works without satellites. And, sure, there are inertial navigation units that weigh 200 pounds we could carry around with us, even though they drift over time. That's a stupid solution when there are satellites in place already, so the GPS in our phone can be so tiny we don't notice the weight.

Same with wisdom. Satellites and a receiver is a better model.

Is this hard to do? Well, yes and no. Is it hard to use structural and civil engineering principles and computer-assisted design to make graceful bridges that don't fall down? Yes, but it is doable and we'd be pretty stupid not to have some group of people that learn it and do it for us.

Is it harder to make social structures that don't fall down, don't become corrupt, give us daily strength to persist our lessons and still have dynamic ability to adjust to changing times? Probably not that much harder.

We've just never tackled the problem that way, because even pondering questions of what determines our behavior or allows corruption to creep in raises emotions and resistance.

Still, it seems an obvious way to go. We just need to keep on asking "Why" one more time, and saying, ok, how can we tackle this problem in social engineering even with resistance and opposition and those who prefer these subjects not be studied?

This is nothing new. T.S. Eliot, in Choruses from the Rock (1934) says
There are those who would build the Temple,
And those who prefer that the Temple should not be built.
In the days of Nehemiah the Prophet
There was no exception to the general rule.
and
In the vacant places
We will build with new bricks
There are hands and machines
and clay for new brick
and lime for new mortar
where the bricks are fallen
We will build with new stone
Where the beams are rotten
We will build with new timbers
Where the word is unspoken
We will build with new speech.
and
If men do not build
How shall they live?



That's the "new bricks" metaphor this weblog site is named for. It's a good idea.

photo credit: I35W bridge collapse photo from Poppyseed Bandits

Wednesday, September 26, 2007

What's wrong with decision-making at the top?

Many companies try to make decisions "at the top" instead of delegating that authority lower down the ladder. In this sense they hope to remain "in control" of what is decided.

Here's the problem - bandwidth. Top management only has so much they can deal with in a given day. So, rather than trying to put in 185 hour days, management does two things.

First, it puts out visible signals that management is overwhelmed, and please stop bringing problems to our attention unless you already know the answer. That cuts out a lot of this flow of information about process defects and makes life look a lot better.

Then, management decides it "prioritize" - which often means that a small subset of the problems that have made it to their desks actually will be dealt with today, and the rest will have to wait to "some other day."

So, management attempts to retain "control" of the process by suppressing news about most things going wrong, and avoiding dealing with most problems at all, at least today.

True, some problems will be dealt with. The serious question is, what are the costs and what are the benefits of this approach. How high are the actual costs of all those problems that are not being dealt with, and the costs of everything downstream that has stopped in its tracks waiting for resolution of the identified problem? These "opportunity costs" are often very high and very real.

Theory Y, bottom-up management, distributed leadership, and lean manufacturing all push the responsibility for problem-solving out of the corporate suite. This does involve letting go of the "control" that is gained by making these decisions, but includes getting hold of the "control" that comes from some kind of solution to the problem being instituted, instead of no solution at all for another day.

In many cases, most of the problems can be resolved at lower levels than upper management -- the ship isn't as responsive to the helm, but on the other hand it has stopped taking on water and no longer feels like it is about to capsize, and that funny noise has stopped -- so, there IS a ship left that can be steered, somewhat.

I fret about the
FEMA national incident management plan
because it is largely a plan to change all the reporting responsibilities and send issues to the "top" for resolution. Bandwidth, I think, will be the issue. A single large issue can claim 100% of the top executives' attention, closeting them in secret somewhere, while the phones go unaswered on every other issue that is, as requested, carefully flowing up the chain of command. That simply is unworkable in a large-scale emergency which is, well, when it is needed the most.

We have this long-standing heritage in this country of success based on top-down management and it is hard to let go and "shift the paradigm" to empowered employees making most decisions. In Katrina, it was the US Coast Guard that was most effective at rescuing people, becuase they had authority already delegated to each ship captain to do whatever made sense in an emergency.

Interesting idea.