How Do We Know We’re Doing Things Right? Part I January 18, 2010

In the face of the unknown – the always nagging uncertainty about whether, under complex circumstances, things will really be okay – the builders trusted in the power of communication. They didn’t believe in the wisdom of the single individual, of even an experienced engineer. They believed in the wisdom of the group, the wisdom of making sure multiple pairs of eyes were on a problem and then letting the watchers decide what to do. Man is fallible, but maybe men less so. Atul Gawande, from The Checklist Manifesto: How to Get Things Right

Things have become increasingly complex in medicine, in technology and no doubt, for architects and others in the design professions and construction industry.

New technologies, new work processes, new codes, new materials and systems, new energy requirements, new priorities –there is seemingly no letting up of the complexity.

Architects pride themselves in being comfortable with ambiguity – but there comes a time when neither pride nor patience serves them or anyone else well professionally.

So what’s an architect to do?

A Focus on Checklists

MacArthur Fellow Atul Gawande, gifted surgeon, New Yorker staff writer and esteemed author of Better: A Surgeon’s Notes on Performance (“A masterpiece,” Malcolm Gladwell,) Complications, and now, The Checklist Manifesto: How to Get Things Right, in the chapter entitled The End of the Master Builder turned his scalpel on the architecture profession and construction industry. And what he discovered is quite astonishing.

The Checklist Manifesto grew out of a New Yorker article about the surprising impact of basic checklists in reducing complications from surgery.

Things have gotten pretty complex for architects and the construction industry and as Gawande writes “we need to make sure we apply the knowledge we have consistently and correctly.”

Messages

It has been years since I read a book so powerful and so thought-provoking…The danger, in a review as short as this, is that it makes Gawande’s book seem narrow in focus or prosaic in its conclusions. It is neither. Gawande is a gorgeous writer and storyteller, and the aims of this book are ambitious. Gawande thinks that the modern world requires us to revisit what we mean by expertise: that experts need help, and that progress depends on experts having the humility to concede that they need help. – Malcolm Gladwell

The book has a number of simple but powerful messages:

• The volume and complexity of knowledge today has exceeded any single individual’s ability to manage it consistently without error despite material advances in technology, training and specialization of functions and responsibilities.

Gawande explains the challenges associated with the exponential growth in both the complexity and volume of information and the inability of expertise alone to manage that information successfully. Gawande informatively distinguishes between simple, complicated and complex problems – where complex problems are like raising a child or designing and constructing a building. He tells us that a simple checklist can help us keep things in order. He writes, “Since every building is a new creature with its own particularities, every building checklist is new, too.”

• Despite demonstrating that checklists produce results, there is resistance to their use

From the book: “Despite showing (hospital) staff members the benefits of using the checklist, 20% resisted stating that it was not easy to use, it took too long and felt it had not improved the safety of care. Yet, when asked an additional question – would you want the checklist to be used if you were having an operation – a full 93% said yes.” In the book Gawande discusses two main types of checklists, characteristics of what constitutes a good checklist and some potential challenges of the approach.

• If you are acting on intuition rather than a systematic process, this book will cause you to pause in your tracks and seek a more disciplined approach

Gawande writes: “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.  …what is needed, however 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 built for novelty and excitement, not for careful attention to detail. Discipline is something we have to work at.”

Some revelations from The Checklist Manifesto

• You should develop and implement a process checklist for critical processes and decisions

Gawande explains how the construction industry operates in a world that has become overly complex to accommodate the traditional Master Builder at the helm, where a sole architect once controlled of all details of the building process. Hence, the Death of the Master Builder (the subject of Part 2 of this post and the title of a presentation Atul Gawande gave at the New Yorker Festival this past October.) Architects and contractors are able to accomplish this, he learns, through the use of multiple checklists.

• It takes more than just one person to do a job well

We’ve been hearing a lot of late of the days of the architect working alone have long passed. Collaboration has become a buzzword in business circles, not just in the architecture, and for good reason. As Gawande writes in The End of the Master Builder, “the variety and sophistication of advancements in every stage of the construction process had overwhelmed the abilities of any individual to master them.”

• A team is only as strong as its checklist

–by his definition, a way of organizing that empowers people at all levels to put their best knowledge to use, communicate at crucial points, and get things done, according to Bartholomew, Senior Books Editor at Amazon.com

• Busy people, caught in the complexities of life can change their ways and can produce better outcomes by using a simple checklist.

Really, checklists! We live in a world that has at our disposal pre-designed checklists in Word, Excel and all kinds of checklists you can download for free.

It’s Complicated

Architects of course have had checklists at their disposal. The AIA’s D200 form is a color-by-numbers step-by-step guide that hand-holds you the way through the design process . But it’s necessarily a false comfort – as Gawande makes clear.

I have resorted to using checklists – but clandestine, hiding them in my file or side drawer – embarrassed that I was unable to trust that I had kept every step, action, question, material, system, deliverable in my head and needed to rely on a list, as one does when food shopping.

The 1995 AIA D200 checklist lays out the architectural design process step by step in a color by number format where all you need to do is connect the dots and voila! You have a building. The architect has the comfort of knowing what to do, when to do it, and what to look out for down the road.

According to the AIA, the D200™–1995, Project Checklist is a convenient listing of tasks a practitioner may perform on a given project. This checklist will assist the architect in recognizing required tasks and in locating the data necessary to fulfill assigned responsibilities. By providing space for notes on actions taken, assignment of tasks, and time frames for completion, AIA Document D200–1995 may also serve as a permanent record of the owner’s, contractor’s and architect’s actions and decisions.

A checklist of this sort acts as a back-up system – where I look like a hero when we get to that part of a meeting and someone says “anything else?” and I list 3 or 4 items than no one else had thought of. Don’t thank me. Thank the AIA.

Who needs scenario planning when you have a time-proven list of what to expect in front of you?

“The truly great don’t have checklists”

But architects pride themselves on keeping everything they need to know in their head. Having to rely on a checklist is a sign of weakness to some surgeons – and no doubt to architects.

Besides, as Gawande mentions, checklists aren’t cool.

As Gawande writes: “It somehow feels beneath us to use a checklist, an embarrassment. It runs counter to deeply held beliefs about how the truly great among us – those we aspire to be – handle situations of high stakes and complexity. The truly great are daring. They improvise. They do not have protocols and checklists. Maybe our idea of heroism needs updating.”

We don’t picture architects Herzog and Demeuron with a checklist. But that is probably because their staff keeps them under wraps and out of sight. But no one doubts that they keep them.

Gawande points out in his book that each project by nature of being a one-off is unique and so no one checklist will serve.

This is true – anyone who has resorted to one of the checklist books – Fred Stitt’s Working Drawing Manual, Pat Guthrie’s Cross-Check: Integrating Building Systems and Working Drawings, or Guthrie’s forthcoming 688 pages 4^th edition of his The Architect’s Portable Handbook: First-Step Rules of Thumb for Building Design Publisher: from McGraw-Hill –

 can attest to that. They are at best cursory, sometimes random, skipping around from reminding you to put in flashing to reminding you to submit for permit.

These field guides, handbooks and lists, by addressing the technology and science of building, give the design professional the false feeling of safety and security – they’re no substitute for covering your tracks by looking things up and crossing your T’s, nor for direct communication with your fellow project teammates and collaborators.

As one reviewer put it, “As in all of his work, Dr. Gawande latest book brilliantly reminds us all of the huge value of getting the human interaction side right to accompany the advancements in science and technology that his (and other’s) field of work has witnessed. It highlights the inadequacy of technical expertise when not joined by an equal (maybe greater) emphasis on strengthening our relationships with those we work with and care about.”

Anyone working with complexity and readers already familiar with Gawande’s previous books, Better: A Surgeon’s Notes on Performance and Complications: A Surgeon’s Notes on an Imperfect Science, will find The Checklist Manifesto no less an informative, entertaining and thought-provoking book.