What is it about the airline industry that makes it such a safe place to be and what did the health industry learn from it that had a dramatic impact on death and disability following surgery? More to the point, why we should adopt Kanban and use exit criteria to improve our success rates in delivering projects, products and services?
Back in 1935 the Boeing Corporation developed a new fighting machine that became known as the Flying Fortress. In a demo flight to the senior people of the USAF, the pilot took the plane to the runway, built up speed, got airborne and began to build height. And then it stalled and crashed to the ground.
A review found that the greater complexity of this aircraft meant there was more for the pilot to do. The plane crashed due to pilot error, but there was more assistance the pilot could have been given in performing vital checks. Boeing developed a checklist to ensure that all the right things were in place before aircraft left the ground.
Physical paper checklists now form part of day-to-day operations in the airline industry. If you want to travel, being on a plane is the safest place to be. Even when there are emergencies, pilots fall back to their checklists as the first place to begin recovery action, rather than reacting to panic, keeping them focused on the job in a calm and rational way.
Not so long ago, over the past decade, leading health professionals in the World Heath Organisation recognised that people were regularly dying during or following surgery due to human error. Highly skilled surgeons were effective when under business as usual conditions but less so when they had to respond to exceptional circumstances.
So they searched for an answer and discovered the checklist approach in the airline industry. Now, it wouldn’t be fair to say that more people die in hospital than in aircraft, because people tend to start off at a disadvantage going into surgery compared to going on a trip. However, with the level of training that takes place for both professional groups, the degree of human error acceptable should be at least comparable.
Led by Atul Gawande, a highly accomplished surgeon, the World Health Authority (WHO) developed a checklist for surgery. This was trialled across seven hospitals and the results were phenomenal: deaths and disabilities were reduced by more than one third. The list is simple, including checking the patient identity and site for surgery before they receive anaesthesia; the team introducing themselves and confirming patient details and site of operation before skin incision; all instruments, sponges and needles accounted for before leaving the operating room. Standard checklists are now in use across the NHS in the UK and being adopted by health organisations world-wide.
In the generally less life-critical world of IT services we have, to some extent, known the value of checklists for some time. In the Prince2 world we have stage reviews that approve the progress of a project from one state to the next; we have definitions of done in agile projects that focus teams on completion; and we have exit and entry criteria in Lean-kanban environments that provide a definitive status of items of work passing through a delivery process.
However, to a considerable extent, people tend to play lip service to the valuable intent behind these techniques. For example, at stage reviews, compromises are regularly made on criteria “to keep the project going”, only to find it really was not in the right state with resulting disaster; comments such as “it’s done, just not fully done” in end of sprint reviews for agile projects leads to shear confusion; items displayed as “done” on Kanban boards, still being talked about and worked on is just not telling the truth.
The answer is discipline and recognising that the process of working through a physical checklist is the real benefit, not the checklist itself. In the world of Kanban and Lean adoption, in particular, driven by much hype within the industry and to the benefit of vendors more than users, the suggestion of sitting down with a peer or the team to tick boxes on a piece of paper, may not be sexy enough. The simple things can be the most effective and, if it’s good enough to transporting passengers several miles high or cutting people open to intervene in life-threatening conditions, it’s good enough to me.
The practical reality of it is: for each item of work, as it passes from stage to stage across a Kanban board, for example, have a physical checklist of exit criteria (or entry critieria) that is used to ensure the item is ready to move on and used by at least two people to agree the status. Ensure it is a physical activity, even if it is performed by phone, as it is as much about the conversation as it is about the action. It then becomes a psychological contract that, to the best of their belief, this is the true status.
In a high tech world, recognising that we as people are prone to error, even with the highest degree of training, using simple tools like Kanban exit criteria, as you can learn in Kanban training, will help to deliver better products and services.