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  • Book Depository: The Checklist Manifesto by Atul Gawande

    Aircraft manufacturers regularly circulate checklists. Every plane contains a book of them, and each airline customises them to their own practices. They enable pilots, skilled as they are, to ensure that the many routine tasks of flying an aircraft are accomplished rigorously. Aside from those that are used for every flight, separate checklists exist to solve problems. They instruct pilots what to do if, for example, an engine cuts out in mid-flight, or a door alarm comes on. Boeing’s checklists condense thousands of hours of experience, analysis of many accidents, and testing in simulated flights, into a succinct list of check-points.

    Flight checklists have saved thousands of lives. In abstracting and decentralising routine operations, they catch careless mechanical oversights that could otherwise cause or worsen accidents. Their simplicity conceals a wealth of research and experience that pilots could not otherwise access. Checklists free the flight crew to use their skill and professional judgement elsewhere. Other industries might improve their effectiveness by using checklists, ensuring that emergencies occur less often, and that people are better prepared when they do. But very few industries do.

    This book describes Atul Gawande, a surgeon, leading a World Health Organisation initiative to drive the creation and adoption of three checklists for use in operating theatres around the world: one before anaesthetic, another before the first incision, and another after operation. The team encounters considerable design and social challenges. They must determine whether to adopt a read-do or do-confirm approach, work out what to put in and what to leave out, make the standardised list relevant to different types of hospital around the world, decide who should be responsible for imposing it during surgery, persuade people to use it, and test its effectiveness. His team’s final checklists, with a total of just nineteen points, were put into practice in a three-month trial involving eight hospitals. The results are significant: the checklists prevent between a quarter and a half of complications and patient deaths during surgery. But even in the light of the success of such a simple intervention, it is difficult to encourage many hospitals to adopt them.

    This is a cultural problem. In general, checklists are not popular wherever heroism and the skills of the individual are celebrated and rewarded. Surgery is such a field, but Atul Gawande also considers the world of investment finance, where a handful of successful investors made their own private checklists. Surgeons are accustomed to rebutting interference and protecting their own interests, and can find the imposition of a checklist demeaning. Atul Gawande argues that this attitude can be overcome, and must be. His surgical checklist includes a stage where people introduce themselves and their roles before the operation. For psychological reasons, this is one of the most important checks: simply taking time to learn colleagues’ names can dramatically improve the effectiveness of an operating team.

    Even in unpredictable situations, and even when qualified, experienced people are in control, it is usually simple oversights that cause trouble. A good checklist will prevent many problems altogether. In forcing preparation of contingency plans, it will also improve the chance of success whenever an emergency occurs, options dwindle, and focus starts to narrow. Forcing people to cross-check their work with colleagues empowers subordinates to speak up, share knowledge, and co-operate, which catches more mistakes.

    At their best, checklists actively create a strong team discipline. The aviation industry, where every accident is analysed forensically, was the first to come to this conclusion. It had to transform the way it saw the world, and other organisations should do the same.

  • Supper’s Digests: Grand Theft Audio

    In much the same way that a distinction exists between somebody who likes to go to the cinema and a cineaste, there is a distinction between people who play computer games and those who consider themselves ‘gamers’. It’s a question of degree of attention, dedication, and discernment. Aficionados in any realm form a relationship with their subject. They cultivate a critical appreciation of the craft: a curiosity that leads them behind the shiny facade of a finished product, informing and rarifying their tastes.

    I never considered myself a computer gamer. What held me back was the realisation, when games had achieved a certain level of sophistication, that they were mocking me. Several years ago I completed Grand Theft Auto IV. I conducted its unmemorable Serbian protagonist through the tortuous stations of a biblically violent morality tale. In a handful of simulated weeks, he transformed himself from a penniless immigrant with a blood-soaked past into a dead-eyed, materially successful, violent mercenary.

    For hours I watched this Faustian avatar tearing up a miniature New York: stealing and driving sports cars, earning money through organised crime, at once befriending and then executing gangsters, and acquiring piles of possessions. He achieved all this, even had some simulated fun, but failed to locate his soul. The on-screen existence clanged with the emptiness it was supposed to. Here’s the actual moral, though: to make this investment in the story required my real-world time and my real-world money. The game entertained and delighted enough to keep it fresh, but after fifteen hours of pillage, the protagonist had become a millionaire who had extricated himself from his past with all the freedom that this entailed. All I’d achieved was a few mouse miles and a stiff back. I didn’t play the sequel.

    What rankled is that my working life at that point was a microcosm of the experience I had just played. At work, too, I was stabbing at a keyboard and pushing a mouse all day while my boss rolled between the office and a country estate in a fleet of huge cars, wining and dining his successful friends. A self-made man, he was absolutely entitled this success, and for his part was as magnanimous as any businessman I’ve known. Nevertheless, it was hard for me to distinguish life from Grand Theft Auto IV. I co-piloted a CEO to measurable achievements, to greater wealth, and to bigger and bigger projects. The better I worked, the larger and shinier his car. I realised that I’d invest my time far better if I worked out how to ‘+1′ my own story.

    Fixing this is the tricky part. Life is famously and lamentably short: at most, we get about three attempts at a big change of course before the game’s up. It’s also very hard to measure success, so it’s not always clear if a particular course is the right one. Steve Jobs picked over this dilemma in a talk he gave to Stanford students, in which he covered the problem of not being the protagonist in your own story or, as he put it, ‘living somebody else’s life’. While his conclusions might inspire us, we might not be happy to imitate him. He became a multimillionaire at the age of 26, but his biography portrays him as a psychopath. Those of us who want to take a more conventional orbit nevertheless face similar difficulties. It is hard and often tedious to work on oneself.

    Most cultures create a dichotomy between a person’s obligations to the world, and those to themselves. In the East, they place the fulcrum between being and doing; in the West, we balance rest (or ‘life’) with work. The idea is expressed just differently enough to convey that our two cultures tend to create different kinds of screw-ups. Westerners like to make leisure feel like work, by turning it into something measurable. Success can be quantified in wealth or children or Twitter followers, and validation pursued through a frenzy of acquisition and consumption. In the East, the line between being and doing is so intractable that some people cannot survive if they separate themselves from their duty. The Japanese language contains the words salaryman, a person who devotes their life to the corporation, and karoshi, a single word that means death through overwork.

    Social networks abound with promised shortcuts to any goal you might have, and they’re not very good. Every professed ‘life hack’ I’ve seen falls into one of four categories:

    1. Transparent scams;
    2. Vacuous platitudes;
    3. How to use a privilege of birth to steal a temporary advantage, before leaving others to clean up the mess;
    4. Tips for turning up your treadmill.

    A hack might truly accelerate your life, but nobody can tell you with certainty whether you’ve pointed it in a decent direction. Just as there is no quick path to enlightenment, and no single book can turn you into an instant expert, you cannot be told what to do with your time. In any case, passage of time and investment of labour is not an inconvenience: we’ve made it the entire point. People can trap themselves into believing that some poor life choice was all the more noble because it hurt. This is called the ‘sunk cost fallacy’, and books about business psychology contain warnings to detach yourself from it.

    This just emphasises that, in some way, humans need a narrative. It feels better to struggle for what you desire than to be handed it for free. It isn’t sufficient to just learn and understand something: you have to grok it.

    Being; doing; balancing the needs of the self against an obligation to serve the wider world. These are old problems with old answers, and here’s one of the best. Rabbi Hillel’s response has continued to resonate with poetic simplicity since the Talmud was written twenty-two centuries ago. ‘If I am not for myself, who will be for me? If I am only for myself, what am I for? If not now, when?’

    The greatest of teachers, when faced with such an important question, answers it with three more. And, in doing so, reveals his contempt for shortcuts.

  • Supper’s Digests: An outsider’s outsider

    It’s time for a musical interlude. Not knowing what to expect, and at the behest of friends whose obsessions, like mine, intersect literature, nerdiness and everything musical, Michelle and I attended the UK filk convention last month.

    Filk music eludes accurate description. It’s more of a mindset than a genre. Over a weekend steeped in its world, trying to identify what it is and why it exists, we were hurtled through a fairground of musical styles, and pondered the nature of people who keep filk alive.

    Originally a misspelling of ‘folk’, filk assimilates as many interests and personalities as it’s able to touch. Practitioners are united by common loves that include music, beer and wordplay. An outsider art, performed by people who know they’re outsiders and don’t care, filk music was once rooted in English and American folk idioms, but today it ventures farther.

    Fundamental to filk culture is the concept of the circle, a gathering where anything from four to thirty people elect just to listen, or to take it in turns to play music to one another. A democracy of nominating and volunteering evolves; listeners at once become backing singers or instrumentalists, trading songs and sharing harmonies. Fresh material is revealed, and shy newcomers are heard and honed. These circles sustain themselves through the night, pouring forth music and holding court until breakfast.

    Starting in 1987, the annual convention now resembles a family reunion, but its atmosphere remains one of unconditional support and appreciation. Music is treated seriously enough for huge stores of material to be composed and practised over the year, but personal eccentricities are taken for granted. The quality of songwriting and professionalism varies hugely. A few hesitant bars of ukulele scraped from a chord chart by a novice may introduce a song performed by a professional chorister.

    No matter what its influences, though, this remains folk art simply because it is not mainstream. Filk is weird, but the longer you stare at a subculture, the weirder it always seems. There are plenty of examples from the recent past: modern opera; psychedelic rock; disco; the New Romantics of the Eighties. As soon as they enter the mainstream, they seem less barmy. Rap music is a pertinent example. The self-aggrandising misogyny, violence and materialism that characterises much of rap is at once a billboard and a sticking plaster. Regardless of the salary earned, nothing is masculine about improvising rhyming couplets against a recorded drumbeat. For all the firearms and swagger, The Notorious B.I.G. was basically Percy Shelley, but with less privileged parents.

    Where was I? Yes, filkers are absurd, but no more so than anybody else. Knowing this, they lovingly poke fun at most of the things they embrace. Songwriters may be science-fiction and fantasy enthusiasts, or irascible folkies belting out nasal renditions of protest songs in the Dorian mode. They may just as easily draw influence from the news, musical theatre, the Great American Songbook, or a trashy video box-set. Nothing is too cherished or too tacky for assimilation.

    Much of the craft is in the performance, so filk music is best caught live. We beheld, for example, a marvellous arrangement of a Tweet about the theft of a Catholic relic, rendered as a doleful sea shanty. It was strongly reminiscent of Ivor Cutler. Another group shoehorned the theme of raising an adolescent boy into a Pete Seeger song (‘Where has all the Kleenex gone? Gone into the teenager’s room.’)

    A novelty song about a German immigrant struggling to learn the delicate art of English understatement won a prize, as did a poignant ballad about what becomes of superheroes when they age. Given a room and time slot of her own, someone set the back-story of a computer game to a Gilbert and Sullivan operetta. There’s a lot of effort in arranging, rehearsing and performing such a work, but considerable patience is demanded of an audience to bear the hour-long punchline. The jokes are not always apparent to a newcomer: with many hours of such programming, one can overdose on filk.

    Would I recommend it? Only to some. Subcultures are subcultures because they don’t set out to please everybody. You have to be a geek, a good musician, or a collector of cultural curios to be a filker: preferably all three. Would I go back to the convention? Yes. I admire it for the same reason I enjoy my walks through Hackney: there’s so much of the Earth’s flavour crammed into such a small space, bumping together, that sparks of inspiration are cast in all directions. Most of these sparks do nothing useful, but occasionally there’s a glimpse of something transcendental.

    I have been left with strong but abstract inspiration. Art always plunders art, and artists fall into spirals of self-regard in a frenzy for inspiration. Filk can do this too, but that doesn’t diminish it. What I’m trying to say is that it doesn’t matter what you’re into. Hang around and listen. No matter how impoverished or dirty or incomplete your contribution, add it to the world. Catch enough sparks and you’ll make some of your own. Who knows: you too could be Percy Shelley, but with less privileged parents.