I found the ideas in this book really resonated with my experience in a number of industries.
Syed’s thesis is that we live in a society that usually plays the blame game when things go wrong. He contrasts this with the ideas used by the aviation industry where mistakes and errors are seen as problems with the system, and not individuals. Because he draws from this industry it uses the thinking behind black box from aeroplanes as the central metaphor.
If something goes catastrophically wrong it’s not the pilot that’s to blame but instead the system as a whole that allowed the mistake to happen. This systems approach is why there are so few aviation accidents.
In the early parts of the book he contrasts aviation errors with medical errors. Doctors are trained not to admit to failure and be “experts”. So instead of learning from failure there’s a culture of “accepting the inevitable” and not trying to stop things happening again. Indeed there’s a really silly idea that doctors’ training makes them infallible.
Syed gives an account of one awful medical accident where a young mother ended up with brain damage because her throat closed up under anasthetic and the doctors spent so long trying to insert a breathing tube they didn’t do a tracheotomy in time. It turns out that under stress people lose track of time, and can end up going past hard limits (like how long someone can survive when they can’t breathe) with bad consequences. In this case the poor woman’s husband was an airline pilot and he didn’t accept the “one of those things” arguments.
Eventually after a fight the husband managed to get to the truth of what had happened. Instead of being bitter he shared what he had found in medical journals, made sure that the simple things you can do to make sure your intense focus hasn’t made you blind was wider known. For example, you can make sure that all people involved can call for certain things, hierachies need to be questioned. Two people work on a problem, but one of them stays out of the decision making loop and the cognitive stress so they can see what’s happening and call time.
This information has saved a lot of lives. The woman’s husband has been written to by many surgeons all over the world. There are examples of how this telescoping time phenomenon caused crashes of aircraft, but that industry changed the way it did crisis management to make the problem far less likely to occur.
It sounds simple, doesn’t it? Learning from failure has the status of a cliché. But it turns out that, for reasons both prosaic and profound, a failure to learn from mistakes has been one of the single greatest obstacles to human progress. Healthcare is just one strand in a long, rich story of evasion. Confronting this could not only transform healthcare, but business, politics and much else besides. A progressive attitude to failure turns out to be a cornerstone of success for any institution.
Next he looks at experts. If there is no feedback loop after they qualify as experts then they do not improve. Without being able to measure your success you are stuck, probably making the same mistakes over and over again.
If we wish to improve the judgement of aspiring experts then, we shouldn’t just focus on conventional issues like motivation and commitment. In many cases, the only way to drive improvement is to find a way of ‘turning the lights on’. Without access to the ‘error signal’, one could spend years in training or in a profession without improving at all
And of course failure is necessary, as long as systems are in place to learn from it:
beneath the surface of success – outside our view, often outside our awareness – is a mountain of necessary failure
This goes much further than the old saw about learning from failure. Syed’s argument is that you must be systematic about it and not blame individuals for systematic failures. But also it is important that individuals take responsibility for what happens and own up when things go wrong. Without this there can be no learning.
Another extremely interesting thread later in the book is when he picks up on marginal gains. This is a way to find improvements and is used by teams like the British Cycling team who were so successful at the Rio olympics. In short: everything matters every detail that can hold back success or performance is important and when you address them all they compound together to create an unstoppable chain of improvements. Small gains, marginal gains become the root of great success.
Marginal gains is not about making small changes and hoping they fly. Rather, it is about breaking down a big problem into small parts in order to rigorously establish what works and what doesn’t.
They use the first test not to improve the strategy, but to create richer feedback. Only when they have a deeper understanding of all the relevant data do they start to iterate.
see weaknesses with a different set of eyes. Every error, every flaw, every failure, however small, is a marginal gain in disguise.
I heartily recommend this book, it’s easy to read and the stories make the examples stay in your head. I hadn’t heard of the marginal gains technique but will be using it myself.