![]() It was a “pilot error.” The problem with the new plane, if there was one, was that it was substantially more complex than the previous aircraft. An investigation revealed that there was nothing to indicate any problems mechanically with the plane. Of course, everyone wanted to know what had happened. Then suddenly, at about 300 feet, it stalled, turned on one wing, and crashed killing two of the five crew members, including the pilot Major Hill. ![]() In other words, it was just a formality.Īs the Model 299 test plane taxied onto the runway, a small group of army brass and manufacturing executives watched. The Boeing Corporation’s gleaming aluminum-alloy Model 299 was expected to steal the show, its design far superior to those of the competition. Only it wasn’t supposed to be much of a competition at all. Army Air Corps held a competition for airplane manufacturers vying to build the next-generation of the long-range bomber. On October 30, 1935, at Wright Air Field in Dayton, Ohio, the U.S. Modern professions, like medicine, with their dazzling successes and spectacular failures, pose a significant: challenge: “What do you do when expertise is not enough? What do you do when even the super-specialists fail?” Gawande argues that these super-specialists have two advantages over ordinary specialists: greater knowledge of the things that matter and “a learned ability to handle the complexities of that particular job.” But even for these super specialists, avoiding mistakes is proving impossible. The response of the medical profession, like most others, is to move from specialization to super-specialization. And even specialization has begun to seem inadequate. Ou have a desperately sick patient and in order to have a chance of saving him you have to get the knowledge right and then you have to make sure that the 178 daily tasks that follow are done correctly-despite some monitor’s alarm going off for God knows what reason, despite the patient in the next bed crashing, despite a nurse poking his head around the curtain to ask whether someone could help “get this lady’s chest open.” There is complexity upon complexity. Gawande breaks this down for the modern medical case: In every field from medicine to construction, there are a slew of practical procedures, policies, and best practices. It’s not just the growing breadth and quantity of knowledge that makes things more complicated, although they certainly are significant contributors. In response to increasing complexity, we’ve become more specialized. Something that “builds on experience and takes advantage of the knowledge people have but somehow also makes up for our inevitable human inadequacies.” We need a checklist. Knowledge has both saved us and burdened us. ![]() The volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. The reason we don’t learn, Gawande argues, is evident: Not only are these failures common-across everything from medicine to finance-but they are also frustrating. Nevertheless, sometimes, success escapes us for avoidable reasons. We have the most educated society in history. We have skills, and we generally put them in the most highly trained and hardworking people we can find. To put us in the proper context, we’re smart. I had only covered an interesting subset of the book- why we fail. A reader recently pointed out that I hadn’t covered his most recent book, The Checklist Manifesto: How to Get Things Right. It’s no secret that I’m a huge fan of Atul Gawande.
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