Thoroughness

Whenever nothing should go wrong, the work must be approached with great thoroughness. This is a culturally deeply anchored expectation, especially in the high-risk environment. If things do not go well, it is once again a human error. Is that all a safety culture has to offer?

Recently, a good friend who still flies the Boeing 777 as a captain told me a story in a casual way. I couldn't get it out of my head. As a joke, he counted the pages of all the documents in which his airline and the authorities give him regulations for doing his job. He came up with the astonishing figure of 12,000. Now we know that not all guidelines are the same. But still. The number leaves its mark.

Let us now imagine that this captain, with his inner attitude characterized by seriousness and reliability, would bend over the 12,000 pages in all thoroughness. And he would read them in such a way that he could claim to know where what is written and to know the content and relevance of all the aspects presented. What would suffer or could be damaged by such an approach?

Quite obviously: efficiency. Because there are pages on which things are described that are of little importance for the execution of his job. Conversely, there are pages where there are things that require his full attention. Things that he needs to understand completely in order, as captain, to get his passengers to their destination safely, comfortably and economically.

And what would also be damaged?

Control mania at work

The story is a beautiful metaphor for the approach we take conceptually when we want to be sure nothing goes wrong. In the case of a flight captain's job, this is understandable because, after all, flying involves serious risks. We want to be sure that they are kept neatly under control. So it's tempting to explain in detail to the executing professional how he has to work. It's all about control. He has to work according to the instructions of those who, for example, designed the aircraft. The manufacturers guarantee the airline that flights in their aircraft are safe if the captain follows their guidelines. Also obvious is the serious face of the captain's boss, who looks him deeply in the eye before his flight and makes him understand that he has the full responsibility to follow the guidelines and rules with thoroughness. Because an action not carried out with the greatest possible conscientiousness would have to be judged as a mistake. Regardless of what the reasons might be. A work performance that disregards the rules would also be unacceptable. Because as far as the safe operation of the Boeing 777 is concerned, there is no quarter. The aircraft manufacturer, the aviation authority and his airline have written everything down to the smallest detail. It's all about correct, serious application of the regulations. A captain who does not take his job with the utmost thoroughness is a risk factor.

Really?

The traces of 12,000 pages printed with requirements

We see that in this story we are in the middle of an environment where earnestness just drips from the ceiling. In addition to the overflowing rules and the bosses stressing responsibility, there is an expectation in this culture painted on the wall in big letters: "Make every effort to do the given work with the utmost care and fidelity to the rules". In itself, there would be nothing wrong with that. At first glance, everything seems to be going right in this airline.

On his way to the flight planning office, the words of his boss run through the captain's mind again; they have made an impression on him. But they probably had an even deeper effect. As a human being, he knows that he is fallible. He is aware that he will get into situations in which he will not succeed in sticking to everything that is written in the 12,0000 pages. That worries him. It scares some of his colleagues. It goes without saying that the credo he adopts in this culture is: "I make a genuine effort to complete the tasks assigned to me in all thoroughness and I will adhere strictly to the rules.

When thoroughness becomes an obstacle

He has half an hour to plan the flight. Together with his first officer, he studies the flight documents. There are many, many of them. His credo gets in the way for the first time that day. If he were to work through all the documentation with the thoroughness he has set his mind to, the flight would be delayed by more than an hour. There would be no objection to that for safety reasons. On the other hand, he and his first officer would be under a lot of stress during the later preparation of the aircraft for the flight. Trying to make up for lost time - punctuality is an important requirement - mistakes would creep in. These would involve much greater risks than not studying the flight documents in all thoroughness.

By successfully standing up to his own credo and putting a stop to thoroughness, he has done something crucial for safety. He has proved that man is not a risk factor in rule-heavy, complex and dynamic systems that are characterized by many interdependencies. On the contrary, he is a first-class safety factor.

He is the only entity capable of walking the difficult tightrope between thoroughness and efficiency in such systems. Safety is not created by making adherence to rules and thoroughness the maxim. Safety in complex systems can only be created if there is someone on the ground in the current situation who, with his experience and knowledge of the overriding interrelationships, decides for more or less thoroughness depending on the situation. This applies not only to airline captains.

People are gatekeepers and not risk-factors

The safety culture is therefore of decisive importance. It must be designed in such a way that it values the decision-makers in the organization. It must allow freedom and be careful not to turn employees and managers into manipulative monkeys with excessive expectations of compliance. Those who culturally associate safety too strongly with compliance and thoroughness it demands, fall victim to a devastating basic assumption. The assumption that the system in which people operate in the company is perfectly built.

If we didn't have people, our systems would create an unacceptable number of headlines. Humans, with their fallibility, are not primarily a risk factor. They are the gatekeepers par excellence. Don't tie them to the goalpost with a misguided safety culture. Because it makes a difference what image in their head they go to work: Risk-factor...? Safety-expert...?