
Why do things go right? - kawera
https://web.archive.org/web/20181001110144/http://www.safetydifferently.com/why-do-things-go-right/
======
TeMPOraL
I'm halfway through the article right now (thanks to Zealotux's cache link).
Don't be discouraged by that 500 error - it seems to be a really solid piece
of writing.

EDIT: a TL;DR:

Topic is failures/successes in complex projects/operations, like construction,
surgery, or manufacturing.

The article first proposes that the usual way of evaluating safety - by
focusing on failure cases - is insufficient, and a more productive approach
would be to focus on the success cases.

The article then observes that the following is found in _both_ the failure
and success cases:

    
    
      Workarounds
      Shortcuts
      Violations
      Guidelines not followed
      Errors and miscalculations
      Unfindable people or medical instruments
      Unreliable measurements
      User-unfriendly technologies
      Organizational frustrations
      Supervisory shortcomings
    

Therefore, it is suggested that focusing on those issues isn't going to reduce
failures further. The article then follows with a list and description of
things the authors observed to be more frequent in successful than failed
projects:

    
    
      Diversity of opinion and the possibility to voice dissent.
      Keeping a discussion on risk alive and not taking past success as a guarantee for safety.
      Deference to expertise.
      Ability to say stop.
      Broken down barriers between hierarchies and departments.
      Don’t wait for audits or inspections to improve.
      Pride of workmanship
    

Overall, a pretty interesting article. I await comments from people in the
field :).

~~~
jacquesm
> Diversity of opinion and the possibility to voice dissent.

> Keeping a discussion on risk alive and not taking past success as a
> guarantee for safety.

> Deference to expertise.

> Ability to say stop.

> Broken down barriers between hierarchies and departments.

> Don’t wait for audits or inspections to improve.

> Pride of workmanship

I love your list, and would like to see how well it would hold up when you
compare start-up failures and successes against these criteria. Will
definitely use this, thank you very much!

~~~
TeMPOraL
It's not my list, it's the authors' :). Don't forget to review the original
document, as each of those points has some commentary attached to it,
explaining what exactly they mean by those phrases.

~~~
jacquesm
Thank you anyway, and yes I have read the article.

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Zealotux
Ironically, the website returns a 500 error, here's a cached version:
[https://webcache.googleusercontent.com/search?q=cache:oc-P2e...](https://webcache.googleusercontent.com/search?q=cache:oc-P2eNLKdgJ:www.safetydifferently.com/why-
do-things-go-right/)

~~~
hyperpallium
Look for the helpers, that are going right. Ironically, the cached version
returns a 404 error, here's a wayback version:
[https://web.archive.org/web/20181001110144/http://www.safety...](https://web.archive.org/web/20181001110144/http://www.safetydifferently.com/why-
do-things-go-right/)

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scrumper
This was an excellent article.

It reminds me a bit of a story I heard years ago about a power utility company
in the mid west that wanted to reduce accidents among its line workers. They
looked at all their line crews, and found one team with a significantly better
safety record than the others. They sent out a consultant to see what was
going on and found that this particular crew was composed entirely of smokers.
Before each job, they'd park their truck and have a cigarette while talking it
through.

Said consultant came back with this information and the company instituted a
detailed pre-job planning worksheet that each crew had to complete. From what
I remember (I can't find the link anywhere - I read this 15 years ago and
Google is no use here at all) the net effect was to worsen safety across all
crews, while reducing the standard deviation between crews a bit.

------
khafra
This article is a strong volley aimed directly at checklist culture. It has a
lot of citations.

But checklists were the hot new thing in 2012. They were going to save
everyone from iatrogenic harm. This article doesn't explain how all the
previous research supporting checklists got it so wrong. I'm updating my
beliefs significantly away from checklist effectiveness, but I'm also really
confused.

Did checklists just stop working in 2015, or something?

[https://qualitysafety.bmj.com/content/24/7/428](https://qualitysafety.bmj.com/content/24/7/428)

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bakul
This article seemed inconclusive. They identified some differences of factors
between things going right vs wrong but didn’t follow through with a
scientific study.

Atul Gawande’s “The Checklist Manifesto” comes to mind, where he argues that
even experts need checklists to walk them through the key steps in any complex
procedure. These complexities are such that it is easy to forget a key step or
two. Following such checklists or written procedures minimize errors. He then
shows how using checklists improves successful outcomes significantly.

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gxs
In sports they always say you should play to win, not play to not lose.

I've always liked that mentality and this articles echoes that sentiment IMO.

~~~
Nadya
I think you have that backwards? In competitive gaming I was always of the
mentality, and taught the mentality, that you shouldn't play to win. You
should play to _not lose_. The best players I've spoken and played with also
share this mentality.

For example, in competitive games in general focus on minimizing mistakes
rather than focusing on capitalizing on your opponent's mistakes.

Particularly in combo-based fighting games, worry about your ability to
execute rather than when to execute. Without fail you should always be able to
100% execute a combo without dropping it, even if you don't _always_ go for
the best combo for the scenario. Always going for the best combo but
unreliably executing it and dropping it will lose you more games on average.

~~~
annywhey
I think this one is mostly reflective of the risk/reward payoffs of aggressive
and unusual play in any particular game. Play to win means - force the
confrontation, take gambles, push your way into a surprise advantage. Play to
not lose means - lean on your techniques, stay in control of the situation,
build an advantage gradually.

And for most games, most of the time, playing to not lose is a more reliable
way to win, because it is more consistently rewarding to practice, even though
it can result in a boring risk-assessed playstyle. Playing to win is an
emotionally-driven way to do things and good technique will usually counter
it, but every once in a while, late in a match, the mask slips and there's an
opportunity to make a play on an overwhelmed opponent.

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gbersac
No interesting opinion to voice here, but this is one of the best article I
read for a long time and will go back to this one later on.

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milanmot
Oh god. An article on things going right is returning a 500 error. :-)

~~~
Cthulhu_
Interesting comment in the light of the article, in that you focus on what
went wrong (in this incident) as opposed to when it goes right.

~~~
BrandoElFollito
Interesting point

This said, when you get a 500 there isn't much which can go right.

To take it further, some things will just fail without any good outcome and
they are too trivial to even learn from them.

