Decision-Making

A Superb Example of Crisis Leadership in Action

May 4, 2020 By Nagesh Belludi Leave a Comment

It is in a crisis that leaders show their mettle. The New York Times notes,

The master class on how to respond [to a crisis] belongs to Jacinda Ardern, the 39-year-old prime minister of New Zealand. On March 21, when New Zealand still had only 52 confirmed cases, she told her fellow citizens what guidelines the government would follow in ramping up its response. Her message was clear: “These decisions will place the most significant restrictions on New Zealanders’ movements in modern history. But it is our best chance to slow the virus and to save lives.” And it was compassionate: “Please be strong, be kind and united against Covid-19.”

Leaders Show Their Mettle During a Crisis Our political leaders’ responses to the current COVID-19 crisis are particularly instructive about how leaders should act in a crisis:

Lead from the front. Initiate quick, bold, and responsible action, even when it carries political risk. Don’t be overcome by panic.
Think the crisis through. Weigh your options carefully, and then make the call confidently. Stay focused. Don’t let stress impede your problem-solving capabilities.
Avert an information vacuum. Any gap in the available information will be filled by guesswork and speculation.
Provide an accurate picture of what’s going on. Be transparent and honest right from the beginning. Acknowledging the gravity of the situation and being clear about how you’re going to collectively address the crisis leaves your constituencies with a sense of confidence in your message.
Choose your words carefully. Don’t create a false sense of security. Avoid making throwaway comments that might be misconstrued.
Communicate often. Fine-tune your message. Update your analysis and reaffirm your assurance of support. Keeping everyone in the loop diffuses fears and uncertainties.
Empower employees to be part of the solution. Invite and respond to employees’ feedback and concerns. They’ll need to know they’re being heard.

Idea for Impact: When a crisis hits, constituencies fall back on their leaders for information, answers, confidence, and direction. Set the appropriate tone for the organizational response by being supportive, factual, transparent, open-minded, calm, and decisive.

Five Where Only One is Needed: How Airbus Avoids Single Points of Failure

April 6, 2020 By Nagesh Belludi Leave a Comment

In my case study of the Boeing 737 MAX aircraft’s anti-stall mechanism, I examined how relying on data from only one Angle-of-Attack (AoA) sensor caused two accidents and the aircraft’s consequent grounding.

A single point of failure is a system component, which, upon failure, renders the entire system unavailable, dysfunctional, or unreliable. In other words, if a bunch of things relies on one component within your system, and that component breaks, you are counting the time to a catastrophe.

Case Study: How Airbus Builds Multiple Redundancies to Minimize Single Points of Failure

As the Boeing 737 MAX disaster has emphasized, single points of failure in products, services, and processes may spell disaster for organizations that have not adequately identified and mitigated these critical risks. Reducing single points of failure requires a thorough knowledge of the vital systems and processes that an organization relies on to be successful.

How Airbus Avoids Single Points of Failure Since the dawn of flying, reliance on one sensor has been anathema.

The Airbus A380 aircraft, for example, features 100,000 different wires—that’s 470 km of cables weighing some 5700 kg. Airbus’s wiring includes double or triple redundancy to mitigate the risk of single points of failure caused by defect wiring (e.g., corrosion, chafing of isolation or loose contact) or cut wires (e.g., through particles intruding aircraft structure as in case of an engine burst.)

The Airbus fly-by-wire flight control system has quadruplex redundancy i.e., it has five flight control computers where only one computer is needed to fly the aircraft. Consequently, an Airbus aircraft can afford to lose four of these computers and still be flyable. Of the five flight control computers, three are primary computers and two are secondary (backup) computers. The primary and the secondary flight control computers use different processors, are designed and supplied by different vendors, feature different chips from different manufacturers, and have different software systems developed by different teams using different programming languages. All this redundancy reduces the probability of common hardware- and software-errors that could lead to system failure.

Redundancy is Expensive but Indispensable

The multiple redundant flight control computers continuously keep track of each other’s output. If one computer produces deviant results for some reason, the flight control system as a whole excludes the results from that aberrant computer in determining the appropriate actions for the flight controls.

How Airbus Avoids Single Points of Failure: Multiple Redundant Flight Control Computers By replicating critical sensors, computers, and actuators, Airbus provides for a “graceful degradation” state, where essential facilities remain available, allowing the pilot to fly and land the plane. If an Airbus loses all engine power, a ram air turbine can power the aircraft’s most critical systems, allowing the pilot to glide and land the plane (as happened with Air Transat Flight 236.)

Idea for Impact: Build redundancy to prevent system failure from the breakdown of a single component

When you devise a highly reliable system, identify potential single points of failure, and investigate how these risks and failure modes can be mitigated.

For every component of a product or a service you work on, identify single points of failure by asking, “If this component fails, does the rest of the system still work, and, more importantly, does it still do the function it is supposed to do?”

Add redundancy to the system so that failure of any component does not mean failure of the entire system.

If you can’t build redundancy into a system due to some physical or operational complexity, establish frequent inspections and maintenance to keep the system reliable.

Postscript: In people-management, make sure that no one person has sole custody of some critical institutional knowledge, creativity, reputation, or experience that makes him indispensable to the organization’s business continuity and its future performance. If he/she should leave, the organization suffers the loss of that valued standing and expertise. See my article about this notion of key-person dependency risk, the threat posed by an organization, or a team’s over-reliance on one or a few individuals.

What Happens When You Talk About Too Many Goals

February 28, 2020 By Nagesh Belludi Leave a Comment

Matthew Pritchett's cartoon: Labour For the Many Brexit Positions Not the Few

To supplement this illustrious sketch by the British cartoonist Matt Pritchett, an excerpt from HuffPost’s article on “How Jeremy Corbyn Lost The Election,”

One big problem was the sheer size of the [Labour Party] manifesto and the number of policies on offer. Candidates complained that they didn’t have a single five-point pledge card like the one Tony Blair made famous. While the Tories had a simple message of ‘Get Brexit Done,’ Labour lacked a similarly easy ‘doorstep offer.’ “We had so much in the manifesto we almost had too much,” one senior source said. “It felt like none of it was cutting through. You needed to boil it down.”

“We tried to give a retail offer and also a grand vision and ended up falling between the two stools. To get across ‘you’ll be better off with Labour,’ we should have made our position clearer much earlier.”

Idea for Impact: Distill your goals into simple messages that others will find relevant and timely. When it comes to persuasion, clarity and conciseness are critical. Weak messages meander. Smart messages immediately express what’s important and help rally your resources towards your mission.

The Best Leaders Can Make the Complex Simple

February 17, 2020 By Nagesh Belludi Leave a Comment

The New York Times‘s Adam Bryant interviewed 525 CEOs for his Corner Office column and compiled two excellent books, The Corner Office (2012) and Quick and Nimble (2014,) on leadership and management advice. Foremost among the themes common with successful leaders, Bryant says, is “a simple mindset”—the ability to synthesize the simple from the complex and create organizational priorities.

There’s a really important quality [in great CEOs] that I call a “simple mindset,” which is the ability to take a lot of complicated information and really boil it down to the one or two or three things that really matter, and in a simple way, communicate that to people.

In big organizations—frankly, in any company—there are always a dozen or more competing priorities. And it is the leader’s job to stand up in front of the troops and say, “These are the three things that we are going to focus on this year,” or “These are the goals and this is how we are going to measure them.” If you really want to galvanize people and get them operating as a team, you’ve got to create a simple scoreboard that everybody understands.

The communication style, to me, is secondary to getting the content right. And what I’ve been so often impressed by is leaders who can essentially boil down the company’s goals and operating model into, literally, less than a page.

This is a real trick to leadership—creating a simple structure so that everybody in the organization can understand how the work they are doing contributes to the broader goals.

Rob Andrews, CEO of the executive headhunting firm Allen Austin, underscores this “boil the complex into the simple” approach in his leadership manual, High-Performance Human Capital Leadership (2015,)

I have found that when I go into a company to lead, it is important to have a plan and to make that plan a simple one that everybody can understand. I am constantly asking the question,—What are the two or three levers that, if done right, if pulled correctly, will really turn this business? What are the two or three things that really matter? And I find that most leaders do not really do that often.

Idea for Impact: One of the essential attributes of a modern leader is the ability to cut complexity everywhere. Develop the ability to take large, complicated things—and information—and make them very simple.

Why Brainwriting is Better than Brainstorming for Rapid Idea Generation

February 8, 2020 By Nagesh Belludi Leave a Comment

Most brainstorming sessions suck. Facilitators aren’t often skilled enough to direct the creative process and overcome interpersonal and intrapersonal barriers to idea-generation. Participants are not as organized as they need to be. One or two “meeting-hogs,” who lack self-awareness and self-control, dominate the conversations with their pet ideas and shut everyone else down. And then there’s groupthink and self-censorship based on responses to earlier suggestions by others. Consequently, bold ideas seldom survive a group discussion.

If you want to buck the odds, try “brainwriting” instead of brainstorming.

In its simplest form, brainwriting has the participants quietly reflect upon an open-ended prompt of appropriate scope, for example, “how could we improve our design process,” and write down their ideas. A group leader can organize the responses by combining identical ideas, grouping thematically-related ideas, and posting them on a wall for the group to appraise them further. Then, the participants vote on their favorites, and the top ‘n’ number of ideas or priorities are identified for future discussion and exploration.

Idea for Impact: Teams Don’t Think—Individuals Do

In essence, brainwriting isolates idea generation from the instantaneous discussion and evaluation that can hamper the creative process.

Brainwriting, when followed by discussion, combines the benefits of both individual and group creativity. Studies have repeatedly shown that people think of more new—and practical—ideas on their own than they do in a group.

In my experience, this creative thinking process is inclusionary, engaging, time-effective, non-judgmental, and mostly free from pressures to conform to others’ ideas. Brainwriting is particularly useful with a group of people who are reserved and would be unlikely to offer many ideas in an open group session.

Avoid Decision Fatigue: Don’t Let Small Decisions Destroy Your Productivity

January 20, 2020 By Nagesh Belludi Leave a Comment

Making some decisions depletes mental resources for making more important ones

Every decision you make impacts the quality of successive decisions you’ll have to make, even in unrelated situations.

That’s because, according to the much-debated “muscle metaphor” of willpower, your mental stamina is limited.

As Roy Baumeister and John Tierney explained in their bestselling book on Willpower: Rediscovering the Greatest Human Strength (2011; my summary), you have a finite strength of will for making prudent choices. As you go about your day, your willpower is depleted and “decision fatigue” sets in. Consequently, you’re likely to employ one of two cognitive shortcuts in decision-making: you avoid the act of deciding altogether or make a less-thoughtful, sub-optimal decision.

Don’t get overloaded with so many pointless decisions that your cognitive productivity ends up falling off a cliff.

President Barack Obama claimed that he makes deliberate efforts to avoid decision fatigue so that he can devote his mental energies to things that matter. Michael Lewis quotes Obama in the October 2012 issue of Vanity Fair,

You’ll see I wear only gray or blue suits … I’m trying to pare down decisions. I don’t want to make decisions about what I’m eating or wearing. Because I have too many other decisions to make. … You need to focus your decision-making energy. You need to routinize yourself. You can’t be going through the day distracted by trivia.

In the same way, Facebook founder Mark Zuckerberg sports a limited wardrobe. He has previously declared that doesn’t waste time and energy to pick his daily outfits: “I really want to clear my life to make it so that I have to make as few decisions as possible about anything except how to best serve the community.”

Avoid Decision Fatigue: Don't Let Small Decisions Destroy Your Productivity

Idea for Impact: Establish healthy routines that can eliminate unnecessary deliberation

Life is the total of all the mundane and momentous choices you make. Being monotonous in handling the former enables you to excel in the latter. Limit decision fatigue by

putting as much of your life as possible on autopilot using routines / rituals and checklists,
limiting the choices you have (read Barry Schwartz’s The Paradox of Choice: Why More Is Less), and
delegating decision-making where possible.

Good routines can provide structure to your day, protect you from your more effective negative impulses, and bring order and predictability to your life. Besides, according to renowned career coach Marty Nemko, “modern life, increasingly defined by unpredictability, can be anxiety-provoking, and routines provide an anchor of predictability.”

How A Single Point of Failure Became The Boeing 737 MAX’s Achilles Heel

January 7, 2020 By Nagesh Belludi Leave a Comment

Two thousand nineteen was one of the most turbulent years in Boeing’s history. Its 737 MACS (pardon the pun) troubles went from bad to worse to staggering when aviation regulators around the world grounded the aircraft and a steady trickle of disclosures increasingly exposed software problems and corners being cut.

The flaw in this aircraft, its anti-stall mechanism that relied on data from a single sensor, offers a particularly instructive case study of the notion of single point of failure.

One Fault Could Cause an Entire System to Stop Operating

How a Single Point of Failure, Reliance on one Angle-of-Attack Sensor, Created the Boeing 737 MAX Disaster A single point of failure of a system is an element whose failure can result in the failure of the entire system. (A system may have multiple single points of failure.)

Single points of failures are eliminated by adding redundancy—by doubling the critical components or simply backing them up, so that failure of any such element does not initiate a failure of the entire system.

Boeing Mischaracterized Its Anti-Stall System as Less-than-Catastrophic in Its Safety Analysis

The two 737 MAX crashes (with Lion Air and Ethiopian Airlines) originate from a late-change that Boeing made in a trim system called the Maneuvering Characteristics Augmentation System (MCAS.)

Without the pilot’s input, the MCAS could automatically nudge the aircraft’s nose downwards if it detects that the aircraft is pointing up at a dangerous angle, for instance, at high thrust during take-off.

Reliance on One Sensor is an Anathema in Aviation

The MCAS was previously “approved” by the Federal Aviation Administration (FAA.) Nevertheless, Boeing made some design changes after the FAA approval without checking with the FAA again. The late-changes were made to improve MCAS’s response during low-speed aerodynamic stalls.

The MCAS system relied on data from just one Angle-of-Attack (AoA) sensor. With no backup, if this single sensor were to malfunction, erroneous input from that sensor would trigger a corrective nosedive just after take-off. This catastrophe is precisely what happened during the two aircraft crashes.

The AoA sensor thus became a single point of failure. Despite the existence of two angle-of-attack sensors on the nose of the aircraft, the MCAS system not only used data from either one of the sensors but also did not expect concurrence between the two sensors to infer that the aircraft was stalling. Further, Lion Air did not pay up to equip its aircraft with a warning light that could have alerted the crew to a disagreement between the AoA sensors.

Boeing Missed Safety Risks in the Design of the MAX’s Flight-Control System

Reliance on one sensor’s data is an egregious violation of a long-standing engineering principle about eliminating single points of failure. Some aircraft use three duplicate systems for flight control: if one of the three malfunctions, if two systems agree, and the third does not, the flight control software ignores the odd one out.

Angle-of-Attack Sensor on Boeing 737 MAX Aircraft - Single Point of Failure that Contributed to Two Crashes If the dependence on one sensor was not enough, Boeing, blinded by time- and price-pressure to stay competitive with its European rival Airbus, intentionally chose to do away with any reference to MCAS in pilot manuals to spare pilot training for its airline-customers. Indeed, Boeing did not even disclose the existence of the MCAS on the aircraft.

Boeing allows pilots to switch the trim system off to override the automated anti-stall system, but the pilots of the ill-fated Lion Air and Ethiopian Airlines flights failed to do so.

Idea for Impact: Redundancy is the Sine Qua Non of Reliable Systems

In preparation for airworthiness recertification for the 737 MAX, Boeing has corrected the MCAS blunder by having its trim software compare inputs from two AoA sensors, alerting the pilots if the sensors’ readings disagree, and limiting MCAS’s authority.

One key takeaway from the MCAS disaster is this: when you devise a highly reliable system, identify all single points of failure, and investigate how these risks and failure modes can be mitigated. Examine if every component of a product or a service you work on is a single point of failure by asking, “If this component fails, does the rest of the system still work, and, more importantly, does it still do the function it is supposed to do?”

Lessons from the World’s Worst Aviation Disaster // Book Summary of ‘The Collision on Tenerife’

November 5, 2019 By Nagesh Belludi Leave a Comment

Jon Ziomek’s nonfiction history book Collision on Tenerife (2018) is the result of years of analysis into the world’s worst aviation disaster on Tenerife Island in the Canary Islands of Spain.

Distinct Small Errors Can Become Linked and Amplified into a Big Tragedy

On 27-March-1977, two fully loaded Boeing 747 passenger jets operated by Pan American World Airways (Pan Am) and KLM Royal Dutch Airlines collided on the runway, killing 583 passengers and crew on the two airplanes. Only 61 survived—all from the Pan Am jet, including its pilot.

These two flights, and a few others, were diverted to Tenerife after a bomb went off at the Gran Canaria Airport in Las Palmas, their original destination. Tenerife was not a major airport—it had a single runway, and taxi and parking space were limited. After the Las Palmas airport reopened, flights were cleared for takeoff from Tenerife, but the fog rolled in over Tenerife reducing visibility to less than 300 feet. Several airplanes that had been diverted to Tenerife had blocked the taxiway and the parking ramp. Therefore, the KLM and Pan Am jets taxied down the single runway in preparation for takeoff, the Pan Am behind the KLM.

Tenerife airport disaster: Pan Am and KLM Aircraft

At one end of the runway, the KLM jet turned 180 degrees into position for takeoff. In the meantime, the Pan Am jet was still taxiing on the runway, having missed its taxiway turnoff in the fog. The KLM pilot jumped the gun and started his take-off roll before he got clearance from traffic control.

When the pilots of the two jets caught sight of each other’s airplanes through the fog, it was too late for the Pan Am jet to clear out of the runway into the grass and for KLM jet to abort the takeoff. The KLM pilot lifted his airplane off the runway prematurely, but could not avoid barreling into the Pan Am’s fuselage at 240 kmph. Both the jets exploded into flames.

The accident was blamed on miscommunication—breakdown of coordinated action, vague language from the control tower, the KLM pilot’s impatience to takeoff without clearance, and the distorted cross-talk of the KLM and Pan Am pilots and the controllers on a common radio channel.

Breakdown of Coordination Under Stress

Sweeping changes were made to international airline regulations following the accident: cockpit procedures were changed, standard phrases were introduced, and English was emphasized as a common working language.

In Collision on Tenerife, Jon Ziomek, a journalism professor at Northwestern University, gives a well-written, detailed account of all the mistakes leading up to the crash and its aftermath.

The surviving passengers’ first- and second-hand accounts recall the horror of those passengers on the right side of the Pan Am jet who saw the lights of the speeding KLM 747, just as the Pan Am pilot was hastily turning his airplane onto the grass to avoid the collision.

Ziomek describes how passengers escaped. Some had to make the difficult choice of leaving loved ones or friends and strangers behind.

Dorothy Kelly … then spotted Captain Grubbs lying near the fuselage. Badly burned and shaken by his jump from the plane, he could not move. “What have I done to these people?” he yelled, pounding the ground in anguish. Kelly grabbed him under his shoulders and urged “Crawl, Captain, crawl!”

Recommendation: Read Jon Ziomek’s Collision on Tenerife

Some of the bewildering details make for difficult reading—especially the psychological effects (post-traumatic stress syndrome) on the surviving passengers. But Jon Ziomek’s Collision on Tenerife is important reading, providing a comprehensive picture of the extensive coordination required in aviation, the importance of safety and protocols, and how some humans can freeze in shock while others spring into action.

The key takeaway is the recognition of how small errors and problems (an “error chain”) can quickly become linked and amplified into disastrous outcomes.

How Stress Impairs Your Problem-Solving Capabilities: Case Study of TransAsia Flight 235

October 1, 2019 By Nagesh Belludi Leave a Comment

As I’ve examined previously, airline disasters are particularly instructive on the subjects of cognitive impairment and decision-making under stress.

Stress Can Impair Your Acuity: Case Study of TransAsia Flight 235

Consider the case of TransAsia Airways Flight 235 that crashed in 2015 soon after takeoff from an airport in Taipei, Taiwan. Accident investigations revealed that the pilots of the ATR 72-600 turboprop erroneously switched off the plane’s working engine after the other lost power. Here’s a rundown of what happened:

About one minute after takeoff, at 1,300 feet, engine #2 had an uncommanded autofeather failure. This is a routine engine failure—the aircraft is designed to be able to be flown on one engine.
The Pilot Flying misdiagnosed the problem, and assumed that the still-functional engine #1 had failed. He retarded power on engine #1 and it promptly shut down.
With power lost on both the engines, the pilots did not react to the stall warnings in a timely and effective manner. The Pilot Flying acknowledged his error, “wow, pulled back the wrong side throttle.”
The aircraft continued its descent. The pilots rushed to restart engine #1, but the remaining altitude was not adequate enough to recover the aircraft.
In a state of panic, the Pilot Flying clasped the flight controls and steered (see this video) the aircraft perilously to avoid apartment blocks and commercial buildings before clipping a bridge and crashing into a river.

A High Level of Stress Can Diminish Your Problem-solving Capabilities

Thrown into disarray after a routine engine failure, the pilots of TransAsia flight 235 did not perform their airline’s abnormal and emergency procedures to identify the failure and implement the required corrective actions. Their ineffective coordination, communication, and error management compromised the safety of the flight.

The combination of sudden threat and extreme time pressure to avert a danger fosters a state of panic, in which decision-makers are inclined to commit themselves impulsively to courses of action that they will soon come to regret.

Idea for Impact: To combat cognitive impairment under stress, use checklists and standard operating procedures, as well as increased training on situational awareness, crisis communication, and emergency management.

Accidents Can Happen When You Least Expect Them: The Overconfidence Effect [Cognitive Bias]

September 3, 2019 By Nagesh Belludi Leave a Comment

Accidents Can Happen When You Least Expect Them: The Overconfidence Effect In the context of decision-making and risk-taking, the “overconfidence effect” is a judgmental bias that can affect your subjective estimate of the likelihood of future events. This can cause you to misjudge the odds of positive/desirable events as well as negative/undesirable events.

As the following Zen story illustrates, experience breeds complacency. When confidence gives way to overconfidence, it can transform from a strength to a liability.

A master gardener, famous for his skill in climbing and pruning the highest trees, examined his disciple by letting him climb a very high tree. Many people had come to watch. The master gardener stood quietly, carefully following every move but not interfering with one word.

Having pruned the top, the disciple climbed down and was only about ten feet from the ground when the master suddenly yelled: “Take care, take care!”

When the disciple was safely down an old man asked the master gardener: “You did not let out one word when he was aloft in the most dangerous place. Why did you caution him when he was nearly down? Even if he had slipped then, he could not have greatly hurt himself.”

“But isn’t it obvious?” replied the master gardener. “Right up at the top he is conscious of the danger, and of himself takes care. But near the end when one begins to feel safe, this is when accidents occur.”

Reference: Irmgard Schlögl’s The Wisdom of the Zen Masters (1976.) Dr. Schlögl (1921–2007) became Ven. Myokyo-ni in 1984, and served as Rinzai Zen Buddhist nun and headed the Zen Centre in London.

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Decision-Making

Wondering what to read next?

Case Study: How Airbus Builds Multiple Redundancies to Minimize Single Points of Failure

Redundancy is Expensive but Indispensable

Idea for Impact: Build redundancy to prevent system failure from the breakdown of a single component

Wondering what to read next?

Wondering what to read next?

Wondering what to read next?

Idea for Impact: Teams Don’t Think—Individuals Do

Wondering what to read next?

Making some decisions depletes mental resources for making more important ones

Don’t get overloaded with so many pointless decisions that your cognitive productivity ends up falling off a cliff.

Idea for Impact: Establish healthy routines that can eliminate unnecessary deliberation

Wondering what to read next?

One Fault Could Cause an Entire System to Stop Operating

Boeing Mischaracterized Its Anti-Stall System as Less-than-Catastrophic in Its Safety Analysis

Reliance on One Sensor is an Anathema in Aviation

Boeing Missed Safety Risks in the Design of the MAX’s Flight-Control System

Idea for Impact: Redundancy is the Sine Qua Non of Reliable Systems

Wondering what to read next?

Distinct Small Errors Can Become Linked and Amplified into a Big Tragedy

Breakdown of Coordination Under Stress

Recommendation: Read Jon Ziomek’s Collision on Tenerife

Wondering what to read next?

A High Level of Stress Can Diminish Your Problem-solving Capabilities

Wondering what to read next?

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