Gawande also looked to the commercial aircraft industry, which has an outstanding safety record. Boeing has been a pioneer in developing checklists that give pilots guidance on what to do in situations ranging from the routine, like starting an engine before taxiing to the runway, to emergency situations arising out of such events as a cargo door coming unsealed during flight at high altitude. It was a checklist that helped insure the safe water landing in the Hudson River of US Airways Flight 1549, which, on January 14, 2009, took off from New York's La Guardia Airport, ran into a flock of geese, and lost power from both its engines.
Motivated by the practices of the construction and aircraft industries, Gawande and his team developed a checklist for the operating room and tested its efficacy over a six-month period in eight hospitals around the world. The results were far better than expected. With the use of checklists, major complications arising out of surgical procedures fell by 36 percent, and deaths fell by 47 percent. Gawande was ecstatic, and the enthusiasm for the practice that he expresses in his manifesto is infectious.
Can there be a checklist for the design process? On the one hand, unlike surgical operations, construction projects, and aircraft maneuvers, which typically follow proven procedures, design is the very act of creating something that cannot be fully proven until it is made and tested. On the other hand -- like surgeons, construction managers, and pilots -- designers can make mistakes that result in failures. It could very well be the case that a properly devised checklist for design could prevent some of those mistakes from being made.
Among the items that might be considered for a design checklist are the following:
- Can the design under consideration be manufactured at a reasonable cost?
- Can a part of the overall design be installed in the wrong way?
- Will the design be able to withstand the environment in which it is expected to operate?
- Does the design call for direct contact of dissimilar metals susceptible to galvanic corrosion?
- Does the fatigue life of its components at least equal that expected of the design as a whole?
- Is the human interface intuitive and unambiguous?
The specific questions to appear on a design checklist would naturally depend upon the nature of the industry involved. In any case, however, designers, like surgeons, can be expected to be skeptical of such an encroachment upon their professional space. But if the results were found to be as good as surgeons have experienced, then designers might become converts as enthusiastic as Dr. Gawande.
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