So, I talked this out with the marlin people. Just like my F-15 squadron, or better yet, just like on an aircraft carrier, we needed to think about this and think about that and have a plan and brief it before we took a marlin charter out to sea because, once we are out to sea, it’s rough, and people are getting sick, and things are happening fast.
The captain was listening to me, so I went on. “If somebody had just told me ‘the boat’s going to do this and we’re going to react this way while you should do that,’ I wouldn’t have been sitting there thinking, ‘What’s everybody doing? Am I in the way? What should I do?’” As a novice, my situational awareness (SA) was nil. Even a short briefing would have pushed my SA much higher and the experience would have been better and I might have gone back for another charter. As it was, all I saw was chaos (fighter pilots hate chaos), and I told them I wasn’t certain I wanted to do it again. Life’s too short—recreation is not supposed to kill me.
Can you see the gaps, the holes, the absence of any structure—much less any feedback—that allowed years of bad habits to perpetuate? Can you see how strange crew members will start bumping into each other, unsure what the standards are, or how novices will walk away from their one experience of marlin fishing with lessons learned that are totally wrong? Can you see how the business owner, the charter captain, might be losing business, might be losing that valuable repeat business because the experience was so bad?
More importantly, can you see how the Flawless Execution Model can be put to work in the specialized world of marlin fishing? This is a fast-moving, chaotic, dangerous environment, often populated with strangers and novices. Plan-brief-execute-debrief. The pleasure of fishing, the feeling of accomplishment when you land a marlin—all the reasons why someone spends their precious time and hard-earned money on the charter are at stake, not to mention lives.
Well, it was like a bell going “ding!” above their heads. They saw the benefits immediately. They know half their business is one-time customers, but they never thought about what might be turning their customers off. These people fish for a living. They know where everything is and what everything does and, by gosh, they just assumed we did too. But it went beyond that. They assumed every crew member they signed on knew what to do, too, but in truth, they really don’t. Fishing is plagued with transients. Captains do double back flips if they can keep a crew together for more than a couple of weeks. But every boat is configured a little differently, so the captain saw a need not only for the Flawless Execution cycle but also for a briefing guide for new crew members.
Flawless Execution makes things go smoothly and saves time when time is precious. By using it in marlin fishing we might one day see a crisp, smart, polished, charter operation that is the national leader in the industry.
I finished what I had to say, and it didn’t take more than a second before I started to hear the ideas. “The briefing could take place before the anglers leave the dock in the morning,” said one. Another said, “We would probably land more of the fish we hook.” A third said, “We do have injuries, don’t we?” and so on. This was no corporate boardroom. But Flawless Execution was already changing their lives.
That’s marlin fishing. Now to medicine. No one needs to be told about lives in the field of medicine. Few people have any idea the extent to which executional mistakes make the job of saving lives a heck of a lot harder than it needs to be (and already is). In truth, studies show that deaths due to medical error could range between 98,000 and 250,000 patients a year.
Just as marlin fishing has its specialized problems, so too does medicine. One is called hand-offs. When you work in a fast-moving, chaotic environment, like the fighter pilot environment or, in this case, the hospital environment, your job requires that you hand off data. I’ll over-simplify to make the point. When I got into my jet and taxied out to the active runway, I got a final weather brief. Winds, direction, density altitude. Rarely did I have a hand-off problem here. Let’s count the hand-offs in just a simple weather report. The meteorologist gathers data from the reporting stations and posts the weather. That’s one hand-off. Then weather officer takes that report and is briefed. Another hand-off. The weather officer then briefs the squadron in the briefing room. Another hand-off. Then, out on the runway, we get another update—another hand-off.
Weather hand-offs usually go okay, but hand-offs in the fighter community can get critical fast. Let me give you an example from an aircraft carrier. Fighters can’t launch on the thrust of their engines alone. They need the catapult to give them an extra 20,000 or 30,000 pounds of thrust, and they need twenty knots of wind to get enough airspeed to climb. The amount of pressure in the catapult piston, however, is completely dependent on the wind velocity across the deck and the weight of the fighter. If you have a data hand-off problem calculating the catapult stroke, you can have a serious problem fast. Let’s say the refuelers load 15,000 pounds of fuel into the jet when the instructions were for 10,000 pounds. If that happens, the catapult officer will dial-in pressure for a jet 5,000 pounds lighter than the jet sitting on the deck. When the cat fires, there isn’t enough oomph to launch the fighter and a $25 million F/A-18 goes into the drink. That’s called a cold cat. In this case, the cause was a faulty data hand-off.
The important thing is, if you aren’t really religious about the way you hand off data, after it gets handed off three or four times, it degrades incredibly. Let’s say that you start feeling bad. You call up your family physician and say, “I don’t feel good.” The family physician talks to you and says, “Oh, you need some antibiotics.” In this day and age, that doctor is not even going to see you. You just call him up and you talk and he calls in a precautionary prescription and you go to the drug store and you take some antibiotics. Another week goes by, and you’re still feeling rotten. As a matter of fact, you have a terrible night, and your wife drives you to the ER. The ER doc says, “Hey, what’s wrong?”
“Well, I’ve got these pains. I haven’t been feeling good.”
“Has the doctor been giving you any medicine?”
“Yeah, he prescribed some type of antibiotic but I’m not really sure what it was.”
So he writes down in the report whatever it is that he thinks that you’re talking about. “The patient’s been on this drug; still has chest pains. I recommend two cc of this,” and puts it in the chart. Then you get processed out of the ER into an outpatient bed.
You go to the outpatient bed. The nurse pulls the chart and says, “Well, the doctor said they thought you were on this and I can’t read his writing, but I think he said twenty cc of this, instead of two cc of this, administered every other day.”
And all of a sudden, you’re feeling very bad. You have another doctor come in and look at you and, eventually, another diagnosis is made and another medicine prescribed, and now this medicine can kill you. Error chains. Poor hand-offs.
The solution? The Flawless Execution engine. By mentally staying inside the plan-brief-execute-debrief cycle, the individual keeps their SA high, puts the chaotic environment into a process, and manages information with a higher degree of sensitivity. He or she will make fewer mistakes because of an organized, systematic process for managing the flow of unexpected events and his or her reaction to it.
Charles Denham, MD (who, not surprisingly, is also a pilot), helps hospitals and physician groups execute better. His mission is to make the medical community a community of Leaning-Forward fighter pilots who execute flawlessly, who sharply reduce the medical error chains. Says Denham, “Applying the principles of Flawless Execution has a real place in healthcare. Why? Because you have multiple players who are working in a high-stress, high-fatigue environment, dealing with complex packages of information. Really good surgeons make sure all the players understand what they’re about to accomplish. And they’re double checking, orchestrating the procedural work, maintaining a position of readiness and anticipation, very much like the environment on an aircraft carrier.”
/> Continues Denham, “The five rights in medicine are the right patient, the right drug, the right route, the right dose, and the right time. The medical community knows all this, and they’re dealing with these five rights, but in fact, there are harmful events that occur outside of these five rights. As an example, if a doctor doesn’t have right information about you, you come in, and I prescribe the right drug to the right patient with the right dose at the right time, I can satisfy all the five rights, but I didn’t know that your kidneys aren’t working. The fact that I didn’t know that, or somebody did know it but didn’t communicate it to me—that’s what we call a hand-off problem. Communication breakdowns and bad hand-offs are very common causes in adverse events in medicine.”
However, by following the Flawless Execution cycle, the complex, rapidly changing, time-compressed environment of a hospital can become a ballet of precision moves. Before one staff comes on and another leaves, one group is debriefing and the other picking up the lessons learned and briefing their upcoming shift. Here’s what we do when an ambulance arrives. Here is what we do when six patients hit the door all at once. Here’s our checklist for triage, for medication, for moving data, for taking breaks. Here are our motherhoods and our standards. Here’s the environment. We’ve got a rock concert tonight so expect some drug and alcohol-related events, and we’ve got rain so expect some car accidents and trauma injuries. By adding fifteen minutes to the management of shift changes and the inflow and outflow of practitioners on the floor, everyone saves time, things are more efficient, chaos is worked out of the system, contingencies are discussed with scripted responses, and the death rate due to errors drops. Denham knows this better than anyone—he’s leading the charge. Through his work and training of other hospitals, he’s helping cut the rate of medical errors leading to patient fatalities.
How, then, does Flawless Execution work for you?
As individuals, each of us is in the middle of perhaps a half-dozen Flawless Execution cycles. In my day-to-day activity I have at least five execution cycles going on at once. I have my workout cycle going, my corporate cycle going, our new product cycles going, my personal financial cycle going, and my travel plans going.
Interestingly, my personal cycles are not working at the same level, nor will they be for you. Each cycle is at a different level of maturity. Why? Because you bring to each cycle different experiences, different levels of accumulated learning experiences. I have almost ten years of accumulated learning experiences when it comes to running our core business. My Flawless Execution cycle on Afterburner, Inc. is mature and operates on a very high level. The words are familiar, the patterns are familiar, and the errors stand out like a sore thumb. My situational awareness is not just high—it’s intense. I can take a problem anywhere in our company, quickly find a solution, and just as quickly weave that solution into our standards, while at the same time picturing in my head the thousands of ways throughout our company things will in small increments be affected. That’s a very mature execution cycle.
But that’s not always possible. As our company goes into a new business segment, we find ourselves on unfamiliar ground. Our knowledge base is limited; our accumulated learning experiences are almost nil. This execution cycle is moving slower, operating on a lower plane. I don’t have the experiences to know with any certainty how one decision might affect another. I can’t make decisions with the same confidence I can on my other cycle. I need to get up to speed, understand subtleties quickly. But I can see my deficiencies because I have a process. I see my weakness because I have a process that tells me I need more data. I need to mature my new product cycle so that as I act on it and think things through and prepare to go into this new business segment, I start moving my SA up a notch and my successful outcomes up an even bigger notch.
I said that I have a training cycle, and I do. I want to be in shape and maintain a certain weight, and I want to have a mix of cardiovascular exercise and muscle toning in my fitness routine. But I also travel and have too many dinner parties and these things work against my fitness cycle. Worse, in the beginning, when I knew almost nothing about training, I wasn’t sure how anything interrelated. My cycle hadn’t matured. Yes, I knew how to feed back lessons learned, and when I saw my weight hit a flat line, I knew how to dig down to the root causes and adjust my fitness plan. Beyond that, I was a neophyte.
But that’s exactly how the cycle pays for itself. Instead of taking six months or a year to work through all the interrelated issues of a balanced fitness plan, I knew how to accelerate my learning experiences. By debriefing myself honestly—utterly honestly—I had a plan that was giving me the results I wanted within a few weeks of starting it up. Now that cycle is mature, I can make smart trade-offs, I stick to it, I have discipline, and I’ve never felt better in my life.
The point is that Flawless Execution works in us as individuals. You set out your life goals (Future Picture) and your personal centers of gravity in your system. Then you produce a Flawless Execution cycle around your daily responsibilities. Around and around this cycle spins, providing you with an internal clock, internal checks-and-balances, an internal method of accelerating your path toward your Future Picture.
I have several cycles going on at once. Fitness is important to me. In this case I have a clear, high-resolution fitness Future Picture. Less than 195 pounds, body fat less than 10 percent, thirty-four-inch waist, cholesterol less than 180, and visible abdominal muscles. Remember Renoir’s picnic or that perfect ballpark hot dog? Using the strategies in this book, I looked at my external and internal systems that would stand in my way; I looked at my centers of gravity. My travel schedule and lack of good exercise facilities in hotels. Restaurant meals. Late night client dinners and cocktails. The excuse that there just aren’t enough hours in the day to get it all done and by the end of the day I am just too tired to work out, so I’ll hit it tomorrow.
Realizing that I had to attack these centers of gravity in parallel, I went to work. Here’s my plan. I will attempt to schedule my seminars all in the same week and try to stay home every other week, so I can get a routine going. On the road I will book hotels close to large, well-known gyms. If there is not a gym close by, I will adjust my workout and focus on aerobic verses anaerobic. I will do conventional ground-based training to replace weights in this case, exercises like push-ups and leg squats without weights. I cannot get away from the restaurant thing but I will not eat anything heavy after 7 P.M. I will eat six smaller meals a day versus two and a half big meals, which will keep me from eating “big.” At home I will work out with a trainer in order to get that extra rep that I did not have the discipline to get alone, and I will go to the gym regardless of my fatigue level if I have paid someone to work out with me.
With this strategy in mind, my fitness Flawless Execution cycle was ready to spin and attack these centers of gravity. If I need to trade-off, I can make smart trade-offs. If I eat a large meal or miss a workout or travel too much? I can insert the trade-offs into my cycle and make adjustments (just like fighter pilots make adjustments for bad weather on a mission or a fuel problem).
Another one of my cycles is knowledge. I wasn’t a top-notch student in the classroom but I seem to have a natural affinity for education in my adult life so I joined the Young Entrepreneurs Organization and I make it a standard practice to sign-up for their lectures, travel programs and other learning experiences. With YEO I have been to Australia, Russia, France, and Canada and met more than a dozen people that I routinely interact with in my daily life.
Flawless Execution even works for the family, too. What do I mean by family? All of us have relationships and each one of our relationships has an impact on our Future Picture. If you were to map out your internal and external “family” system, you’d put on your list people like “parents,” “children,” “spouse” or “significant other,” “friends,” “downtime,” “religion,” and “civic duties.” Every one of those are significant elements within y
our “family system.” Each of those parts of your “family” impact your free time, your professional time, your workout time, your meals, your travel, your spiritual well being. You draw from those Elements and Centers of Gravity which help you move forward. And you give to those Centers of Gravity to help them move forward. In “family,” Centers of Gravity overlap. A wife is in the husband’s system; a husband is in the wife’s. Both may have children and parents in their system. In family, Flawless Execution cycles need to be like a cluster of cogs turning a common shaft. Your Flawless Execution cycles need to interrelate with the cycles around it; they need to mesh.
Your workout cycle has to “work” with the schedules of others without degrading their cycles.
Your business cycle has to work with the business cycle of those in your system without degrading the others.
And all the better if the cycles actually improve one another. One of my close friends made a decision to become an Ironman athlete. He put in the hours, hit the pool, changed his diet and made the adjustments in his professional life that allowed him the personal time to train. Fast-forward six years. Six years later he’s traveled all over the world competing, is absolutely fit, has incredible mental clarity (which has translated into six of his best years yet in business) and found his soulmate. Guess what she does? You bet—she runs the Ironman, too. They have woven together their personal cycles into an efficient, effective, smoothly functioning family cycle. These two now get more done together than they ever dreamed of as individuals.
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