What do a soldier, a doctor and a pilot have in common?

Aug 16, 2016 by Maria del Camino Hurtado Comments (1)

Maria del Camino Hurtado is an Operations Officer at the World Bank’s Science of Delivery unit, and a team member of the Global Delivery Initiative’s Secretariat.

Summer is here. You wrapped up some projects, others are about to pick up, deliverables continue to find their way into your inbox, and deadlines relentlessly come at you as you navigate your operational cycle. But think about the months you just left behind and tell me: did you at any point pause and reflect?

We’re constantly on “delivery mode”; coming and going from missions, submitting documents, reacting to client requests, meeting with colleagues... There seems to be no time to catch a breath. No time to connect the dots and learn. Yet, the literature tells us that taking time to reflect on what we've done teaches us to do it more effectively the next time around.

In many professions pausing and reflecting is not only considered standard practice but a key to analyze and improve performance.

  • The US Army’s Opposing Force (OPFOR) has used After Action Reviews (AAR) for over 30 years as a method to jointly reflect, discuss, and extract lessons that can be applied to future missions. OPFOR is a military unit tasked with representing the enemy during trainings and war games (BLUFOR is the name of the “home team” – the force that is being trained). The Army’s After Action Reviews are part of a broader learning cycle that takes place throughout the training campaigns, from the moment the senior commander drafts operational orders, and after each significant event in the training. During these war exercises AARs are used by opposing teams as structured and safe spaces to openly discuss and analyze what happened, why it happened, and how it can be done better. In AARs there’s no rank, no blaming, and no praising. No fear of retaliation. Everyone’s opinion counts and all present are expected to be candid, insightful, and creative about past challenges and events.
  • Hospitals deal with complexity on a daily basis. Whether in the Operating Room or the Intensive Care Unit, teams of surgeons, nurses, anesthesiologists, residents, and many others need to assemble several times a day and work together regardless of whether they have worked together before. Practices like Morbidity and Mortality Conferences occur regularly and have been in use since the 1900s. In these conferences specific case studies are presented to residents to jointly identify areas of improvement and to discuss medical errors in an open, safe manner. Different types of team debriefings are also widely used - either as regular practice or after a critical incident - in recognition of the importance for team members to provide honest feedback and reflect on their recent performance. These debriefings have been linked to increased survival and enhance the learning process in an often chaotic environment.
  • In the Aviation Industry - as Atul Gawande's "The Checklist Manifesto" very eloquently exposed – several checklists are routinely used to prevent basic errors and address emergency situations. Although captain and crew always hold an initial brief before the flight, in this case checklists act as a different type of “pause points”. Longer debriefings are a common practice during FAA training and after aircraft accidents, but in-flight checklists are largely geared towards ensuring safety by making certain that basic actions are undertaken at different points in time. They often require several crew members, who most likely didn’t know each other before the flight, to interact while reading out the instructions in each checklist. This quick and continuous “check-in” is of course informed by the lack of time for extensive debriefs during the flight, but it nevertheless contributes to constant awareness and reflection. I would even call it facilitate quick reflection.

There are some common characteristics among these “pause and reflect” spaces:

  • They are safe. Participants are encouraged to be honest and say what they think without fear of retribution or negative consequences.
  • Everyone’s opinion matters. If you’re there it’s because you were in the operating room/war exercise/ cockpit, and what you say is important.
  • They’re focused on understanding what happened and learning from it. Not on placing the blame, or attributing failure.
  • They’re forward looking. The conclusions from the discussions translate into actions to improve the outcomes for the patient, the passenger, or the soldier.

There are also many commonalities between the group dynamics described and the ones we face every day. We’re under pressure to deliver. We work in diverse teams conformed by people we often didn’t know before. We work in a changing environment where we never have complete information, and we often need to react quickly to what happens in a country. But do we have built-in mechanisms, spaces in our project cycle and our daily work to pause and reflect? Do we learn in the way learning is supposed to work? (Check out this video and the interesting work that the WBG's IEG team are doing)

We surely have similar spaces for discussion. The extended team gets together for a Concept Note Review. We have team meetings to listen to our peers as they try to help us improve our design. We have implementation reviews and completion reports in which we are supposed to discuss what really happened during implementation and extract lessons that we can apply next time.

We do have those spaces, but I would argue that they are not enough, and for the most part they don’t possess the four characteristics above. The question is: Can we change that? Can we use them better? Safe spaces where we can be completely honest about successes and failures not only lead to true learning – one that becomes action – they also connect us to the wealth of talent and experiential knowledge around us. They’re like having that coffee with a colleague we trust to ask her for advice - on steroids.

Now think about what it is that all the occupations mentioned have in common. Why has pausing and reflecting become such an integral part of their activities?

Well, if they don’t, people die.

We are not responsible for the lives of others like a doctor, a soldier, or a pilot is. But our work affects the livelihoods of thousands, millions of people every year. And that should make us pause and reflect.


Yes, "connecting the dots and learning" is of course crucial.  If it could be done in at atmosphere of "no blaming...retaliation,..candidness...creativity" so much the better.

So why not adapt an M & E approach to it?  While normally we think of measuring things to look at external performance and ensure accountability, it could also used as a means (and a symbol) of how our cultures are working--or not, including whether real learning is occuring.  That would facilitate the "better" "safe spaces" sought in the conclusion. 

I got into this in a related way in the last sentence of http://www.sustainablebrands.com/news_and_views/new_metrics/matt_polsky/while_celebrating_improvement_one_metric_beware_unintended_co.

Finally, the checklist example given is a mixed bag.  Yes, it's important for safety in such areas as aviation, so by all means.  But for systematic issues, we want to avoid what has been called "checklist mentality."  That is, checking a box is not necessarily compatible with real "reflection" or "learning."  

The process of developing metrics for connecting dots, involving seeing non-linear relationships, would be interesting in and of itself; whereas doing it for learning could probably take advantage of other fields. such as organizational learning.

posted 4 years ago