Don’t underestimate the human side

As an illustration, take Robin Marantz’s article published by the National Academy of Sciences reviewing progresses that have been made in reducing infections in operating rooms through the adoption of checklists and cultural changes. In this case, the technical part of the solution—the equipment—was a parameter: it didn’t change. What resulted in a drastic reduction of infections was how the problem solvers operated—a human change. This required for ICU nurses to run through the newly adopted checklist and insist that physicians follow it. Now I’m told that many surgeons have, well, healthy egos (in fact, as a group they might be one of the few kinds of human beings that outdo tenured faculty on that metrics) and that they don’t like to be told what to do by people they perceive as lower than them in a hierarchy. So, success requires that hospital administrators fully support nurses in this capacity, and they do: for this task, the instructions go, the nurses have authority and can boot you out of the operating room if you don’t follow the procedure, no matter who you are. Cultural change comes at a price, but it can also have fantastic rewards: following this cultural change, central line infection rate at Johns Hopkins fell from 11% to 0.

In other settings, a solution to a technical problem might not be a technical one, but a cultural one. Two examples to illustrate. The first is how Stockholm addressed its traffic congestion a few years ago. See, the city spans 14 islands that are interconnected by 57 bridges, and a few years ago, it faced crippling congestion.

Framing the problem as an engineering one would probably have resulted in building another bridge. Instead, the city framed the problem as a human one, aiming at changing people’s behavior. So, Stockholm implemented a “tax and drive” system with transponders installed in the users’ cars that charged a larger amount at rush hour. Within four weeks, the system removed 100,000 vehicles at rush hours. An initial trial system was put in place in 2006, which reduced travel times sufficiently for the general public to notice. This, in turn, is credited for a landslide reversal of public opinion toward supporting the measure. [See Chevallier, Eliasson, Eliasson et al., and Grasso]

Or consider another, similar problem: The guests of a hotel complain about the slowness of the elevators. To address this, the manager consults an engineer, who recommends installing another elevator. Unimpressed by the cost, the manager seeks a second opinion, that of a psychologist, who observes how the guests behave as they wait for and ride the elevators. She finds out that the real problem is not so much how fast the elevators ride but that guests get bored. So, she recommends giving the guests something to do: for example, by installing mirrors or televisions or providing magazines on each floor and/or in the elevators themselves. Indeed, sometimes the “obvious” solution (one more elevator) isn’t the most desirable one. [See Verberne]

So what? Well, first, “soft” skills have very hard consequences, so maybe we ought to stop calling them that; “transferrable skills” sounds a lot more appropriate. Second, don’t underestimate the human component of problem solving: Even the best technical solutions aren’t worth anything if they don’t get accepted. Just like the technical side of the solution, the human side is necessary but not sufficient.

Robin Marantz, The hospital checklist: How social science insights improve health care outcomes. National Academy of Sciences, 2017.

Chevallier, A. (2016). Strategic Thinking in Complex Problem Solving. Oxford, UK, Oxford University Press. p. 30.

Grasso, D. and D. Martinelli (2007). Holistic Engineering. The Chronicle of Higher Education.

Eliasson, J., et al. (2009). “The Stockholm congestion–charging trial 2006: Overview of effects.” Transportation Research Part A: Policy and Practice 43(3): 240-250.

Eliasson, J. (2009). “A cost–benefit analysis of the Stockholm congestion charging system.” Transportation Research Part A: Policy and Practice 43(4): 468-480.

Verberne, T. (1997). “Creative Fitness.” Training & Development.

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