Saturday, April 19, 2014

Fail Amnesia

As our ability to engineer the world has increased exponentially, catastrophic failure has become increasingly rare. This is undoubtedly a positive trend resulting in countless saved lives. It also creates a tendency to be shocked to the point of denial when catastrophe eventually does strike. Unless you’re highly trained to deal with stress and danger, the normal reaction to a catastrophic event is probably shock, disbelief and delayed reactions. We would expect people to react this way. But when those in charge are in denial, the outcome is usually far worse. 

On 9/11, some floors of the World Trade Center failed to evacuate when they could or waited too long to start. Taking down even one tower, let alone both was an unthinkable act before 9/11. The shock of the situation was other-worldly for everyone watching the event. I can’t imagine what it must have been like to be in the building… to be both part of the event and unable to get perspective on what was unfolding.

The passengers and crew of the Costa Concordia faced a similar situation. Ships of this size don’t sink these days. At least they very rarely sink. When it happened, it was probably clear to the crew fairly quickly that the boat was going to sink. There are sensors and alerts and It comes down to a simple matter of how many compartments are taking on water. But I suspect that the fact that it was the captain’s fault combined with a general state of denial made him reluctant to accept the inevitable and get everyone off the ship as fast as possible. A lack of leadership by the captain creates confusion for the crew which translates into lack of action and fatal delays for all on board. It seems like a similar story is unfolding with the Sewol, the ferry that sunk off the coast of South Korea this week. 

In both cases, the captain and his immediate crew were able to get off the ship safely. They are high above the water line, always near a door to an outside deck, and have the most knowledge of the situation… the "commanding heights" in military terms. However it seems that the unlikelihood of the outcome combined with the deep responsibility it entails seems to defer leadership and promote a sense of self-preservation. It is almost a romantic notion that the captain would "go down with the ship" when he can so easily save himself.

The Tsunami in Indonesia is somewhat similar but more from a generational perspective. It was a natural disaster not one caused by human error. But the elders of the villages recognized what was happening when the water rushed outwards and told people to flee. Foreigners and younger locals wondered what was unfolding before their eyes. By the time the danger became clear, it was often too late to act. 

In all of these situations, there was a reluctance or at the least a critical delay in acting. The performance of our man-made world is now so good that failure, particularly of the catastrophic kind, is so rare that most of us are never asked to train for any possible outcome other than success. In my safe world of web development failure is still quite common. We expect it to happen and have processes in place to deal with it when it does. Failure at the scale of the Costa Concordia or Twin Towers is rare but still possible. When it happens, it is worth remembering that our leaders might not be leading from the top. They might have already left the ship.