By Gary A. Klein
Knowledgeable explains how the traditional knowledge approximately choice making can get us into trouble--and why event cannot be changed by means of principles, strategies, or analytical tools.
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Extra resources for Streetlights and Shadows: Searching for the Keys to Adaptive Decision Making (Bradford Books)
They are a shield against interruptions, reducing the chance that 16 Chapter 2 a radio call from an air trafﬁc controller or a dispatcher might distract the pilot into omitting an essential step in a routine. Procedures also help us evaluate performance. We can see if someone knows the procedures, and is following them. Flight checklists are just one example of procedures that have successfully captured a task and have improved performance and safety. Procedures are also relevant to health care.
An elderly person with none of these precursors has only a 12 percent chance of falling in the coming year. The odds go up to 100 percent for an elderly person who has all the precursors. Therefore, an experienced gerontologist would study the patient’s balance, her feet (somewhat swollen), and the ﬁve medications she took (their cumulative side effects often include dizziness). An experienced gerontologist would watch as she got out of her chair. ) A skilled gerontologist would inquire about her eating habits.
During an accident investigation, if someone ﬁnds that a procedure wasn’t followed, even if it didn’t directly cause the accident, there is a good chance that ‘‘procedural violation’’ will be trumpeted as one of the contributing factors. I once participated in an aviation accident investigation. The ﬂight data recordings showed pretty clearly that the pilots hadn’t done everything exactly by the book. The senior pilot next to me pointed out that pilots violate some procedures on almost every ﬂight.