First, trust the instructions


The pop-up dental clinic is being set up in a high school in Memphis. Tarp laid and chairs set up.

One of my foodie friends enjoys reading the comment threads on recipes to read the responses from the recipe haters who swap out this for that and sub out a few more things they didn’t have on hand and angrily give a one star review to a recipe that bears no resemblance to the the one posted. A wiser person than me finally handed me the clear rule that I have now adopted, the first time you make something, just follow the instructions to have some idea of how it is supposed to go down.  Even respecting the instructions so much can change your outcome.  Using baking as an example, how hot is your oven really? How much moisture is in that flour that has been sitting in your dry as bone mid-winter house? You get the picture.

This was one of many lessons I had re-enforced when I went down to Memphis recently to fulfil a long held curiosity to help at a pop-up medical clinic put on by Remote Area Medical. I was in turn, fascinated and pushed to exhaustion by my minimal contribution to this clinic.

One of my firmly reenforced mantras was to first, seek to trust the instructions. What abetted this trust was understanding the reason behind the instructions and hearing it from such credible sources.

I was trained on-the-spot for a number of tasks in a clear, step-by-step fashion. These instructions might include things like the number of parts I was looking for and what order I would have to do them in. Perhaps most importantly, they would usually include the why behind the instructions. The job accurately billed as the worst of the day was to set-up 60 folding dental chairs. They were heavy and not entirely cooperative but could be made to stand just fine if you followed all the instructions. In one case we had to move the position of a central rod using a crank before we started other parts of the set up. If you did this in the wrong order, you’d have to redo the set up to correct. Horrors. In other cases we would sanitize an item and then leave some object in a particular place as a symbol that we had done all the required steps.

I generally follow rules and instructions so it wasn’t a hard sell to follow along and given that you have the background motivation that you want vulnerable people well served. That said, there were motivations to cut corners.  This work was exhausting with a small crew that had mostly been recruited to do actual medical work and it wasn’t the patient-facing work which many volunteers were likely hoping to do when they signed up.

What also helped was that I could fully and completely trust the source of the instructions.  My admiration for the RAM folks was very deep because it was evident that they had hammered out the design of the clinic thoughtfully and deliberately over time (they have done over 800 clinics).  Things are put away in a specific way so that they can be carried or hauled and so that it is clear what is in each bin. They tie off plastic bins to show that they are full with three complete settings for dental stations. No need to count, we can trust this.  Carrying cases are colour coded so they are directed to the right vehicles.

As a last observation, I can see now that I was also motivated to follow the instructions because I was continually surrounded by people who would help keep me on track if I was unsure as to how to go ahead- not choking micro-management but supportive access to supervision.  There was no need to wildly freelance to fill in the gaps.

Learn more about Remote Area Medical here.

See a 60 Minutes story on RAM here.


The Checklist Manifesto – Atul Gawande


This is a review of a book with a bland title has a really interesting premise – know how and sophistication have increased remarkably in almost all realms of endeavour and as a result so has our struggle to deliver on them.

One of the examples that Gawande examines in detail is how large buildings now get constructed. Determining if a large building is to code is more knowledge than one person can have.

Response to complexity is to push decision-making to the centre but we should be pushing it to the periphery and giving each person room to adapt based on experience.  For instance, in New Orleans, after the hurricane, the command and control method of getting through the crisis didn’t work well.  Walmart took another tack and gave district managers the permission to make decisions above their level and make the best decision on the information available.  In the end they could distribute diapers and ice and break into pharmacies to distribute emergency medication.  As a result they got out food and water before the government.

The mechanism that worked was a mixture of freedom and expectations that work would be coordinated.

How does the checklist come in?

We need freedom and coordination but we also need a way to reign in the simple problems that besiege us.  For lawyers (and bureaucrats) this might be deadlines.   As Gawande says, checklists can defend even the most experienced against failure with a cognitive net.

The elements of the checklist in combination with the act of running through it orally as a team, are a way to increase communication.  This creates good conditions to problem solve and avoid errors and lead to an increase in job satisfaction.

Here is the bottom line: we don’t like checklists – they are painstaking and seem beneath us and they demand a discipline.  They also help us avoid errors.

I’ll be doing some more thinking about how I might work up checklists for my work environment going forward.  I think one easy steal from this book is that I’ll move to ensuring that delegation of bigger items includes a sit down Q and A session with some standard elements to make sure that big assumptions are clarified from the start and that a dialogue gets started early.

Design: realizing the image in my head

A reblog of a different flavour than I normally post here as it appears to be about the genesis of a hair cut but stay with me here. I am a huge fan of design thinking and what I love about this article is the deliberate work done to break down how to give direction in a particular setting and to explain the ideas in your head. In short: Find examples. Not too many as that gets muddy. Figure out what works and what does’t work. Pick two or three of each. Again, keep it from getting muddy. Finally, let the process generate its own product. I have lots to learn about how to create a similar process for feedback in my world.


As a designer, I’m always interested in moments that help me understand what it’s like to be a client. I’ve mentioned it before. Like when I was preparing the as-built drawings for my parents to do some renovations to my childhood home. I understood the disorientation many clients seem to have when they see their home on paper.

A recent experience has helped me gain perspective on another frustrating part of the designer/client interaction: inspiration photos, accessing the image they have in their head, and helping them to understand that image.

A big challenge for every client is describing the image they have in their head.
A big challenge for every designer is understanding the image in their client’s head.
The biggest challenge for both is accepting that no image in anyone’s head, neither the client’s nor the designer’s, is what the final design is going to be.


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13 Item Hit List That Will Make A Successful Artist | Chase Jarvis Blog



The Hit List: 13 Things Crucial For Your Success [In Any Field]

A lovely list – I’ve excerpted the list and left the language “as is” but it’s not for the faint of heart.

Get shit done.  Yep I have written about this before.

“Over-thinking, pontificating, and wondering are tools for the slacker. People don’t care what almost happened, or what your problems are or why something wasn’t. “

Educate yourself.

“Think someone else is responsible for your education? Think again.”


“Nothing–and I’ll say it again, but louder–NOTHING will spring from your creative self fully formed. […] The summary of those iterations will aggregate into something special.”


Take a deep breath.

“Life, work, art can be hard. Anxiety – not to be confused with the positive stress of deadlines and forced production schedules – is counter productive. So when shit is getting hairy, take a breath. Everything is going to be okay.

Take delight.

“Your work should be fun. […] If you don’t take delight, your career will be short, either by choice or by fate.”

Find some quiet.

“Synthesis–the gluing together of your ideas–requires some sort of quiet, be it just a moment or bunch of moments. So carve out this time.”

via 13 Item Hit List That Will Make A Successful Artist | Chase Jarvis Blog.

What policy makers can learn from designers

From the TEDx network, the most inspiring  intersection of concepts I have seen in a long while.  This is a  video well worth watching on the intersection between design thinking and politics and policy making by Jocelyn Bailey.  She works at a policy think tank.

She starts the talk by simplifying the concept of design by saying that it is changing an existing situation into a preferred one.

The key concepts she would draw from the design field would be that the work should be unbiased, we should focus on thinking about people and that we should experiment.

Her manifesto:

– Don’t rely too heavily on the past or rely too heavily on things that have been done before.  I’d link this to concept that the our current problems are wicked problems that we haven’t grappled with before.

– Don’t rely on party politics – keep questioning your assumptions.

– Find new ways of generating knowledge – observation and experimentation.

– Care about the artefacts – what will the material interaction be between the policy change and the real world?  This will include how our clients understand our changes.

– Be more optimistic – especially in the face of austerity on the public service side.  Everything is designed and can be re-designed.  Focus on what we have to work with and not what has been taken away.