Complex Problems: How to Solve Them, the Simple Way

This article is an excerpt from the Shortform summary of "The Checklist Manifesto" by Atul Gawande. Shortform has the world's best summaries of books you should be reading.

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Brenda Zimmerman and Sholom Glouberman, who study complexity, defined three kinds of problems: simple, complicated, and complex. What’s the difference? Particularly, what’s the difference between complicated problems and complex problems?

A complex problem is a problem that has many variables and for which the outcome is uncertain. An example of a complex problem is raising a child. You learn from raising one child, but the next child may require a different approach.

We’ll look at the nature of complex problems, how they differ from complicated problems, and how to solve complex problems in the workplace.

From Simple to Complex Problems

The successful experiences of using checklists in aviation decades ago suggest they could be applied widely. They protect even the most experienced from making mistakes in a whole range of tasks. They provide a mental safety net against typical human lapses in memory, focus, and attention to detail.

Simple Problem: An example of a simple problem is baking a cake from a mix — there’s a recipe and a few techniques, but once you’ve learned them, following the recipe usually works.
Complicated Problem: An example of a complicated problem is sending a rocket to the moon. Complicated problems can be broken down into smaller problems. Solving the problem involves many people, teams, and specialists. Unexpected issues pop up, but you can learn, repeat the process, and perfect it. Timing and coordination are key.
Complex Problem: An example of a complex problem is raising a child. Every child is unique. You learn from raising one child, but the next child may require a different approach. With complex problems like raising a child, the outcome is uncertain. Yet it’s possible to raise a child successfully.

In classifying the three problems described so far in this book — the bomber crash of 1935, the issue of central line infections, and the rescue of a drowning victim — the key problem and solution in each case were simple:

To avoid crashing the bomber, focus on the rudder and elevator controls.
To reduce central line infections, maintain sterility.
To saving a drowning victim, be ready to perform a cardiac bypass

All could be resolved by using a simple tool to compel the needed behavior — a checklist. We’re constantly confronted with similar simple problems that can be mitigated by checklists — for instance, a nurse’s failure to wear a mask while putting in a central line or a surgeon’s failure to recall that one cause of a cardiac arrest could be a potassium overdose.

But can checklists be used to address complicated or complex problems, such as ICU work, where there are many tasks performed by multiple people, dealing with individual patients with individual and complex problems? Medicine encompasses all three types of problems — simple, complicated, and complex. It’s important to get basic things right, while allowing skill, judgment, and ability to react to the unexpected.

The medical profession could learn from the construction industry, which handles the design and construction of huge and complicated structures with the help of sophisticated checklists addressing the full range of problems.

The Demise of the Master Builder

Let’s look at an example of how checklists can solve complex problems.

People used to hire master builders, who designed, engineered, and oversaw the construction of large and small projects from start to finish. For instance, master builders built Notre Dame and the U.S. Capitol building.

However, by the mid-20^th-century master builders became obsolete because one person alone couldn’t master the advances occurring at every stage of the construction process. Architectural design and engineering design became separate specialties. Other specialties and subspecialties developed. Builders split further into areas of expertise such as finish carpenters and tower crane operators. Major projects now involve 16 different trades and hundreds of workers who must do their jobs in coordination with others.

The construction process is orchestrated using sophisticated schedules and checkpoints that enforce roles, communication, and follow-through. The simple act of building has become a complex problem. The major advance in the industry over the last few decades has been perfecting this process of tracking and communication.

To manage increased complexity, the entire construction industry was forced to evolve. However, much of medicine is still structured like the master-builder era — with a lone physician executing all of a patient’s care — even though times have changed to the extent that a third of patients have at least 10 doctors involved in their care by the last year of their life. As a result, care can be uncoordinated and subject to error.

In construction, failure isn’t an option. Massive structures must stand up straight and withstand all kinds of pressures and potential disasters such as fires and earthquakes.

Complex Problems: How to Solve Them, the Simple Way