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The power of checklist

Recently I read the book “The Checklist Manifesto” by Atul Gawande. 

“An essential primer on complexity in medicine” is what New York Times states about his book whilst The Hindu states this as “An unusual exploration of the power of to-do list”.

As an individual committed to perfection, in constant search of scientific and smart ways to test/prevent and as an architect of Hypothesis Based Testing, I was spellbound reading this brilliantly written book that made the lowly checklist the kingpin, to tackle complexity and establish a standard for higher baseline performance.

The problem of extreme complexity The field of medicine has become the art of managing extreme complexity. It is a test whether such complexity can be humanly mastered: 13000+ diseases, syndromes and types of injury (13000 ways a body can fail), 6000 drugs, 4000 medicines and surgical procedures each with different requirements, risks and considerations. Phew, a lot to get right.

So what has been done to handle this? Split up knowledge into various specializations, in fact, we have super specialization today. But it is not just the breadth and quantity of knowledge that has made medicine complicated, it is also the execution of these. In an ICU, an average patient required 178 individual interactions per day!

So to save a desperately sick patient it is necessary to: (1) Get the knowledge right (2) Do the 178 daily tasks right.

Let us look at some facts: 50M operations/year, 150K deaths following surgery/year (this is 3x #road-fatalities), at least half of these avoidable. Knowledge exists in supremely specialized doctors, but mistakes occur.

So what do you when specialists fail? Well, the answer to this comes from an unexpected source, nothing to do with medicine.

The answer is: THE CHECKLIST

On Oct 30, 1985, a massive plane that carries 5x more bombs roared and lifted off from the airport in Dayton, Ohio and then crashed. The reason cited was “Pilot error”. A newspaper reported, “this was too much airplane for one man to fly”. Boeing the maker of this plane nearly went bankrupt.

So, how did they fix this issue? By creating a pilot’s checklist, as flying a new plane was too complicated to be left to the memory of any one person, however expert. The result: 1.8 million miles without one accident!

In a complex environment, experts are against two main difficulties: (1) Fallibility of human memory, especially when it comes to mundane/routine matters which are easily overlooked when you are strained to look at other pressing matters of hand (2) Skipping steps even when you remember them, as we know that certain steps in a complex process don’t matter.

Checklists seem to provide against such failures and instill a kind of discipline of higher performance.

Peter Provonost in 2001 decided to give a doctor’s checklist a try to tackle central line infections in ICU. So what was the result after one year of usage? Checklist prevented 43 infections and 8 deaths and saved USD 2M! In another experiment, it was noticed that patients not receiving recommended care dipped from 70% to 4% and pneumonia fell by a quarter and 21 fewer parents died.

In a bigger implementation titled the “Keystone Initiative” (2006) involving more hospitals of 18-month duration, the results were stunning- USD 17M saved, 1500+ lives saved!

ALL BECAUSE OF A STUPID CHECKLIST!

So where am I heading? As a Test Practitioner, I am always amazed at how we behave like cowboys and miss simple issues causing great consternation to the customer and users. Here again, it is not about lack of knowledge, it is more often about carelessness. Some of the issues are so silly, that they can be prevented by the developer while coding, and certainly does not demand to test by a professional. This is where a checklist turns out to be very useful.

In an engagement with a product company, I noticed that one of the products has a product backlog of ~1000 issues found both internally and by the customer. Doing HBT level-wise analysis, we found that ~50% of the issues could have been caught/prevented by the developer preventing the vicious cycle of fix and re-test. A simple checklist used in a disciplined manner can fix this.

So how did the checklists help in the field of medicine or aviation? They helped in memory recall of clearly set out minimum necessary steps of the process. They established a standard for higher baseline performance.

Yes! HIGHER BASELINE PERFORMANCE. Yes, this is what a STUPID CHECKLIST CAN DO!

So how can test practitioners become smarter to deliver more with less? One way is to instill discipline and deliver baseline performance. I am sure we all use some checklist or other but still find results a little short.

So how can I make an effective checklist and see a higher performance ? Especially in this rapid Agile Software world?

This will be the focus of my second part of this article to follow. Checklists can be used in many areas of software testing, I will focus in my next article on ‘How to prevent simple issues that plague developers making the tester a sacrificial goat for customer ire by using a simple “shall we say unit testing checklist”.

Related article: Design checklists to “Do, Sync & Act”


If you find the article interesting, please ‘like’, ‘share’ or leave a comment below.

 

 

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Horse Blinders & Fish Eye vision

In a system which is a collection of various processes, templates form an integral element to aid implementation. Templates provide a framework to capture information in a structured manner. Very necessary in systems that require rigorous compliance.

Why do horses used for pulling wagons wear blinders? Horses that pull wagons and carriages wear blinkers to prevent them from becoming distracted or panicked by what they see behind the wagon. They keep the horse’s eyes focused on what is ahead, rather than what is at the side or behind. (Courtesy- http://bit.ly/2gkjGeA & http://bit.ly/2fc5iZB)

Templates are like “horse blinders”. They enable sharp focus of a narrow field restricting purposefully the peripheral vision enabling strict compliance.

In a creative environment where a 360 degree vision is required, templates are a bad choice. What is needed is a “workspace”, that provides a good environment which can be adapted flexibly for different needs.

Workspace like the Fish Eye helps you see the complete big picture enabling you the connect the various individual dots

It allows you to see the full 360 picture, enabling you to proceed in a direction of choice and changing course as needed to adapt. A well thought out workspace provides you with an environment with high degrees of freedom yet ensuring that you are not adrift.

Rather than having ‘boxes’ to collect information, it provides you with ‘spaces’ to collect information as necessary without restricting you to a specific order, thereby enabling you to connect the dots to see the full picture.

Templates like horse blinders enable you to focus on ‘DOING WORK’, while Workspaces akin to Fish Eye help you to ‘THINK BETTER’.

The previous article highlighted the importance of ‘visual thinking’ to see better in the “mind’s eye”, this one continues on the same thread allowing you to “see better with the real eye” !

Immersive Session Testing (IST) is a style of testing that exploits the logical left brain with the creative right, enabling you to immerse deeply and test in short sessions. Powered by HBT (Hypothesis Based Testing) that provides the scientific rigour and “Workspaces” equipping you with the creative fluidity, it enables you to immerse, think logically, write less, do more with a sharp focus on outcome.

Reconnaissance workspace in IST helps you to see the users, their use cases, system features & attributes, environment, behaviour conditions, configuration settings, access control enabling you to see the complete big picture

Marketing blurb: If you are keen on adopting IST, a smart, scientific, rapid & modern approach to software testing, check out the one-day experiential workshop on Dec 9, 2016 by clicking here.

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“Visual thinking” – Test smarter & faster

It is interesting that in the current technology/tool infested world, we have realised that human mind is the most powerful after all, and engaging it fully can solve the most complicated problems rapidly.

One of the key ingredients of an engaged thinker is “Thinking visually” ; to clearly see the problem, solution or gaps.

Design Thinking relies on sketching/drawing skills to imagine better ideas, figure out things, explain and give instructions. Daniel Ling(1) in his book “Completing design thinking guide for successful professionals” outlines this as one of the five mindsets – “Believe you can draw”.

Sunni Brown(2) in her book “The Doodle revolution” states “doodling is deep thinking in disguise – a simple, accessible and dynamite tool for innovating and solving the stickiest of problems“ by enabling a shift from habitual thinking pattern to cognitive breakthroughs.

David Sibbet(3) a world leader in graphic facilitation and visual thinking for groups in his brilliant book “Visual Meetings” outlines three tools for effective meetings to transform group productivity : (a) ‘Draw’ to communicate visually (b) ‘Sticky notes’ to record little chunks of information and create storyboard (c) ‘Idea mapping’ which are visual metaphors embedded in graphic templates and worksheets to think visually.

Dan Roam(4) in “Show and Tell” states that the three steps to create an extraordinary presentation are (a) Tell the truth (b) Tell it with a story and (c) Tell the story with pictures. The book ‘written’ beautifully in pictures entirely is about ‘how to understand audience, build a clear storyline, create effective visuals and channel your fear into fun’.

Jake Knapp(5) in “Sprint – How to solve big problems and test new ideas in just five days” outlines a five-day process to problem solving relies on SKETCHING on Day 2. He says that “we are asking you to sketch because we are convinced it’s the faster and easiest way to transform abstract ideas into concrete solutions. Sketching allows every person to develop those concrete ideas while working alone”.

It is interesting to note that visual thinking has taken centre stage now with emphasis on sketching, drawing as a means to unleashing the power of the mind.

As a keen practitioner of software testing, I am amazed how people get swooped into the thinking that automation is the solution to ensuring software quality. Indeed tools and automated testing practices enable continuous evaluation rapidly, but there is indeed no substitute for the power of smart thinking.

Testing is a funny business where one has to be clairvoyant to see the unknown, to perceive what is missing and also assess comprehensively what is present ‘guaranteeing’ that nothing is amiss.

To be able to do this very well, good visualisation is key. To see with stark clarity what is present, needed and missed out.

Immersive Session Testing (IST) is a style of testing that exploits the logical left brain with the creative right, enabling you to immerse deeply and test in short sessions. Powered by HBT (Hypothesis Based Testing) that provides the scientific rigour and “Workspaces” equipping you the creative fluidity, it enables one to immerse, think logically, write less, do more with a sharp focus on outcome.

Workspace is a visual aid that provides an environment to analyse & understand, design & evaluate using mind maps, ‘stick-its’, doodles to enable visual thinking and “see in your mind” with stunning clarity the users, flows, features, attributes, environment, behaviour conditions…

The power of visual thinking in IST enables you see the big picture of the system and its full context of end users, use cases, environment and attributes, visualise the end user’s usage to empathise with them, get under the hood to extract conditions to model behaviour and design test cases, and finally visualise the quality of delivered system.

IST enables old fashioned intelligent testing, by equipping you with modern thinking tools and paradigms which when combined with technology/tools makes testing smart, fun, fast, rich and value adding.

Have a great day.

Marketing blurb: If you are keen on adopting IST, a smart, scientific, rapid & modern approach to software testing, check out the one-day experiential workshop on Dec 9, 2016 by clicking here.

References

(1) Daniel Ling “Completing design thinking guide for successful professionals”, CreateSpace Independent Publishing Platform, 2015.

(2) Sunni Brown, The Doodle Revolution: Unlock the Power to Think Differently, Portfolio, 2014.

(3) David Sibbet, “Visual Meetings: How Graphics, Sticky Notes and Idea Mapping Can Transform Group Productivity”, Wiley India Private Limited, 2012.

(4) Dan Roam, “Show and Tell – How everybody can make extraordinary presentations” Penguin, 2014.

(5) Jake Knapp, “Sprint – How to solve big problems and test new ideas in just five days”, Bantam Press, 2016.