The Importance of "Systems"

Hello again! Gordon Graham here with my monthly contribution to this great website. I sincerely hope that all is going well for you and that this spring season will be fantastic. I always enjoy coming out of winter (although the weather has been a bit odd around America this year) and headed into spring and then summer and we are so fortunate to live in sunny Southern California. I am preparing this piece on United Flight 116 to Chicago where (according to the Captain) it is 32 degrees with an inch of snow on the ground. I was in Ohio last week and it was snowing and they had to “de-ice” the plane prior to takeoff from Cincinnati. I think the Captain that they referred to this as the “de-icing” process. Which brings me to the point of this brief piece.

Long before I ever went to law school, I picked up my Graduate Degree from USC in “systems”. I could bore you for months with my ramblings in this respect, but I love systems. You can call them processes, procedures or as Nathaniel Webster calls them “a structured approach to doing a given task”. My familiarity with “systems” predates my graduate education. When I joined the CHP in 1973 I was introduced to the “systems” that great organization had in place. The Patrol had a number of names for these processes including policies, procedures, SO’s, GO’s, rules, directives, SOP’s and a bunch of other titles for the “written word” within the CHP policy manuals. Systems are important because if you have multiple people doing the same task in a different manner you will ultimately (or perhaps instantly if they are on the same event) have problems. And when you have 7500 CHP officers in 125 different locations all doing the same task using a different approach – that can cause substantial problems.

I had my Bose headphones on today (and having told you that makes them tax deductible) while we waited for takeoff clearance on LAX 25-R. BTW, are you aware there is a system for how they number the runways at airports around America? And as we waited for permission from ATC to start our takeoff roll, I saw a United Commuter plane landing adjacent to us on 25-L and then the controller directed our Captain to take off (after advising him of the wind conditions) and as we were picking up speed going down the runway I heard the same ATC person direct the United Commuter (and you can differentiate between the regular United flights and the commuter flights easy enough as the commuter flights always have four digits in their flight number) to hold at the end of runway 25-L prior to crossing 25-R. Almost simultaneously the ATC controller also told United Flight 854 who was apparently the next plane in queue (the longest word in the English language in which the first letter pronounces the entire word) that he was following a 757 (our plane) and that he should be wary of the “wake turbulence” that Boeing product generates when passing through the air. How about that? When a 757 is taking off or landing, the ATC (around America but not in Europe so perhaps the 757’s do not create the same turbulence when out of our country) people notify the following aircraft of this “turbulence” issue that I understand is rather dramatic in nature.

It is a shame that this notification of wake turbulence “system” was not in place about fifteen years or so ago when the corporate jet owned by the good people at “In-N-Out Burgers” followed a 757 too closely into John Wayne airport and literally got ripped out of the sky by the turbulence and caused the fiery crash of the IOB Jet into the Santa Ana Auto Mall. This crash killed five, including the President of the burger chain, Mr. Rich Snyder. I had done some work for him earlier in my life and can tell you he was an honorable man. Subsequent to this terrible tragedy, the FAA created this new “system” to warn pilots of this risk of “wake turbulence” peculiar to the 757.

My point here is that the tremendous safety record we have in U.S. Aviation is because of strict adherence to the rules associated with “systems”. Our ATC system has hundreds or possibly thousands of these “systems” in place and as long as they are “properly derived, kept up to date, and fully implemented” things will go right and we should avoid nasty consequences.

And more focused now, the American Fire Service is fully involved in “systems”. On a national level we have ICS and NIMS – and the “s” in both of these acronyms stands for “systems”. And my guess is that your specific fire department has many of their own processes, procedures and structured approaches to doing a given task. And at the risk of being redundant, if these systems are “properly designed, kept up to date and fully implemented”, they will never let you down. And when you are in a high-risk industry (where the consequences are very severe) like the airline industry, it is essential that everyone know his or her role in “systems” design, update and implementation.

Fire service operations are high risk in nature. Now I am not in the your business, but I do know quite a bit about the nasty consequences you face when things do not go right. I am intimately familiar with what happens when seatbelts are not in use – and I think the formal name for the seatbelt is the “restraint system”. It is properly designed, kept up to date but too many public safety personnel choose not to use this system and when it is not implemented, tragedy is in route.

I could continue on about some of the recent news stories regarding harassment in the workplace. Your department has a harassment policy – and my guess is that it is properly designed and up to date. The problem is that too often it is not being followed (read: implemented) and severe problems occur.

I was walking by a fire station on the campus of Stanford University last week, and just happened to note that the lower portion of the “door” that rolls up to allow fire apparatus ingress and egress to the structure was severely damaged. I wonder how that happened? My guess is that the involved department has a “process” – a “system” on how to enter and exit the fire station, but for some reason this “system” was not being followed.

After studying nasty consequences in both of our professions for several decades, I can state with certainty that while some of our problems come from a lack of well designed systems or out of date systems (more on that in another iteration of these writings) – most of our problems come from a lack of “systems implementation” – people not following rules that apply to the task, incident or event they are handling.

What causes this failure to follow policy? Sometimes it is linked to “arrogance” – department rules do not apply to me. Sometimes it is “ignorance” – I didn’t know we had a rule that said that. And some times it is linked to “complacency” – “I have always done it this way and I have not had a problem yet”. And no disrespect intended, but you can be arrogant and ignorant and complacent in many jobs in our society – but the fire service is not one of these jobs that will tolerate such behaviors.

Which brings me to the thought that generated this entire piece today. As I was getting dressed this morning, the channel 11 news had the story and some live footage of LA County Fire fighting a structure fire someplace. And I watched with great interest on how the firefighters (all being filmed from a news helicopter above them) were doing their work on the roof of this building including making some holes for the “ventilation” that is so important to you (because you are probably in the business) and not understood at all by me who is just an interested observer. And the buffoons in the news room (and this reminds me of the video clip now going around about the D.C. newscaster sitting in the studio and reading the teleprompter covering the story about the overturned big-rig carrying the cattle and some of the cattle (and they were Black Angus variety) escaped – and no joke there is a great line in the clip where they have a picture of a head of cattle being rounded up and the newscaster ponders if that was “Black or Gus” that was on the photograph and he was quickly corrected by another news person in the room who had just a little bit more on the ball and who informed him that Black Angus was the type of cattle that were involved in the incident – not their first names!) were stammering on about what the firefighters were doing.

Anyhow, the newscaster – and I easily forgot his name – was pontificating about all the firefighters were doing and while I am not in your line of work, I do know what he was saying contained a lot of baloney. Fortunately, an LA County Fire PIO and I think his name was Captain Frank Sandoval got to him via phone and explained all the “systems” that the firefighters were using to do their job properly, safely and efficiently. Captain Sandoval – like Mr. Humphries of LA City Fire – represented LA County Fire extremely well and was able to explain to the clueless news people and the interested viewers some of the dangers involved in roof operations and how the first firefighter on the roof had obligations to do this and that and this and that to assure the integrity of the roof and my little head immediately defaulted to the importance of “systems” on roof operations – and in all the other high-risk tasks in which you participate. My guess is that your department has these different “systems” in place and that they are in fact properly designed and up to date – it is up to you and each of you to make sure that these “systems” are in fact being implemented.

So what is my point in this brief communication with you? If you are the Company Officer (or any other form of supervisor) you have got that key role in making sure that you and all of your people are fully and adequately trained regarding the “systems” applicable to the things you do in your specific job description. And if you are the line employee, you have to know and follow your organizational policies – not some of the time, not most of the time – but all of them time.

Again, I am just the outside interested observer, but if everyone in that company of LA County Fire personnel had a different way of handling that specific “roof operation” surely tragedy would soon occur. And that is the thrust of my message to you for this month. Know the policies and procedures (systems) that apply to your specific job – and please follow them. It is the right thing to do.

Anyhow, we are now flying over Denver I believe and it is so beautiful down there. We are so fortunate to live in California – but more important than that – we are so fortunate to live in this greatest country in the history of the world. Until our next visit together, I wish you continued success, health and happiness.

Gordon Graham
Co-President, Lexipol LLC