Ever heard of triage?

May 15, 2010

My experiences at Dallas Airport yesterday are still fresh in my mind and if anything my level of frustration is increasing. This is not so much because things went wrong, then always will and at the most convenient times. Thunderstorms are a part of life in Texas and I can see its dangerous for the ground crews to be out and about when the storm is within a few miles of the airport. Volcanos cannot be persuaded not to throw ash into the skies after all, we just have to cope when they do.

My latest worry on travel is the volcano as the news indicates it may impact on my return to the UK on Thursday night and potentially my trip to watch the Blues v Toulon in Marseille on the weekend. However I will just have to wait and see on that. I would prefer to be stranded in Santa Fe than in New York, but it has not panned out that way!

Now I could just whinge about this in my normal inimitable style and roll out an attack blog. However the real frustration is that the solutions to each problem I encountered were pretty self evident to any intelligent observer. Resilient strategies assume failure, but focus on fast recovery. To do that requires a sophisticated use of constraints which includes the use of triage systems. So what I want to do is describe the problems as they hit and suggest some of the solutions. I’ll also try and summarise this in terms of constraint management, the essence of complex systems strategy. Just to make it clear, I am talking here from the experience of travel, someone with professional knowledge may be able to tell me why what I perceive as common sense solutions would not work (the first point on storms for example). Also, if anyone adopts any of these solutions tell me – the least they can do is pay a royalty!

Problem/Description of events 101 stuff easy to do, should have been done Planned resilience, needs some investment but …
A couple of hours out of Dallas the pilot comes on to explain that Dallas has been largely closed by thunderstorms and we have to divert. He has chosen Chicago O’Hare as it has other crews and more connections. The existing crew has a limit on the time they are allowed to fly. He hopes we will be able to refuel and then go onto Dallas as soon as the weather clears. The first and most obvious question is why on earth do this? An aircraft is a Faraday cage, it can take being struck by lightning and its a low risk anyway. Better to have have your international flights parked near the terminal so they can move in during gaps in the storms. Holding patterns are cheaper than landing and taking off.

There were some mumblings about it being the wrong type of storm but I’m not sure about that one, planes manage all sorts of storms in the sky and a holding pattern with entries between storms sounds to me feasible, especially for incoming long haul flights with many connections.

In airports prone to Thunderstorms think more actively about mobile lightning conductors and other measures that would actually remove the risk around the terminal buildings. It could be a tourist attraction!
We land in Chicago O’Hare and pull into a terminal. We are told the position has improved and we will be refueled while the pilot checks the weather. We are also told that no one can leave the plain as Homeland Security were not expecting us. After a fairly short stop we take off again for Dallas There were probably 30-40 people on the plane who could have been accommodated with re-routing better from O’Hare (which also had perfect weather conditions) that from a delayed arrival to Dallas. Thats an estimate based on conversations with other passengers around me. I was one of them as I knew that there were flights I could make if I had been allowed to leave the plane.

The Homeland Security argument is a complete nonsense, it doesn’t matter which airport you land at and I am sure Chicago could have coped with a couple of extra planes. Passengers could have been called off, they had know about the problem for several hours. Alternatively we could have been given the choice. Frequent Flyers often know the schedules better than airline staff.

see above, it was really not necessary. However changing the process if an aircraft makes a temporary stop to look at passengers (even a few would make a difference) and call some exceptions would make sense
We arrive in Dallas twenty minutes after my flight is meant to have left. Now given the overall delays at the airport I still have hopes that I could catch it so I leave the airplane in pole position. We are told that people (its not clear who) are aware of our situation and that many flights have been cancelled and others delayed but there is no way we will know until we have cleared customs. This is really silly, the sign of a system that has lost control as it is stressed. At the very least it should be easy to tell people before we land whose flights have been cancelled and which they may still be able to make. That information is already available and could easily be communicated to the crew. Even if this was hard then a couple of staff and a large notice board outside the jet bridge would have helped. In practice a large number of passengers will already have been rescheduled and this material is available. The vast majority of us will have given email and mobile phone numbers to the system prior to boarding. The merry tinkling of blackberries and iPhones after we landed means that a very large number of passengers could have know what was happening to them before they left the airplane. My revised flight and the hotel I had been booked into could have been provided this way. That would have relieved much pressure elsewhere in the system

It was a distress rate by the way, airlines in America don’t take responsibility for Weather, but they will get you a cheap rate, although its pot luck. Last week cockroaches, this week five star luxury but both for $69).

I arrive in the customs hall to discover that several planes have landed just ahead of us. The queue for US Residents is short and remains short (queue time less than 15 minutes). For Aliens the snake is already three lanes and the prior flights are from China and Jamaica which is always going to increase delays with language and visa issues (I make no comment on the ethics of this, its just reality)

There are only four officers for aliens, twice that number for US Citizens. I end up taking 90 minutes or process through and I am standing up throughout that period. Also the numbers of officers reduced as the shifts had been calculated on normal aircraft movements not massive delays.

This is simple triage. Massive delays all round even though there were staff marshaling people, but only at the head of the queue. Some people tried to argue their case on grounds of short timescales but in effect just ended up further back in the queue. All that was needed was to set up a few qualified queues (easily validated by existing paper work): (i) Flights leaving in the next hour, (ii) straight forward entry, (iii) families with small children, (iv) Others.

That would have taken half an hour to organise and would have relieved pressure and saved money. Holding those back (along with US Citizens) from the front line would have allowed people to be fed into the system based on some form of priority.

Get a couple of airline staff with communications equipment into the customs hall to help and advise passengers while they are waiting. That could include giving them details of new flights and hotels per my prior comment, that way they know what they are doing when they leave the customs hall

Extend the electronic entry to non-american citizens happy to provide biometrics etc. At least from those countries where entry requires no more than filling out a Green Card. It would give security better data and the odd random check would handle any security issues.

Get volunteers from the local community with language skills to volunteer to be called in to help people with filling out forms etc. That move alone would reduce stress and considerable input throughput.

I finally leave the Customers Hall and now face an even longer queue at the re-checkin area. For the first time I can look at a departure board and learn my flight has either gone or been cancelled. Knowing the airport I decide to go up to departures and join the queue there. A good call as its shorter but it still takes me two and a half hours to reach the head of the queue.

The staff are being harassed, a lot of people speak poor English and again we are standing up. In all I didn’t sit down between 1930 and midnight when I got on the shuttle to a hotel. Experience meant I had used the rest rooms before leaving the aircraft and on exit from Customs Hall. Others were begging people to keep their places and many would not. The atmosphere got ugly and police were called in three times to calm down passengers.

When I got to the head of the queue it took three minutes to be given a revised flight number and time and hotel details. I should say that the whole area was very confused and it was not clear where you should go. Again people were going off shift as the evening progressed. We went from five to two over two hours with knock on consequences for stress on all those involved

Basic triage again. Take one full bank of checkin desks and dedicate them to experienced staff who do not need help with the computer system (we kept loosing one person who had to help others out). Put a basic triage system in that sorts people into two categories: (i) accept the solution we have come up with or (ii) talk about it with an agent.

Give people numbered tickets (like they have in supermarkets and amusement parks) so they can get a coffee and/or sit down for a period before being called. Some people were in real distress. Print clear instructions as to how to get a shuttle to the hotels being used in three/four languages that can be given to people. I had to wait for fiveteen minutes while one elderly french couple had these basic details explained to them in very loud English. The Americans have picked up on the British habit of shouting at foreigners on the grounds that they will then understand you; maybe it goe with Empire?.

If you are using downtown hotels, then get Supershuttle to have a van in every half hour to pick people up at a properly signposted waiting area. All of us had to phone the shuttle service individually , which meant two calls, one to book and one to trigger pickup, in practice they were coming in every half hour anyway up to 0100 and beyond for all I know.
Bring in some form of catering, it only has to be iced water or something just to relieve the tension. Move some televisions into the areas, provide newspapers. Anything to keep people occupied

See above, the problem should never reach this stage, but you could use the electronic checkin machines for routine cases (new flight, boarding pass and hotel voucher.

Use the police, and some pilots and other crew if they can be persuaded to stay to mix with people and talk. The airport police the same. Defuse tension, tell people about what has happened, create a sense of shared pain and concern. Spot people who are liketly to blow early. Engage people in talking, use humour. I’ve put this here as it requires training and planning, but it could easily be done.

Lets have a look at this in terms of the approach. In Cynefin terms I have recognised that the situation has moved from being complicated to complex, and in consequence my strategy needs to change. In normal operations we have a complicated system that can be engineered. We know size and landing frequency of planes, we can build models that allow for optimal use of resources and take a one time fix approach to where issues are handled. Root cause analysis, process engineering, optimization algorithms, simulation software etc. all come into play. The engineering process by its nature manages by increasing constraint to the point where behaviour is channelled and largely predictable. Failures in normal conditions result in learning and system modification. All good stuff, until the sheer number of abnormalities, the number of agents and the restricted context of constrain design tip the balance into the complex. Now I need to do things differently, and I need to do it fast. Remember the three basic principles of complexity based management: finely grained objects, distributed cognition and disintermediation.

What are the key aspects of the changes above?

  • I know that there is no one right solution, so I abandon linear processes based on a one time fix and move over to parallel or multi point solutions that attempt a many time partial fix solution. That means having several points at which individual passenger issues can be resolved at different points in time. I am then dealing with smaller (finely grained) problems in different places. I know that at each point people will slip through the net, but each time there are fewer people and I am reducing the problem when it hits the point of last resort – the rechecking desk.
  • Any process based on low volume and planned outcome has to be looked at quickly and changed. For example hotel bookings are normally done in advance and transport booked. It thus makes sense for someone after the baggage claim to ring to advise they are present and get a shuttle collection time. With increasing volumes over shorter times with recently initiated hotel books this will not work, or at best will slow things down and increase frustration. By batch booking transport and printing leaflets I am reducing explanation time on the desk so increasing passenger throughput. I am also increasing the ability of passengers to help each other out as they gather in the waiting area. I am increasing agent interaction without boundaries which means I am encouraging distributed cognition and problem solving.
  • I am moving human agents into key points with simple heuristic based judgements (such as who goes into which queue). Humans have more flexibility and adaptability when constraints are slacked. The last thing I want is a couples of jobs worth characters enforcing a process designed for a completely different context.
  • The distinction between staff and customer is being blurred to handle the complexity, distributing cognition to more experienced passengers who given minimal information will be able to work most of the rest our for themselves, freeing up staff to deal with the more naive. By providing more information via technology I am creating the conditions under which several passengers will be able to solve the issue for themselves.
  • At all stages I am trying to do as much pre-processing as possible, bring as many things forward in parallel to that I can reduce bottlenecks, creating staging or holding areas in many places not just one or two.
  • The one big thing I have not mentioned is the use of this crisis to change things, to experiment. You never get a better opportunity to innovate than in a crisis. So if one comes along put a couple of bright young people and some experienced hands on the floor to help out and talk with people. Try things out, its a great opportunity for safe-fail experiments. If some fail it will be OK, some may succeed and then you can build them into your standard processes to iprove efficiency and reduce costs when things become complicated again.

There is a lot of redundancy in these solutions, people missed at one stage can be picked up at a later one Its not difficult, its all about resilience, absorbing not reducing complexity. Its common sense informed by sound theory. The trouble with out over engineered culture is they can only accept complete and planned solutions. When these fail they fall back to using existing processes and just hoping it will eventually sort itself out.

That is what happened here. No one changed the system they just let pressure built up and were lucky it didn’t blow. Any more ideas?

PS: there may be more comments tomorrow, I have yet to sort out Hertz who are unable to change my booking other than by charging me twice (a now show and a new booking) despite the fact that I am using the car for one less day. The international Gold Card help line expressed the hope that I could sort it out locally as she could do nothing.

PPS: no need, the local staff at Hertz in Albuquerque were brilliant. My car was waiting for me with the boot open, a free upgrade and sat nav. I had pre-paid three days one one day could not be refunded, so they did something which really cost them nothing but made me feel good. Also the guy at the exit directed me to the nearest Starbucks but advised me there was no city mug for Albuquerque (sob) only New Mexico (purchased). He was not sure about Santa Fe but I will test that in the morning when I plan a dawn walk around the town with camera.

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