Tuesday, September 29, 2009

Fixing Healthcare, Just Like Fixing Airplanes?

With all the talk lately of American healthcare troubles it got me thinking on the subject of problem solving. That IS the goal I think; but it seems that very few if any of the myriad techniques available are being applied, other than the amateurish principle of “trial and error,” which may well be the worst method there is. I’ve heard people in the administration actually say things like, “The problem is SO catastrophic that we NEED to do something, ANYTHING; we can always “tweak” it as we go later.”

Similarly, back in “the stupid old days,” the US military routinely used the “field and forget” method to employ new weapons systems,” a fiasco of a way of doing things that usually ended up as “field and fix.” The annals of our military history abound with horror stories of hastily-employed weapons; the extent of their failings discovered at the worst possible time, that is, “when the weapon met the war.”

The “fog of war” is murky enough without making it worse with untested equipment, yet until relatively recently we routinely did this foolishness. Usually it happened because of politics (sound familiar?), or where some high placed officials thought THEY knew better than the REAL experts, the experts of course being the enlisted folks and officers who have to actually use the stuff.

During my time “in” I was around quite a bit of problem solving, which started with my time as a technician and technical supervisor. But all that turned out to be preparation for what I got into during the last half of my career, when I graduated from repairing individual planes to resolving issues involving entire fleets of aircraft. If I’m completely honest though, rarely was I the actual “solver,” but always I was certainly part of “the problem solving process,” a process that invariably involved input from a team of “solvers.”

I got onto the whole “big picture” problem solving ride by accident. It started as I entered into the last 13 years of service, the half way point of my time in the military. From there my career path meandered to the extraordinary, at least compared to a lot of other airmen’s careers.

My job path took off on this “merry tangent” in 1989 when I left the position of shift leader for a new job in the Quality Assurance Office after being recruited into it by the master sergeant I eventually replaced. (I caught his attention one morning as he observed the no-nonsense way I handled my troops during the weekly “FOD walk”). During my next 6 years in the Quality Office I also took on the ancillary responsibility of overseeing a contract field team of around 25 or so civilian technicians whose job it was to strip out most of the original 30-year-old electronics in our vaunted C-130 “Hercules” cargo plane, and installing modern systems in their place.

What I found the most interesting about that 6 year QA gig was constantly running into new problems, some big, some small. There were about 80 airplanes on our flightline (including the Air Guard’s)—a lot of C-130s. With so many “birds” it took several years to modify all of them; so for quite some time we had a mix of newly modified aircraft, along with “birds” still creaking along with 30 and 40 year old technology.

As lead base for C-130s, often times we were first to get the newest systems, on a trial basis so to speak. In effect, we were the guinea pigs for the rest of the fleet; as such, I was confronted with glitches and gremlins almost on a daily basis. My job was to research these malfunctions, in the short term find out the “whys,” and finally, to come up with answers and even resolutions.

It was during this time of continuous problem solving that I began to simultaneously submit my “fixes” by way of the Air Force Suggestion Program, as well as to the primary approving agency being the Air Logistics Center at Warner Robins AFB in Georgia.

I remember the first time I had a suggestion approved just a few months before I joined the QA team. It was to modify an incorrect troubleshooting tree for engine oil pressure transmitters. It wasn’t all that complicated, but months later, seeing the pages amended in the technical orders to reflect MY changes was quite heady. In a small way I had affected the entire fleet of several hundred C130s. I felt pretty good about that, and about the little award check I got out of it as well.

The stars lined up perfectly when I joined the QA shop and found myself responsible for the proper installation of a host of new aircraft electronic systems. As part of these responsibilities I worked with the Lockheed “mod team” to write the installation workbook requiring that I saw and or touched every new wire bundle, screw and rivet that went into the plane. As part of that workbook I made it mandatory that I personally sign off the okay to reinstall every panel to make sure there was no debris left behind it before they were allowed to button it back up. There was a good chance that I would be the last person to inspect those areas for years to come; and believe me, I felt the pressure of knowing that. When it comes to aircraft work there is no such thing as being too critical; it either meets spec or it doesn’t. My very last signature was the one I made on the acceptance sheet which brought each airplane out of depot status back into operation with the Air Force.

Earlier I spoke of how the military has made a science of properly fielding new weapons systems (in fact, the army has a university devoted to perfecting and teaching acquisition at Ft Lee, VA); BUT, when installing so many new systems onto a 30 year old platform like our C-130s were, while still keeping much of the deteriorating original wiring and archaic electrical power, in the aftermath of that we were bound to have to do some major “tweaking.”

Indeed, MY CFT guys put a LOT of new gear into those old planes: Let’s see, one of the most complicated installations was a brand-new redundant Self-Contained Nav System that also provided attitude information to the flight directors; the team also put in a host of flat panel and digital instruments to replace the old spinning dial analog indicators, a new autopilot, GCAS (ground collision avoidance), a partial upgrade to aircraft power, a much improved radar altimeter and Doppler radar, as well as several new radios and associated antennas and secure voice kits. Toward the end of my tenure we also started to put in GPS, TCAS (aircraft collision avoidance) and electronic countermeasures to include the chaff and flare dispensers. After almost 15 years since my involvement I’ve forgotten some of the systems MY team installed, but per aircraft all that work took hundreds of man-hours, thousands of feet of wire, countless hundreds of wire pins and terminals, and scores of connectors; and it all had to be done perfectly and on schedule, aircraft after aircraft. All those long overdue upgrades were bound to lead to a host of problems, and boy, did it ever!

From 90 to 91 I took a short break from “my path” by going to war; during the two years it took those 7 months to pass I became a regular maintainer again. After the war I returned to Little Rock to find shocking changes in my absence; the Air Force had gone through a major organizational and philosophical shakeup—maintenance had become completely decentralized; there was no longer a single colonel in charge of maintaining all 64 aircraft. Overnight each of the four squadron commander’s took over complete responsibility for their own birds’ upkeep.

Not only that, but a new concept called TQM, or Total Quality Management (a term now long out of vogue), had become the latest management fad. Under it, all of us once scary QA boogiemen lost our scariness and instead we became nerdy “quality facilitators.” Lucky for us though, our Logistics Group commander was shrewd enough not to dismantle us the way other C-130 bases had done immediately to their QA shops once the reign of TQM had begun. The fact that our QA pretty much remained intact paid off big as far as I’m concerned.

I must admit though that I wasn’t sorry to see the days of inspection quotas ended; I never liked doing all those tedious exams anyway. Instead of inspecting individuals’ work (making them extremely nervous!) and checking out test equipment, we began concentrating on “process improvement.” And ho hum, I guess we did some of that, but what really excited me was getting all that new electronics correctly installed, and just as important, finding and fixing all the associated glitches and bugs.

And HERE is why our commanders were so brilliant in keeping us QA boys around—we became the corporate knowledge bank, the go-to-guys for oddball problems, and the overseers of high interest taskings from the command.

There is a very scary truism about airplanes: You don’t know what’s screwed up if you don’t know what’s screwed up. This strange axiom became obvious when our wing became the only one still conducting so-called acceptance inspections of those C-130s returning from the depot facility at Ogden, Utah. We had just way too many airplanes to let our contract field team do all the modifications, so Ogden and Warner Robins did them as well. The problem is that the colonel in charge at Ogden became upset with us because we were the only ones complaining about their work. I would go out to an airplane just arrived from Utah and fill page after page of squawks on a legal pad, and many of them were grounding write ups (I once found over 100 writeups). The Ogden colonel was so irked at us that he paid for me and my right hand man, a brilliant avionics troop by the name of Shawn Dougherty, to come to his facility so he could show US how wonderful HIS installers were. As it turned out, we were not the least bit impressed and in fact showed them the many errors of their ways. At first their resentment was disconcerting, but eventually I think we won them over with our earnestness.

The point is that WE KNEW what to look for because we were were intimately familiar with every disturbed and new wire bundle and connector, so we immediately recognized the improprieties, but we were the only inspectors left at the wing level who continued to do these post-depot inspections. A chilling thought—what about the OTHER aircraft never looked at with the same knowledgeable eyes? As far as all the other users the installation was A-okay. The only actual acceptance inspection done at the depot was done by an aircrew that had no clue about what was physically done to the aircraft and whose only worry was to accomplish the checkflight. As far as they were concerned, if the systems worked on that flight, then it was good to go. In other words, “Ignorance is NOT bliss.” …shudder…

And NOW, to finish up this LONG post—my counterpart, Shawn Dougherty, and I, began to LOOK for problems or just ways to make maintenance actions less cumbersome and more efficient. Here’s what we learned: if you stay your ass in the office, you will NEVER learn a thing. You GOT to find out what you DON’T know. A common fault of problem solvers is that they THINK they KNOW; they DON’T. Following that premise we made our rounds to the flightline, to the squadrons, to the shops, to the contractors, all with the goal of talking to “the experts.”

Hardly a day went by where some sergeant or senior airman didn’t come up to me to complain about some new glitch or malfunction. It got to the point that troops seeing me drive by would jog over and flag me down, something they NEVER used to do when I wore my white boogieman QA hat. They loved that I always had a sympathetic ear and asked lots of questions. Complaints, moans, and groans—I LOVED it. If they had a problem I WANTED to hear about it. Their squawks became my bread and butter.

To finish blowing my own horn, we began to establish a reputation, especially once all the approved suggestion awards began to roll in along with the award checks. Every month during commander’s call Shawn and I would receive not one or two checks, but usually 5 or 6. This went on month after month, for almost three years; and once the word got out that WE were the people to see to get things fixed, even more folks approached us with their tales of woe. I’m pretty sure our success inspired others to do the same thing. I loved it, being able to make a difference.

As I said, seldom if ever was I the one that came up with the fixes. Most of those ideas came from the same folks who came forward with the problems in the first place. Ask someone for a problem and chances are they can also tell you how to solve it.

But my REAL secret weapon in tackling especially big problems was my contract field team. Those fellows were incredibly brilliant at finding the best solutions. Most were retired military with decades of experience working on aircraft long before they started modifying planes as civilians. Whenever I approached them with a problem, I’d make my pitch, usually at the break table, and then I’d leave them to mull it over. Without exception, within a few days they’d have a workable solution, usually complete with diagrams and written procedures. They always told me that they wanted nothing in return since by contract everything they came up with officially belonged to Lockheed. It was a joke to them; they said they’d rather I have credit than Lockheed. Absolutely remarkable men!

In 1992 or 93 the base commander even chose me to be his Suggestor of the Year, or at least some one in the suggestion office did, not that I was even aware that such an award existed. It was nice but it could easily have gone to Shawn, since we collaborated on most of our projects. I always say that THE best idea I ever had was hiring him to work with me in QA.

I learned during those exciting times that my strong suit was seeing the brilliance in others and tapping into that brilliance as a primary resource; and I found that the best answers invariably come from the same folks who come forward with the problems in the first place. If the solution is the drink then I was the humble vessel. I did my job best by completely defining the problems and their scope, usually after that, what had to be done became obvious. I’m sure the answers to our healthcare dilemma can be found in exactly the same way; and not by a bunch of self-serving politicians and lobbyists who THINK they know the answers; THEY don’t.


Anonymous said...

I left you a present on my sunday post...

Anonymous said...

Great post. My time "in" was shorter than yours, as an attack/fighter guy in the navy. We were organized a little differently... and I spent lots of time wearing the maintenance hat, even QA for a bit. Went from analog to digital with A-6E to F/A-18's... worked with some amazing problem solvers, and had to sign off more than my share of inspections.

Mostly however, I flew a jet that guys like you made sure were ready to go. So many unsung heroes and professionals! Later I worked tech/C4I issues from the staff side overseas, solving other problems. And you're right on target with the health care debate.

Since every aspect of that debate is infused with politics (sort of like trying to stick TQM into processes that were already finely tuned), I just don't see government-run health care- for the masses- being managed efficiently, reliably and in a long-term manner that protects the well-being of those needing services. It will be a spending hole full of fraud...

Thanks for sharing your thoughts. - Beau