#029 When You Should Give Up - The Christmas Tree Effect

“Simplicity is not so simple to attain.” - Nassim Taleb

This week we're going to talk about The Christmas Tree Effect.

You've come across this before.

A system breaks. You add something to fix it, then carry on.

It breaks again and you fix it again, much like the lights on your Christmas tree.

But do this enough, and what was once simple becomes complex.

The problem is, complexity creeps in without you realising it.

Then, you're in trouble.

Here are three examples of the Christmas Tree Effect in action:

"Slow Down" Signs Cause Accidents

Over 8 years, displaying the number of traffic deaths on motorways caused an extra 2600 accidents and 16 deaths.

The aim of the signs was to reduce accidents. It caused the opposite. Why? Second order effects in action.

The signs were designed to grab people's attention. And grab attention they did. The problem is, that attention is needed to drive. Reducing attention on the road caused more accidents. Logical, but only obvious looking back.

The conclusion of this study was, “Ceasing these campaigns is a low-cost way to improve traffic safety.” Ouch.

Addition can be harmful. When it comes to driving, we should be subtracting distractions, not adding them.

Hospital Efficiency

When I listened to Henry Marsh speak this year, he shared a decades old entry from his diary:

"A fine list yesterday - aneurysm, endoscopy, meningioma, MVD and a back."

Today, I'd be glad if I got through one or two of these operations in a day. What's changed?

To improve patient safety, the number of checks, systems and paper work have grown over time. Each step increases the work required to get a patient from the ward to the operating table.

Has some of it improved safety? Yes.

Is every step needed? No.

Are any of the steps harmful? Potentially.

How can checks to improve patient safety been harmful to patients? Some of the checks work, but we don't know which ones. This reduces efficiency. If efficiency goes down, then less patients get operations in a day. If less patients get operations, then more have to wait at home in pain or disability. The harm is unmeasured and effects the unseen.

Like traffic signs, checklists are necessary but not sufficient for safety.

“Half of what we are going to teach you is wrong, and half of it is right. Our problem is that we don't know which half is which.” - Dr. Charles Burwell, Harvard Dean of Medicine

Home Improvements

The thermostat in my house broke last month. Despite being up all night operating, I watched the engineer tinker with our house wiring.

There were many shakes of the head and Glaswegian, "What the f- man?" as he inspected the wiring in our basement.

It turns out the wiring in our house is ancient. Each time something broke a new wire was added. A wire here, some tape there. Year on year. Now it was impossible to figure out how the house was wired.

Much like a doctor making a diagnosis, our engineer did an intervention, like adding a wire, and tested its result. After an hour of work the boiler finally fired up.

"I don't know how it's working, but it working." I shook Dave's hand, grateful to having heating again. Like him, I wasn't bothered by the process as long as the we had the desired outcome.

But when the wiring breaks again, neither of us will be able to pinpoint the problem. The wiring is now so complex that the only solution will be to tinker and add more complexity to a complex system.

In two minds, but still with my surgical hat on I asked, "What would have happened if you couldn't fix it?"

"A new boiler and rewiring the house."

Sometimes it's better not to know.

Solution

The Christmas Tree Effect causes harm. It grows silently in the blindspot of your thinking.

It can effect simple systems like the wiring of a house. Complex systems like hospital efficiency. Or cause harm like some road traffic signs.

When dealing with a system failure, ask these questions:

1 - Do I need to add something or take something away? Only add if subtraction won't work.

When maintaining your systems ask:

1 - What am I currently doing that adds unneeded complexity?

2 - If this breaks, can I rebuild it from scratch? If not, the system is too complex. Give up on it now and rebuild.

Unless you want to fit a new boiler on a cold winter's day.

See you next week.

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