{"id":1917,"date":"2019-05-19T15:51:27","date_gmt":"2019-05-19T22:51:27","guid":{"rendered":"http:\/\/b-spoke.net\/?p=1917"},"modified":"2026-06-29T22:00:29","modified_gmt":"2026-06-29T22:00:29","slug":"trouble-shooting-meltdowns","status":"publish","type":"post","link":"https:\/\/thirdactmedia.com\/b-spoke\/2019\/05\/19\/trouble-shooting-meltdowns\/","title":{"rendered":"Trouble-Shooting Meltdowns"},"content":{"rendered":"
A five minute read.<\/h6>\n

Just as most adults think they’re a \u201cbetter than average\u201c driver, and at least ninety percent of managers rate themselves as \u201cbetter than average\u201d communicators, if you assemble group of professionals and ask them to rate their problem-solving skills<\/em>, most will say they\u00a0 are among the best.<\/p>\n

\"problems\"<\/a>Confidence, particularly in trouble-shooting abilities, is great. Knowing that, no matter the challenge, you\u2019ll be able to face it down and find the solution? That’s what being a Man of Action is all about.<\/p>\n

Often, though, this confidence isn\u2019t from an ability to face the unknown and successfully navigate through a murky situation \u2013 it comes from the memory of simply making it out alive the last time.<\/p>\n

Those that rate themselves as great problem-solvers generally have experience with a specific issue. They\u2019ve \u201cseen this\u201d \u2013 or something very much like it \u2013 before. They are faster than most at recognizing<\/span> the concern and can quickly recall<\/span> how they got out of it. (Not necessarily \u201csolved\u201d it \u2013 or it wouldn\u2019t be back, would it?)<\/p>\n

Their challenge comes when facing something new<\/em>. Or something that presents<\/u> as a \u201cnormal\u201d problem, but has all the hallmarks of a real corker.<\/p>\n

The danger is in knowing enough<\/u> about a problem to be unafraid to tackle it, but not<\/u> knowing enough to recognize how little is really known.<\/p>\n

A textbook case of this features in HBO\u2019s Chernobyl<\/em>. The premiere episode perfectly captures the hubris particular to the boldest of cause-jumpers: calm, in control, smugly self-assured, but absolutely and dreadfully wrong<\/em>. This is tragedy in its classic sense: Deputy Chief Engineer Anatoly Dyatlov (perfectly captured by Paul Ritter), though well-intentioned, brings ruin upon himself – and half of the Soviet Union- because he refuses to see the truth.<\/p>\n

Craig Mazin\u2019s script highlights some classic Dangers of the Cause Jumper.<\/p>\n

Danger Number 1 \u2013 Believing Our Initial Instinct Is Correct, No Matter What Others Tell Us<\/h4>\n

If there can be a Most Classic of the \u201cclassic Dangers\u201d, this is it.<\/p>\n

Operator 1:
\nWhat just happened?<\/p>\n

Operator 2:
\nI don’t know.<\/p>\n

A third operator enters the control room.<\/p>\n

Operator 3:
\nSomething blew up…<\/p>\n

Dyatlov thinks through this.<\/p>\n

Dyatlov:
\nThe turbine hall… The control system tank… Hydrogen\u2026 You morons blew the tank.<\/p>\n

People don’t get promoted without knowing a few things, and Deputy Chief Engineer is no different: he “knows” that if there\u2019s a fire in the hall, a tank exploded. Every time he’s seen a tank explode, there’s been a fire like this one. So if there’s a fire like this one, his thinking goes, then the only reasonable explanation is an exploded tank. <\/em>This is faulty reasoning, of course – just because A always causes B, it doesn’t mean that B is always<\/span> caused by A.<\/p>\n

\"\"He instructs the operators to send cooling water into the core. But one of the operators tells him, \u201c<\/em>There is no core.\u201d<\/em><\/p>\n

He is dismissive: \u201cYou\u2019re confused. Cores don\u2019t explode.\u201d<\/em><\/p>\n

Dyatlov orders them to continue pumping water into the core. The core they (correctly) believe is gone. He says \u201cwe\u2019re wasting time\u201d, and they are \u2013 they\u2019re doing something that won\u2019t help, to something that isn\u2019t there anymore.<\/em><\/p>\n

Later, Dyatlov does some mental math to convince himself of his original diagnosis. He asks if his instructions were followed, if the cooling rods were lowered into the core. An operator, at a complete loss, tells him, \u201cThe core\u2019s gone.\u201d<\/em><\/p>\n

Dyatlov rages, tells the operator he\u2019s delusional. When it\u2019s pointed out that this operator is covered in radiation burns, Dyatlov sticks with his diagnosis. \u201cRuptured condenser lines will do that. He will be fine. I\u2019ve seen worse.\u201d<\/em><\/p>\n

As bureaucrats fill the conference room, another engineer describes seeing a piece of glowing graphite on the ground. Dyatlov tells him:<\/em><\/p>\n

You didn’t see graphite.<\/p>\n

Engineer:
\nI did.<\/p>\n

Dyatlov:
\nYou didn’t. You didn’t. Because it’s not there.<\/p>\n

Dyatlov’s boss:
\nAre you suggesting the core exploded?<\/p>\n

Engineer:
\nYes.<\/p>\n

Boss:
\nYou’re a nuclear engineer. Please tell me how a core explodes. I’d like to know.<\/p>\n

Engineer:
\nI can’t.<\/p>\n

Boss:
\nAre you stupid?<\/p>\n

Engineer:
\nNo.<\/p>\n

Boss:
\nThen why can’t you?<\/p>\n

Engineer:
\nI don’t\u2026 I don’t see how it could explode.<\/p>\n

The boss throws his arms up, to say, See! I was right all along!<\/p>\n

Engineer:
\nBut it did.<\/p>\n

Once a Cause Jumper has latched on to an explanation, like a bulldog with a rawhide bone, he\u2019ll never let go.<\/p>\n

Corollary to Danger Number 1 \u2013 Bullying the Group<\/h4>\n

When the danger first presents itself, another operator, clearly afraid \u2013 whether for his safety or for his job security is unclear \u2013 agrees with Dyatlov: \u201cWhat you\u2019re saying,\u201d he tells his colleagues, \u201cis impossible\u201d.<\/em><\/p>\n

How often do good people pipe down in a meeting because the loudest voice claims authority? Or just won’t stop repeating themselves? The rational thinkers lose momentum, and the false narrative becomes the only narrative.<\/p>\n

A Man of Action will document the bully\u2019s opinion, but also make sure to capture any contrary views.<\/p>\n

Of course, putting effort into capturing the facts is the cure here. And facts can be tricky little buggers\u2026<\/p>\n

Danger Number Two \u2013 Cherry Picking Data<\/h4>\n

To solve a problem, the Man of Action \u201cgoes to the Gemba\u201d \u2013 wanting firsthand, visual evidence of the issue. They want to see, hear, smell, touch, or taste what\u2019s happening. In Chernobyl, though, the Gemba was a deadly place to be!<\/p>\n

\"\"Even so, throughout the episode, operators go to and return from the reactor, covered in radiation burns; they are bleeding, limping, literally melting \u2013 and yet no one uses that data. (Several operators complain about a specific metallic taste in the air \u2013 surely evidence this is not a normal fire. That data is never captured).<\/p>\n

In almost any situation, there\u2019s objective, non-anecdotal data to be gathered – and at a nuclear power plant, the surest indicator is radiation levels.<\/p>\n

Dyatlov decides to take measure. He\u2019s told that the reading is \u201c3.6\u201d.<\/em><\/p>\n

\u201cNot great, not terrible,\u201d he says. (We learn later in the episode 3.6 is, in fact, terrible enough that the entire town should have been evacuated.)<\/em><\/p>\n

Even without that knowledge, he should be concerned \u2013 the maximum<\/u> reading on the meter is 3.6! It\u2019s pinned in the red \u2013 there\u2019s no way to know how bad the situation really is.<\/em><\/p>\n

More robust test equipment is kept under lock and key (presumably because rank and file can\u2019t be trusted). Once it\u2019s retrieved, and turned on, it reads so much danger so quickly that it shatters.<\/em><\/p>\n

Dyatlov snorts, \u201cTypical\u201c, and his boss agrees. \u201cThey send us shit equipment\u201d.<\/em><\/p>\n

They try again, and a different one breaks: \u201cAnother faulty meter.\u201d<\/em><\/p>\n

How many times are circuit breakers reset \u2013 or pumps replaced \u2013 rather than chasing down the root cause? When every preventive measure in place trips, a good trouble-shooter doesn\u2019t presume every measure is flawed.<\/em> She looks for the cause of the cause.<\/p>\n

Danger Number 3 \u2013 Focusing on Blame<\/h4>\n

Dyatlov isn\u2019t entirely certain of what\u2019s happening, but he knows<\/span> someone screwed up. (\u201cYou morons blew up the tank.\u201d)<\/em><\/p>\n

In the opening scene, we are told by our narrator, \u201cAll we want to know is, who to blame.\u201d<\/em><\/p>\n

Plant managers and bureaucrats descend on the conference room and grill Dyatlov.
\n<\/em><\/p>\n

Dyatlov:
\nWe ran the test exactly as the Chief Engineer suggested.<\/p>\n

Chief Engineer:
\nDyatlov was supervising the test.<\/p>\n

They reiterate the “low” (3.6) rad reading.<\/em><\/p>\n

Then they actually applaud themselves on how well they are handling the crisis \u2013 while literally spewing nuclear waste into the air that their wives and children breathe.<\/em><\/p>\n

Apollo 13 is often cited as a case study in trouble-shooting skills triumphing over the fates of the gods themselves. But even then, after the explosion onboard the spaceship, the first words out of Tom Hanks\u2019 mouth are: \u201cWhat\u2019d you do?\u201d<\/p>\n

\"\"There will always be time for blamestorming. But good problem solvers wait until the fix is in place before they even begin to worry about who screwed what up.<\/p>\n

You will likely (hopefully) never face a situation like the engineers of the Lenin Nuclear Power plant in Chernobyl, Ukraine. But a Man of Action needs to be ready to move quickly and with limited data.<\/p>\n

Sometimes that means jumping to the wrong course of action (deciding to cool a nonexistent core, for example). But once more information comes in<\/em> \u2013 anecdotal or measured data \u2013 a Man of Action pivots. It\u2019s a delicate balance \u2013 blindly adhering to an initial course isn\u2019t \u201caction\u201d but activity.<\/p>\n

A Man of Action will aggressively capture the facts, and challenge assumptions.<\/p>\n","protected":false},"excerpt":{"rendered":"

The engineers in HBO’s “Chernobyl” demonstrate the all-too-real flaws of poor problem-solving: Jumping to cause (and never letting go), refusing to accept data, and focusing on blame. Continue reading Trouble-Shooting Meltdowns<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":2298,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[6],"tags":[47,57,74,85],"class_list":["post-1917","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-managing-problems","tag-man-of-action","tag-pop-culture","tag-root-cause-analysis","tag-visible-thinking"],"jetpack_featured_media_url":"https:\/\/thirdactmedia.com\/b-spoke\/wp-content\/uploads\/2019\/05\/chernobyl-featured.png","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/thirdactmedia.com\/b-spoke\/wp-json\/wp\/v2\/posts\/1917","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/thirdactmedia.com\/b-spoke\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/thirdactmedia.com\/b-spoke\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/thirdactmedia.com\/b-spoke\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/thirdactmedia.com\/b-spoke\/wp-json\/wp\/v2\/comments?post=1917"}],"version-history":[{"count":2,"href":"https:\/\/thirdactmedia.com\/b-spoke\/wp-json\/wp\/v2\/posts\/1917\/revisions"}],"predecessor-version":[{"id":2350,"href":"https:\/\/thirdactmedia.com\/b-spoke\/wp-json\/wp\/v2\/posts\/1917\/revisions\/2350"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/thirdactmedia.com\/b-spoke\/wp-json\/wp\/v2\/media\/2298"}],"wp:attachment":[{"href":"https:\/\/thirdactmedia.com\/b-spoke\/wp-json\/wp\/v2\/media?parent=1917"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/thirdactmedia.com\/b-spoke\/wp-json\/wp\/v2\/categories?post=1917"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/thirdactmedia.com\/b-spoke\/wp-json\/wp\/v2\/tags?post=1917"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}