View: Written procedures are key to safety and quality, but Jugaad works in certain situations

“Houston, we have a problem” is the most famous line in Apollo 13, the 1995 film starring Tom Hanks about the near-catastrophic accident during the US moon mission in 1970 and the subsequent heroic efforts of the engineers to bring the astronauts safely back to Earth. But the line that sticks most in my mind is “Do we have a procedure for this?” This line and its variants referring to written procedures appear at least ten times in the film.

Written procedures are at the core of any system designed to improve and maintain safety and quality. Written procedures and documentation of completed work are the first steps in achieving the two main goals of a high-quality system:

• Reducing variability This is achieved by having different employees follow the same written instructions – preferably with sufficient detail.

• Traceability of activities This result is a natural consequence of keeping track of completed work, as it helps to identify the causes of any deviations from the trend.

The Apollo 13 screenwriter and director deserve credit for incorporating dialogue on such a mundane subject as procedures. Perhaps NASA staff consulted during filming emphasized the importance of written procedures for safe and consistent operations during an activity as risky as space flight. (Last week, a Netflix documentary called Apollo 13: Survival was released, which may shed more light on the matter.)

In India, there is still not much emphasis on well-written procedures. Safety and quality incidents are often due to the lack of detailed and well-written procedures.

Our systems are overly reliant on memory and verbal communication. From the silliest form of order taking in a restaurant, to banks, diagnostic clinics, and construction projects, there are examples of working with verbal information exchange—and a resulting reliance on memory to store that communication—leading to inaccuracies in the finished work. Knee-jerk kneeling to systems from the developed world is not a preferred approach. India has a rich tradition of highly sophisticated systems for oral information transmission, even if we do not fully appreciate these past achievements. This system was perfected to make our ancient hymns succinct and in the correct rhyme and meter for easier memorization and perfect delivery. Since there was no means of writing during that time, perfect delivery was essential to avoid the domino effect where errors piled up with each round of oral transmission.

The abundant availability of recording devices makes it unnecessary to rely on memory. In addition, complex instructions cannot be reformulated into concise sentences that facilitate memorization. The transition to well-written documents must be made.

A troubled past does not mean dismissing the benefits of modernity. Modern quality systems have been shown to deliver consistent performance at scale. Possible exceptions include the “Dabbawala” lunch delivery system in Mumbai, which interestingly was featured as a Harvard case study. But these remain exceptions.

The “Jugaad” mindset is touted as the entrepreneurial spirit. And in certain situations, Jugaad actually works. A team that is extensively and exclusively trained to follow written procedures can freeze in dynamic and uncertain situations. In organizations, these are sudden and unforeseen disruptions—accidents, system failures, pandemic restrictions, a new competitive threat, civil unrest—and individuals can become paralyzed without an “instruction manual” to follow.

Such situations require that entrepreneurial and creative spirit. There is a way to keep that spirit alive and still keep the organization running in “normal” times based on established procedures.

Even NASA or ISRO can do jugaad. The entire Apollo 13 return flight after the accident is proof of this. A prominent example was the solution to absorb excess, life-threatening CO2 that was suffocating the small lunar module. This was “engineered” by replacing the saturated absorbents in the lunar module with absorbents from another part of the spacecraft, using available materials (including socks).

But even in the Jugaad, written procedures played a fundamental role. And this is the case in any system in which high quality plays an important role.