What Are We Missing?

On 20 April 2010 a drilling crew read an anomalous test as acceptable. Eleven men died. Smart people. Good information. The wrong decision. What were they missing? This book argues that the information was rarely the problem. The question was. Across real-world cases, from Deepwater Horizon, Challenger and Volkswagen to Theranos, the 2008 crash and a hospital in Merced, it shows how a problem can be framed badly even when the people involved have good facts. It then gives you PRISM, a five-move check to run before a decision at your desk, in a meeting, or alone. PRISM is a synthesis of tested parts, not a separately validated model, and the book says so. The cases draw on the public record: official commissions, hearing transcripts and peer-reviewed research. For managers, founders, doctors, parents, and anyone whose decisions other people have to live with. Planned publication: 13 February 2027.

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