The Tham Luang cave rescue: Decision-making with the highest stakes

Ashley Kilgore:

For nearly three weeks during the summer of 2018, the attention of millions across the globe was focused on Northern Thailand, where a massive effort was underway to locate and rescue 12 members of a boy’s soccer team and their coach who were trapped underground in the rapidly flooding Tham Luang cave. Among those watching was Yael Grushka-Cockayne with the University of Virginia’s Darden School of Management. As she watched this incredible rescue effort unfold, she recognized it as a massive and complex study in risk management and decision making. One in which the highest stakes were involved. Today, I’m thrilled to be joined by Yael to take a look back at this event and share the insight gained from her own case study of a rescue that had different decisions been made at key points along the way, could have had a very different outcome.

Yael, it’s such a pleasure to speak with you today. In preparing for our interview, I listened to webinar by the INFORMS Decision Analysis Society where you discuss this subject and for our listeners, I’ll include the link in the show notes at resoundingthehuman.com. And your passion for this topic is obvious. I’m just really excited to dive in.

Yael Grushka-Cockayne:

Okay. Wonderful. Nice to talk to you today. I’m excited to talk to you about this case study that I really have enjoyed teaching.

Ashley Kilgore:

Now, within your study of this event, you actually break it down into two case studies, a case A and a case B. A being the effort to locate the boys and B being the actual rescue. Can you walk us through this approach?

Yael Grushka-Cockayne:

From a pedagogical perspective, or from a learning perspective, it felt to me a natural break point in the story. Things shifted in the mindset. The focus shifted, the goal shifted. And since I was coming at it with a project planning and decision making kind of approach, to me, it made sense to think about how our goals affect our behavior, and how our goals might affect our organization, and how the reality of the world was just totally different before and after finding the boys. The task at hand was different. And so, the more me and my co-author just dug into the story, the more it became pretty apparent to us that we had to kind of have that shift and breaking it up to an A and B case seems like the natural way to do that. There’s also a natural crescendo moment and climatic moment in the story that we get from the moment of finding the boys. And so as disparity increases in the search, I think the finding of the boys was a real kind of special moment for various reasons where a lot of the tension is eliminated and everybody can sigh a good sigh of relief that they’re healthy, and that they’re found, and that we resolve that unknown. That huge unknown. And I think if we didn’t have that natural break between the A and the B case, that climatic moment may have gone lost.

So kind of you want to pause, you want everybody to compose themselves, you want everybody to recognize that the boys have been found, safe and sound. But now, oh, now it opens the door to, okay now what? And kind of the recognition that we have a whole episode two to kind of go through, or season two, if you will, of planning the second phase. And so, that was part of the reasons. I’ve taught it as an A and B. So read only the A and then come back and read only the B. And I’ve also taught it where people read them upfront, both of them. And I think depending on the pedagogy and the class flow, you could do it either way, but this gives you the versatility that you may want in order to stage it slightly differently.

Ashley Kilgore:

Yael, what were some of the unique factors of this rescue that either complicated the rescue, such as the flooding from the monsoons, or helped, such as some of the unique technology or skillsets that were brought on site?

Yael Grushka-Cockayne:

Yeah, it’s really the complexities of this case are basically as you described the combination of the circumstances, the combination of the lack of experience. So the specific combination of flooded caves, of boys in the cave in June right before the monsoon season. Those are a set of circumstances that came together to create this very unusual event. Now, if you look at crises, other crises that we’ve seen, and the world has been fascinated by, if it’s the Chilian miners, if it’s the Everest, if it’s the Apollo, all these other cases that we’ve written case studies about, and there are so many others that we can learn from. To be honest, most circumstances like this, most crises like these are unusual in their own, right? And so, this is not that dissimilar in that sense that the set of circumstances seems unusual and very rare to occur. Otherwise we would have more experience with it. So that’s one.

And the skill sets that are required to deal with it were unknown upfront. So the exact severity of the problem was not really known at the get go. And as they discovered more and more, they discovered how much more they don’t know, and then they could go and kind of bring in more people to try and brainstorm and find the solution. And so that ad hocness of discovery was very apparent in this case, probably more so than in other situations, because it took a good portion of the time, the first two weeks to find the boys, and that discovery, or 10 days, those 10 days were really just expanding the horizon more and more and more. Recognizing more what skillset they may be lacking and what could be part of the equation without actually knowing what it is for certain, which meant this huge opening of the solution set to random people coming in, trying to help, and trying to kind of contribute. And a friend bringing along a friend and people knowing each other and experts bringing other experts to ultimately bring the set of skills that we needed in order to find the boys and then to rescue them. So it’s interesting that some of the skills that were brought on board during the search that were not as well utilized initially, would then become very important later on when we needed them for the execution of the rescue.

And so, it’s the ad hocness of the task and the crisis, the randomness in which things happened and the extreme, unusual circumstances, and the lack of knowledge, for so long. Like we just didn’t know what exactly we were facing for such a long duration of the instance that we had to continue and search and bring in people and crowdsource ideas, which led to a certain disparity, right? You hear it when you talk to John and Rick, the two main divers, you hear them having those moments of despair towards the end of June there, 30th, 29th, 30th of June, a couple of days before they were actually finding the boys, that they almost turned away and went home. It was just so, so bad that the unknown component was so dispiriting that it was hard to continue to push forward.

So those were the unusual circumstances. Cave diving in itself is challenging. Cave diving in itself is risky. And so, even under the best conditions, even if we knew upfront what we were dealing with, cave diving with this kind of mucky water requires such an extreme tolerance and extreme set of skills and capabilities that very few people in the world can bring to the table. And so that definitely added complexity to the situation.

Ashley Kilgore:

Who were some of the other individuals or organizations that came together with this unique expertise or skillsets to contribute to this rescue effort?

Yael Grushka-Cockayne:

So there were many. There were so many, I mean, hundreds of people were aggregating there and bringing their capabilities. Anything from the US Special Forces, they were stationed mostly in Japan, but stationed in the Pacific there. And those were this kind of skills that I mentioned earlier. They were requested to join and asked for their help was around 26th, 7th of June, which was about a week after the boys went missing. And then they really were critical and fundamentally changed the nature of the operation afterwards, when they had to plan the rescue, it was the US Special Forces capabilities that brought everybody together. They were the mediators, if you will. They had the regimen. They knew what to do, how to deal with unusual crises moments. They called everybody to the table. They knew how to encourage decision making. They added a lot of structure to an unstructured situation, encouraging practice, and going through basically what’s called a rock drill. So it’s kind of a practice run if you will, of the operation, run of the operation. And through those military kind of disciplines and activities, a lot of lessons were learned and it helped to have a smooth operation in reality.

They were also encouraging what they call hot washes, which is similar to like stand ups, or like sprint retrospectives, and so on, that people do in practice in other areas. They were encouraging these hot washes every day during the rescue itself where they learned lessons for the next day, and they put them into implementation. So they brought a lot of discipline related to preparation, planning, and execution, which was vital to the team. They were also a unifying voice helping the Thai military, the Thai civilians communicate with the divers, which were civilians, British civilians or international civilians, and having not only the language translation capability, somebody who spoke good English, but also later brought the kind of translation between the context between the military language, the military mindset, and a civilian mindset was really, really important.

Other resources that were helpful, organizations that were useful. There’s a gentleman called Josh Morris. If anybody reads the case, he’s quoted in the case, he was very helpful in crafting the cases. And he’s interviewed in some of the books and movies that came out since. And he just happens to live in Thai. He’s not a cave diver, but he’s a climber. He does rock climbing and mountain climbing. And he’s an American living in Thailand who helped a lot, again with the translation, the physical, and the cultural, and the linguistic translation. He’s married to a Thai woman, he speaks fluent Thai. And you don’t think always about finding the right person to be able to bridge the gaps, cultural gaps and language gaps, and he provided that.

We had representatives from Shell, from Chevron, from a bunch of oil companies pumping, helping with ideas around pumping and drilling, and seeing if they can bring their know-how from their oil and gas industry to the region. There was specific individuals, like Dr. Richard Harris from Australia, who happens to be one of the most skilled cave divers that also happens be an anesthesiologist. So he could help with the medical side and help sedate the kids, which was determined to be fundamental for diving them out. So there was just a bunch of very unique skill sets with international kind of capabilities. They casted their net wide to seek these skills out, and clearly to prove to be useful.

Ashley Kilgore:

Along the timeline of this event, from when it’s realized that the boys are missing and trapped in the cave to when they’re finally rescued, there are moments when key decisions were made, either for better or worse. Can you walk us through some of these pivotal moments?

Yael Grushka-Cockayne:

Yes. Not in chronological order necessarily, but two definite moments come to… Well, actually three definite moments come to mind. And as I discuss, I probably will think of more. Towards the end, and so this is not in chronological order, I apologize. But there was a key moment where the decision was taken on the 6th of July to actually do this dive. So once the boys were found and everybody knew where they were, and they were clearly in what was determined, reasonable health and they got food and drink at this point. They had to decide how to get them out. And so there were definitely different alternatives being suggested, like drilling alternative openings, or pumping out all the water, or leaving them in there. And then the alternative of diving them out was considered very risky, but almost at some point was considered the only thing that they could do. They didn’t expect that all of the boys would come out safe and sound, but they thought that at least they could save some, as opposed to the alternatives, which were slowly being assessed as are going to be catastrophic for all.

And so they decided on the 6th of July to actually go ahead and approve it. And this went up all the way to the top of the Thai authority, whether it’s the government authorities, all the way at the top. If it’s the king himself, we might not ever know exactly who was on the phone and who gave the permission, but we know that it went all the way to the top and that there was given a final go ahead with the actual diving operation. The team was already ready practicing for a day or two, but it really had to go through the final approvals. And it was the day when the Thai Navy Seal passed away, died sadly during one of the more routine divings that they did to bring food back and forth and to put oxygen tanks back and forth, that it was clear how dangerous the dive is. And at the same time, it was clear that they had a plan, with the sedation, how to get the boys out. So it was that moment. So that’s a key decision. Okay, we’re going to do it. We’re committed to this point of action, to this way of action, and we’re committed to diving these boys out.

Two other key moments. One key moment was at the very beginning, on the flip side, on the very beginning, when the boys were just lost. Within the first, not even 24 hours, when they realized that the caves were filled with water and that they didn’t know their way around the caves, they quickly reached out to Vern, a local who was living in the region, an expert in the cave itself. He’s done a lot of work on the cave, Vern Unsworth. He’s British originally, but he’s… Actually, I think he’s British. I’m almost sure he is British. He’s been living in Thailand for many years, and somebody decided to reach out to him, which in a way kind of points to a little bit of the chaos and the anarchy that was going on there, but it was vital. Because if Vern didn’t randomly get there by somebody knowing him as a local expert, and reaching out to him and saying, we need you because you know this cave more than anybody else, he happens to know the international diving scene really, really well. And so, it was Vern that then reached out to Rick, and John, and Rob Harper to get them invited over. But he was very pivotal in his expertise and in his approach. And so, the decision or the opportunity to invite Verne to show up on site was critical to the rest of the evolution of the story.

And then finally, Vern himself put the little note forward, here are the experts, call the UK embassy, get these experts here as soon as possible. When Vern wrote that note, which is now very famous, and people may have seen that little piece of paper, the fact that there were a few ministers in the room, their minister of interior, but also the minister of tourism and sports that decided to listen to him, which by the way, I give them a lot of credit. Not everybody always listens to advice that is given in moments like this. So they saw the note, they recognized what he was saying. He said that they need this very, very rare capability to dive in very difficult caves. They recognize the importance. They reached out to the team, to the British divers, and they arranged behind the scenes to get them there as soon as possible. And so that decision, to listen to Vern’s recommendation, reach out to the divers and bring them on board, I think was also super fundamental along the way, and led to a real game changer in terms of the capabilities on the ground.

Ashley Kilgore:

Are there aspects of this event in particular that set it apart from other similar rescue efforts?

Yael Grushka-Cockayne:

Well, by and large, first for the good reason that it was a success, it was a success in the sense that the boys were rescued safe and sound, and that it was very extreme, like 10 days without knowing where they are and then rescuing them safe and sound when they had no diving capabilities and they had to be sedated. I mean, it is so out there in terms of the description of the complexity and the challenge of this event and this operation, and yet they came out. It was like clockwork, the operation to rescue. It was like four rescues a day, five on the last day, but it just worked so well. And yes, there were struggles along the way, but they all overcame. That is like out there in terms of the likelihood of success, and the fact that they achieved it is just really surprising.

So, one thing that separates this is that it’s a success. We don’t really hear of crises that end, not that many crises end in a success, sadly. And so, I think there’s something that feels good about that. Yes, there were casualties, right? So the casualties were on the Thai Navy Seals side, which was devastating and very unfortunate and tragic, but the boys themselves that were trapped were safe.

I also think the fact that it’s boys, the fact that it’s kids, teenagers primarily between the ages of 12 and 16, I think there’s something very unusual with that. It’s not, not to minimize at all the unfortunate tale of, or the fortunate tale of the rescue of the Chilean miners who also were saved, and they had to overcome a lot. But they were professionals that were in the cave that, they were miners by trade. So there was a little bit of a difference there. And here, where you’re talking about 12 boys. They were just on a Saturday afternoon doing a little, I wouldn’t call it a hike, but a little like expedition to a very known site. And so, the individuals involved, I think here are very unique as well. And in the sense that everybody’s still curious as to what they were thinking and what they went through in the cave. And for a lot of reasons, I think the media has tried to protect them and not overwhelm them with requests, which I respect, but that side of things, I think fascinates everybody as well, and it adds a layer of uniqueness to this challenge.

Yep. And the rescue operation itself was incredible. I don’t know, actually, I’m pretty sure that I’ve heard Dr. Harris say that this has never, never been done. People do not sedate other people, put them in a suit and stick them underwater. Like you don’t do this, right? You don’t hear of instances where people are sedated and then are really submerged in water. And that, it’s just never been done. And I think that in the future, if there’s any need to operate in this way, at least this will become a possibility in the sense that it’s very stressful, right? I mean, I cannot imagine, I get very stressed under dark tunnels. And if you think about having to dive, if you’ve never, I’m not good at scuba diving let alone these kinds of dives, but I cannot imagine what the boys might have felt. And so, having the ability to sedate them and for that to work, I think was really, really interesting and probably going to be beneficial in the future.

Ashley Kilgore:

Yael, as you mentioned, this event had a happy ending, however frequently, these types of scenarios don’t end well. How close is the margin of error between an optimal result and one that is unfortunately not?

Yael Grushka-Cockayne:

Too close for comfort, right? It was down to like milliseconds of activities, right? It’s down to a very, very specific actions that each one of the divers took along the way that could have been disastrous, right? And to some good old fashion luck that some of the monsoons held off and that the rain didn’t actually start as vigorously as it could have during those three days of July 7th through the 10th when they were actually, or the 8th, 9th, 10th, when they were actually rescuing them.

So it was a matter of one breath one way or the other, right? There were a few moments during the rescue where they actually one diver, very professional diver. So in addition to Rick and John, the two main divers who found them, there were two others that were brought in to help with the rescue because they were saving four a day. They were bringing out four a day. So you had four real experts that picked up a boy at the beginning, in this chamber nine, where they were, and took them all the way out. And one of those four, he describes that one day, he didn’t hold onto the line. They have something called the line that they lay in the caves, that if you hold onto line, it takes you all the way out. That’s one thing they did at the beginning, they laid the line so they could have this, if you want like a rail that takes you from the start to the end. And one of the divers accidentally let go of it because he was holding the boy in such a way and it disoriented him. And luckily enough, he kept his calm. He dove back a little bit. He didn’t realize that he was going backwards, but he went backwards a bit. Then he stopped, he paused to think and to compose himself, and he bumped into another diver who helped him find the right way out.

Other days, they realized that at some point they stopped and they had to give another anesthetic, keep the kids sedated. One of the boys, you know, all these little choices when they pause, when they take a look at the boy, if they have a moment to kind of compose themselves, it depends on the stream of water and how their body is angled. So many little things could have been so catastrophic in this instance, and their ability to keep themselves calm, their ability to communicate with each other, the team that was supporting them along the way, and the luck related to both the weather and everything else was just really on their side.

Ashley Kilgore:

Yael, I have truly enjoyed exploring this incredible event with you. Thank you so much for sharing your insight. Before we wrap up our conversation, what do you think are some of the biggest takeaways learned during this rescue effort?

Yael Grushka-Cockayne:

Well, so I teach it in a very specific way and my lessons learned might be different than others. So I encourage and I invite everybody to draw their own lessons and inspiration from this story in whatever direction that is. And there can be many, many ways to be inspired by this story.

For me, the lessons learned is that, especially in moments of crisis, at the beginning of a crisis, many of us tend to expect a lot of order, and hierarchy, and clear planning, and clear chain of command, and very clear roadmaps forward. And I think in moments of crisis like that, when we crave that organization, when it’s not there, it’s just not there and it doesn’t exist. We need to recall and help ourselves remember that there could be something important in the chaos. It could be the way forward is to have a thousand flowers bloom and have a lot of people bring each other and crowdsource activities, and really diverge our efforts in a way that then allows us to find the path forward. And as leaders in organizations, our ability to let go in moments like that, and really be welcoming and open our doors to different sets of skills and different expertise, it’s not easy. Especially in those moments. And so it’s important to have the recall of stories that remind us that it could be all the difference between a solution that is found and a solution that is not.

And I think the publication of this case, it took us a couple years to write this case, and the publication of this case, which I think we first kind of wrapped it up in 2000. So, putting it all together and completing it around the beginning of the COVID crisis, a lot of companies that I’ve taught this to draw analogies to how they felt at the beginning of the pandemic, in the sense that it was unusual for us, on our scale to cope. Of course it is, the world was in a turmoil. We didn’t know what to expect. We didn’t know where the solution would be. We didn’t know if to wash our hands, put a mask on our face, stay indoors, wear gloves. We just didn’t know what the solution was going to be two weeks, one month, a whole year. Vaccine, not vaccine. Remember that.

Now we seem like we’re experts, all of us, in how to deal with the pandemic. But back at the time, we weren’t. And companies and the world, in general, kind of went into a little bit of a turmoil and a chaotic moment. And organizations brought together these cross-functional teams. They brought together diverse individuals. They brought together skill sets that they wouldn’t always be inclined to do. And companies that succeeded were the ones that really, I think, expanded the horizon and let the chaos yield productivity and discovery. And that’s kind of what we see at the beginning of this case. And there are moments where you think it’s going in the wrong direction, and you wish somebody took charge, but sometimes it’s the randomness around that process that is really, really critical. So that’s a really important lesson to me, and then maybe also important, but maybe slightly less so, is the discipline that they came with the actual planning once the boys were found. So the focus was on getting them out. The task was much clearer. The mission and the goals were much clearer, and they had to sit down and do their due diligence, and practice and practice and practice and be creative and disciplined in their planning. And I take a lot of inspiration from that as well.

Ashley Kilgore:

Want to learn more? Visit resoundinglyhuman.com for additional information on this week’s episode and guest. The podcast is also available for download or streaming from Apple Podcasts, Google Play, Stitcher and Spotify. Wherever you listen, if you enjoy Resoundingly Human, please be sure to leave a review to help spread the word about the podcast. Until next time, I’m Ashley Kilgore, and this is Resoundingly Human.