The Magic of Checklists

The Checklist Manifesto: How to Get Things Right by Atul Gawande is a very important addition to the literature about improving the execution of just about anything.

Gawande was asked to lead a panel of World Health officials in coming up with ways to improve the outcomes of surgical procedures world-wide in a daunting variety of Health Facilities, from rural health clinics in India to historic hospitals in England. There was a lot of discussion about the many improvements that could be pushed out to the health community, but they decided to borrow from the world of aviation where the use of checklists has a long history of effectiveness.

Gawande shows that there have been remarkable improvements in safety and positive outcomes when Checklists are instituted in hospital trials around the world. In this book he also learns from Aviation experts how to get checklists right.

Checklists are helpful for a number of reasons

  1. Humans are notorious for assuming that they can keep everything in their heads. This is tied to the main tenant of the Getting Things Done approach to personal effectiveness. It takes a lot of mental resources to keep more than a few items in our heads, as a result, we have added stress and we miss things. A checklist is a great way to save the tasks so that we do not have to. I found this was the case when I as a youth worked at Burger King. I can proudly say that I was exceeding fast on the Whopper Board (where we made the single patty burgers). However when I came back to work there part-time after a spending two years in Chile, I could not perform as well. Before Chile, I would mark the special orders on the burger packages, immediately as they were called over the PA system and we were swift as lightning, however two years later, after Chile I would for some reason try to keep it in my head, and would invariable miss orders.
  2. Checklists allow the whole team to focus on a small number of important behaviors. They found that something as simple as including an bullet to have the team tell each other their name and their responsibility within the operating room, yielded a great deal of benefit of improved communication during the procedure. Team members were more likely to voice concerns and mistakes were avoided.
  3. Checklists bring consistency to the world of Mavericks and Heroes. Many people bristle at the thought of having rules and procedures take the life or creativity out jobs, however, when we leave it to chance and impromptu action, then we leave room for mistakes and inefficiency. It reminds me of the case of the piano tuner who decided to do everything slowly and properly, he found that he actually completed his tasks faster than when he cut corners and rushed. Check lists allow us to carefully do things the right way.

I like how this fits into the Getting Things Done approach where we capture a list of next actions within our computer, or notebook or whatever. Even making a list of things to be packed for camping is such a time saver. Like going over a checklist before a regular planning meeting to see that we are discuss all the right stuff. We use our brain power in one concerted effort to make a good checklist, and then we can spend our mental energy on more creative efforts, and to improve the checklist.

I can see application of these principles in many places, such as in a family with a “Saturday Night Checklist” with (find church shoes; make sure church clothes are laid out; etc.)

The topic sounds boring, but Gawande has good stories that apply to the application of these principles. He also wrote Better: A Surgeon’s Notes on Performancewhich is also fascinating reading about improvements in medical care.

How do you think that checklists could make your life easier?