I’ve had the checklist manifesto in my “to-read” list for about 5 years now. It’s a book I’ve had reccomended to me many times and, unsurprisingly, it’s a manifesto for the use of checklists. Atul Gawande who wrote it is a surgeon who has a history of process improvement projects. The checklist manifesto is his attempt to convince people that checklists, simple as they are, can massively improve the output quality and consistency of tasks that we repeat frequently. What is more surprising though, is that his research uncovers that even in areas where there are complex problems for which we can’t checklist – checklists can help significantly in resolving complex and unforeseen problems.
The thesis is simple. Checklists raise output quality and consistency. The reason they do this is simple – we dramatically overestimate our ability to routinely perform series of tasks. In scenarios where there is stress or complication, the rate at which we overestimate our ability (and screw things up) rises dramatically. Gawande examines three key scenarios – flight checklists, large scale construction projects and his own home – the operating theater to provide anecdotes and then evidence for how effective checklists are..
IN each scenario, he tackles simple, routine problems and also complicated and complex problems. What emerges is a surprisingly strong case for checklists as a tool to ensure consistency, and to change behavior, and also as a tool to aid resolution in complex and unforeseen circumstances.
The bottom line is that we are inadequate repeaters of routine tasks, people routinely skip steps for one of two reasons – either they just forget through distraction or inattention, or they don’t know about, or don’t believe in the efficacy of a step – so they skip it. In each of these cases, checklists function as a kind of spot audit – telling people that they didn’t perform a step, and ensuring that they do. In many cases, check steps were important and (just like in the toyota production system) authority was granted for usually unauthorised people to stop a process if it wasn’t performed as written. What followed in each case was a dramatic improvement in performance – in one case, more than a thousand fewer deaths a year.
Routine tasks aside, complex tasks were also found to benefit. In routine simple and complicated tasks, the series of steps required to be carried out were documented in order so that they could be directly followed. In complex tasks however, this wasn’t possible because what was required to be done was typically an emergent phenomenon like an accident or disaster and needed to be analysed and dealt with on the fly. While task based checklists were not capable of operating in this environment, what was shown to produce results were checklists mandating communication among team members – simple things, like formal introductions prior to surgery so that people knew each other’s names, and discussions about what they were about to do. A side point was also made that delegation of responsibility away from the centre is of extreme importance in effective crisis response.
The book contains excellent tips on how to make checklists work. It boils down to
• Keep the checklist short, precise, and practical.
• Don’t over-describe – provide reminders of only the most critical steps.
• The point of invocation of the checklist needs to be clear for it to be useful.
• Keep the checklist between 5 and 9 items.
• Formatting and readability matter.
• Checklists come in two distinct types – do-confirm and read-do. One is about an audit of what you carried out, the other provides steps to follow – which you do in order and tick off.
Checklists are the simplest way to protect yourself and others, from you and the systematic mistakes you make by believing that you’re systematic when you’re not. They’re also the simplest way to get an advantage without being smarter or first, you can be more thorough – EVERY time. The anecdotes that end the book state that despite the gigantic and obvious advantage, they are not regularly taken up, people are looking for the sophisticated – because it almost couldn’t be that simple. Unfortunately for them, as the weight of evidence in the book proves, it is – so who’s going to take them up?