The Value of Checklists

Let’s start with the premise that you’re fantastic. In fact, you’re well-trained, experienced and routinely exhibit good judgment. So, do you need a checklist? Ask a pilot or a surgeon.  Surgeon Atul Gawande did exactly that and learned some interesting — and sobering — things.  In a recent interview, he discussed his latest book, The Checklist Manifesto: How to Get Things Right, which recounts his exploration of the value of checklists.  Time and again, he found that checklists were an effective antidote to ignorance, uncertainty and complexity.  He and his team developed a two-minute checklist that covered some basics for surgery (e.g., do we have enough blood and antibiotics?), as well as some basics for good teamwork (e.g., does everyone in the Operating Room know the name of each person in the room?).  They then tested these lists in eight different hospitals.  The results were stunning.  For example, when they took the time to make introductions, they had a 35% decline in deaths and complications related to surgery.

Creating checklists for routine procedures makes sense.  They allow you to act quickly and confidently.  Creating checklists for complex situations are even more important since these are precisely the times when you are most beset by uncertainty and may not even know what you don’t know.  In these cases, it’s helpful to have a checklist that can help pin down facts and eliminate areas of concern.

After the trial period in eight hospitals, 80% of the surgeons involved said they would continue to use the checklist.  Interestingly, 20% remained resistant.  They believed that the checklists were a waste of time and didn’t add value. However, when asked if you were having an operation, would you want your surgeon to use the checklist, 94% of those resisters said they would.

So why are professionals resistant to checklists?  Atul Gawande thinks that this is because experts have a hard time admitting their own fallibility.  There are also experts (be they lawyers or knowledge managers) who approach their work as “artistes.”  Therefore, they believe their creative outflow cannot be reduced to a dry checklist.  Finally, there are the thousands of us who race through our days just struggling to get things done.  In the press of business, it is hard to take the time to stop and reflect on what works and what doesn’t.  It’s harder still to take the time to document it.  Tragically, when an error or accident happens, we are forced to stop and think about what went wrong.  Under those circumstances, the analysis is charged, value-laden and painful for all concerned.

Is there a two-minute checklist you could develop this week that might help strengthen your work flow or work product?  If so, can you afford not to make the investment of time required to create that checklist?

[Photo Credit:  Adam Sacco]

11 thoughts on “The Value of Checklists

    1. I suspect several of us are approaching that age! Even for those of us indenial about the reliability of our memories, the checklist is a greatsafety net.Thanks for sending along the link, Atle. That *New Yorker* article appearsto be the precursor to the book Atul Gawande has just published.- Mary

  1. I have always used a checklist when training on processes that I'm very experienced at – it reminds me of the complexity of the task, and forces me not to take too much for granted. I'm hoping to revise some of the procedures manuals in my library this year, and may (based on this) move to checklists instead of detailed step-by-step procedures for some activities! Thanks Mary!!

    1. You're absolutely right about the importance of not taking too much forgranted, Wendy. Further, a physical checklist stops us from glossing overthe tough spots. By contrast, a mental checklist can be most unreliablewhen we need to us remember where things were complex or painful.- Mary

  2. I disagree somewhat. How long did the study go on for. Did he review the use of the checklist 2 years later and look at the results.Checklists have a tendency to proliferate, to not be updated and to end up as an audit tool, “did you tick every box, what do you mean that the step does not make sense, you must tick or you are non-compliant”.The reality is that a checklist is nothing more than a simplified process map. The same problems that afflict process engineering, affect checklists.

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