I just finished reading The Checklist Manifesto by Dr. Atul Gawande (New York: Metropolitan Books, 2009). It’s a well-written, entertaining book that promotes the use of checklists to make sure that important steps are followed. He uses examples from areas as diverse as health care (he’s a surgeon), finance, and aviation to demonstrate that checklists can have a tremendous impact. He especially stressed their value for two things: making sure simple requirements aren’t overlooked, and promoting (even forcing) communication at key times.
Working with the World Health Organization, Dr. Gawande conducted a trial of a surgical checklist with eight hospitals in countries as diverse as Jordan, Tanzania, and the U.K. The results were dramatic and highly statistically significant: a 36% reduction in surgical complications and a 47% reduction in deaths. Furthermore, the checklist demonstrated value in hospitals across the economic spectrum.
Of course, many were skeptical, especially at first. Before implementation, his team monitored the omission of key steps in these hospitals, and errors were alarmingly common. Even after people saw these results, it was sometimes necessary to drag them through the process so they could see the value for themselves. Dr. Gawande makes a number of suggestions that can help make checklists easier and more effective, for example: keep them simple and unambiguous, put in only the most leveraged items, and encourage people to tailor them to accommodate local practices.
I’m a strong advocate of well-constructed checklists. We have employed them in ProChain implementations for years and have found them to be very useful in establishing culture change. They can help to make sure that people learn to communicate in the new ways. However, we’ve also found the same kinds of resistance that Dr. Gawande saw: people are openly skeptical, or they say “yes” and act “no.” Checklists can appear harder to justify for project improvements, when people’s lives don’t seem to be on the line. But consider this: if a crucial new product reaches the market earlier, that really can save lives, and it really can save jobs. Missing opportunities to gain that month could have a tremendous human impact.
