"Using a checklist—you improve the outcomes with no increase in skill. That’s what we are doing when we use the checklist."
In The Checklist Manifesto, author Atul Gawande, MD, MPH, explores how the use of a simple checklist can help eliminate errors in even the most complex jobs and industries. Gawande is a surgeon, writer, and public health researcher who began studying the effectiveness of checklists’ through his work at World Health Organization.
Gawande begins the book by asking the question, why is it that top professionals today, who are better educated and better trained than at any point in human history, still make simple, avoidable mistakes? Mistakes that waste huge amounts of money and even cost lives.
As Gawande set out to find a better way to fix these errors, he met with professionals in healthcare, aviation, and construction to learn how they are leveraging checklists to drastically avoid controllable mistakes. Throughout the book, Gawande shares with us real-life examples of how these complex jobs leverage checklists to achieve success.
Why We Fail
"If the knowledge exists and is not applied correctly, it is difficult not to be infuriated."
Today, more than at any other time in human history, much of the workforce are “knowledge workers”—people working in jobs that involve using information to make decisions. Given this, people have to continuously know more and learn more if they want to succeed and thrive.
Gawande starts off by addressing that it’s unrealistic for people to know and/or understand everything they’re supposed to know at all times and in all situations. “The volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us.” And while no one is perfect, it doesn’t mean that if a mistake is made that it wasn’t avoidable. Gawande shares the two main reasons that failure occurs:
- Ignorance – “we may err because science has given us only a partial understanding of the world and how it works.”
- Ineptitude – “in these instances the knowledge exists, yet we fail to apply it correctly.”
Think about where both apply in your life. The challenge we now face is ensuring that the knowledge that we do have is applied consistently and correctly, which is where a checklist can be of great value.
The Checklist and Solving Problems
"Checklists seem able to defend anyone, even the experienced, against failure in many more tasks than we realized. They provide a cognitive net. They catch mental flaws inherent in all of us—flaws of memory and attention and thoroughness."
In Gawande’s research, he came across two professors who studied the science of complexity, which highlighted three types of problems in the world: the simple, the complicated and the complex. They are defined as:
- Simple Problems – “are ones like baking a cake from a mix. There is a recipe. Sometimes there are a few basic techniques to learn. But once these are mastered, following the recipe brings a high likelihood of success.”
- Complicated Problems – “are the ones like sending a rocket to the moon. They can sometimes be broken down into a series of simple problems. But there is no straightforward recipe. Success frequently requires multiple people, often multiple teams and specialized expertise. Unanticipated difficulties are frequent. Timing and coordination become serious concerns.”
- Complex Problems – “are ones like raising a child. Once you learn how to send a rocket to the moon, you can repeat the process with other rockets and perfect it. One rocket is like another rocket. But not so with raising a child. Every child is unique. Although raising one child may provide experience, it does not guarantee success with the next child. Expertise is valuable but most certainly not sufficient. Indeed, the next child may require an entirely different approach from the previous one. And this brings up another feature of complex problems: their outcomes remain highly uncertain. Yet we all know that it is possible to raise a child well.”
In each of these problems, checklists can provide direction and protection against elementary errors in the process. As you’ll see in insight #2, it is important to determine which type of problem you’re looking to solve or address when considering how a checklist can help achieve the outcome that you’re after.
When You’re Making a Checklist
"When you’re making a checklist---you must define a clear pause point at which the checklist is supposed to be used."
Throughout the book the author refers to the term “pause points”. These are points in any process where there’s a natural pause in the action before doing a job. This is where and when a checklist can be best leveraged. During these “pauses” there are typically two types of checklists that are used and they are do-confirm checklists and read-do checklists. They are defined as:
- Do-confirm checklist — “team members pause to run the check-list and confirm that everything that was supposed to be done was done.”
- Read-do checklist — “people carry out the task as they check them off—it’s more like a recipe.”
Per insight #1, depending on the problem or situation that the checklist is being used for, either type of checklist could be leveraged.
Gawande touches on some additional guidelines for creating effective checklists, which I want to quickly cover. The checklist cannot be lengthy (rule of thumb: keep between 5-9 items) and needs to take between 60-90 secs to run through. Perhaps the most important piece after a checklist is developed is for it to be tested in the real world. From there it should be tweaked and modified until it fits the need it’s intended to serve.
The Checklist Manifesto is an engaging read that examines a simple tool which has been proven to produce remarkable results. The job of a checklist is simply to help eliminate errors and things that we have control over. Given the complexity of our jobs (no matter what field we’re in) we can all learn to leverage this simple tool. I’d encourage you to examine how you can incorporate checklist into your personal and professional lives.
As Gawande says, “Try a checklist.”