The last time you bought groceries, did you take a shopping list with you? What about when you moved house or packed for a trip or holiday; did you use a checklist?
These questions came to mind for three reasons. One was because we’ve just created a set of checklists for e-moderators. The second reason was because I’d come across the book – The Checklist Manifesto – How To Get Things Right http://www.amazon.com/Checklist-Manifesto-How-Things-Right/dp/0805091742. The third reason was that I stumbled upon an article I wrote in the early 1990s about performance aids.
My own article reminded me of the work of a very clever yet modest man, Peter Pipe. He it was who created a classification for performance aids, tagging them as one of 5 different sorts, which became known as Pipe’s Types. He mentions checklists as one of a group of performance aids he called “Prompts”. This group also includes recipes, labels, diagrams, rules, coding and mnemonics. Feel free to download the whole picture from http://dl.dropbox.com/u/3063607/Pipes%20Types.pdf. If you want to see Onlignment’s e-moderators’ checklists then just ask.
Atul Gawande’s book talks about how we all manage complexity to some degree in the modern world. It’s easy to get things wrong. The headline example is from a hospital in the USA where a CCU specialist wrote down five things that doctors must do to avoid infection when they insert catheters into major veins.The advice includes basic things such as washing hands with soap and wearing sterile barrier clothing. These steps are so obvious that it seemed patronising to use a checklist, but you could reckon on one line in nine being infected and doctors were routinely skipping crucial steps. A five-point checklist was given to nurses and with the backing and authority of senior management they checked off each step as doctors did their work, and badgered them if they missed anything. Within one year, infection had reduced from 11 percent to zero. After 2 years it was estimated that the checklist had stopped 43 infections, prevented 8 deaths and saved 2 million dollars.
Other examples with similar success rates abound in Gawande’s book. He shows how, while Government spent days mobilising itself, before Hurricane Katrina had even reached land Walmart stores were over-stocked with essentials such as water, flashlights, batteries, and canned food. He relates how a rock band’s insistence on having a bowl of M&M’s with all the brown ones removed was a cunning test of whether attention had been paid to details that might make the difference between life and death!
We should heed the message that the volume and complexity of knowledge today goes beyond the capacity of any individual’s ability to manage it consistently without error. Even we whose job is to train and support must acknowledge two fundamental weaknesses:
- With minds in constant overload, we easily overlook routine and banal matters
- Experts have a tendency to skip steps even when they remember them if past experience has shown that they usually don’t matter.
If you need persuading think about Captain Sullenberger and the crew of US Airways flight 1549. By rigidly adhering to their checklist procedure, they covered the “never does but one day might” issues and so achieved the “Miracle on the Hudson” landing. Checklists and clear communication among teams are essential for eliminating errors and improving performance whether in the construction industry, aviation, surgery or, dare I say, the design of instruction and information processing. We aren’t perfect. Systematic approaches make us better.
Final thought in case you feel checklists are too basic for you to use – When hospital staff were shown the benefits of using a checklist, many said it would take too much time and would not improve safety. Guess what percentage said yes when they were asked, “Would you want the checklist to be used if you were having an operation?”
