Monday, June 27, 2011
Checklists save lives. Dr. Atul Gawande makes that very clear in his fascinating book, The Checklist Manifesto: How to Get Things Done Right.
Gawande focuses mostly on airline pilots and medical teams (ICU and surgical). Builders of skyscrapers and other complex structures, and managers of investment funds, also get some attention. (Van Halen and David Lee Roth make a brief appearance, too.)
Aviation checklists have proven their worth for many years now. Manufacturers like Boeing have become experts in creating effective checklists: precise and practical, and tested in flight simulators. Airlines then make customizations; Gawande tells us that "when airlines merge, among the fiercest battles is the one between the pilots over whose checklists will be used."
Such checklists aren't exhaustive, covering every possible issue; they focus on the "the killer items — the steps that are most dangerous to skip and sometimes overlooked nonetheless." When Gawande spoke to Daniel Boorman of Boeing, he learned that "even the look of the checklist matters. Ideally, it should fit on one page. It should be free of clutter and unnecessary colors. It should use both uppercase and lowercase text for ease of reading."
Unfortunately, the surgical checklist developed by the World Health Organization — Gawande was a key player in developing this list — has had much success, but has yet to gain anything close to complete acceptance. I just checked my own area, and many hospitals are actively using the checklist — but many are not. Gawande mentions how he started using the checklist himself, thinking it wouldn't be all the useful in his practice. "To my chagrin, however, I have yet to get through a week in surgery without the checklist's leading us to catch something we would have missed."
Checklists, Gawande argues, don't turn the users into "mindless automatons." Rather, a well-made checklist "gets the dumb stuff out of the way, the routines your brain shouldn't have to occupy itself with ... and lets it rise above to focus on the hard stuff." Both the aviation and the surgical checklists also help build the sense of teamwork needed to effectively deal with emergencies.
While many of us don't work in the complex environments that Gawande describes, checklists can still be useful tools. Reading this book made me appreciate them all the more.
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