A Checklist to save the world (or at least improve your own performance)

Checklists are the the way to stop making simple mistakes, and reduce your cognitive load saving energy for the decisions that really matter. A simple list really can change the world.

Picture the scene. Its 1935, the American military is looking to award a company making tender to the next generation of military plane. Boeing dominate the airline industry at this time and of course have a plane so advanced that people expect it will be daylight to second place when the contract is awarded. The day of the flight demonstrations arrive and there is a crowd of military people, all craning to get a glimpse of the future of the American Air Force.

To great fanfare, the Boeing is unveiled with its competitors, Martin and Douglas. The Boeing has a wingspan of 103 feet, is the first plane with four engines and able to fly twice as far and as fast as the competition. It was like a professional sportsman turning up to the primary school sports day. The crowd exchanged knowing glances and looked forward to seeing the Boeing soar.

The moment arrived when it was Boeing’s turn to demonstrate their plane. It taxied down the runway, built up tremendous speed and smoothly soared into the air…. where it promptly stalled, turned on one wing and crashed to the ground killing 3 of the 5 passengers onboard.

Douglas got the contract and Boeing almost went bankrupt.

So what went wrong?

Investigations found that the accident had occurred because the pilot — one of the most experienced aviators in the US airforce — had forgotten to release the break on one of the engines. A team was formed to come up with a solution to this complex flying machine and what they came up with was a simple checklist. No bigger than an index card with only a few simple prompts to ensure the pilot did all the critical tasks. The B-17 as it was soon dubbed subsequently flew 1.8 million miles without a single additional incident.

B17 Bomber (Credit WWII database)

Checklists are the the way to stop making simple mistakes. They take the mental energy out of trying to remember every thing and free you up to be creative. Study after study has shown, a simple list really can change the world. Some more examples:

• Studies consistently find that if you want to save money — then make a list of what you need at the shops and buy only that
• Checklists in medicine save lives — just a simple bit of paper. A study in the Hopkins hospitals in America showed that by introducing a checklist for correctly washing your hands, and using the nurses to ensure the OR doctors followed it, infection rates reduced by 20%.

A doctor caring for a patient has to deal with the patient’s primary ailment as well as attend to details such as inserting intravenous tubes. A checklist reduces the risk of missing a step and reminds a physician to follow accepted procedures and protocols. (Mauboussin)

Atul Gawande writes in the New Yorker how checklists outline a higher standard of baseline performance, providing two main benefits:

First, they helped with memory recall, especially with mundane matters that are easily overlooked in patients undergoing more drastic events. (When you’re worrying about what treatment to give a woman who won’t stop seizing, it’s hard to remember to make sure that the head of her bed is in the right position.)

A second effect was to make explicit the minimum, expected steps in complex processes. [Researchers were] surprised to discover how often even experienced personnel failed to grasp the importance of certain precautions.

Tom Graves discusses the use of checklist and how they relate to the SCAN (Simple; Complicated; Ambigous; Not know) framework for sense making and decision making (Also see Cynefin framework).

Checklists help to reduce the cognitive load, by reminding us of concerns that must not be forgotten — concerns which, if they are forgotten, are likely to increase the potential variety (and hence potential risk) in the context. And by providing a clear, explicit structure and sequence, checklists also help to keep the panic at bay when the variety-weather suddenly turns stormy.

As Gawande demonstrates in his book, checklists provide a proven means to reduce risks and undesirable outcomes in inherently-complex contexts. They do not represent an attempt to ‘remove’ complexity, or even to reduce it, but do provide a key part of tactics to better manage it. The implication is therefore that well-designed checklists will have a very high value in most enterprise-architectures.

Back to Mauboussin:

A checklist is also helpful in a stressful situation. Emergencies make it harder to think clearly and act appropriately because the chemicals of stress actually disrupt the functioning of the frontal lobes, the seat of reason. A READ-DO checklist provides a recipe for action that lets you take concrete steps to address the problem, even when you’re not thinking clearly.

So how do you go about developing a good checklist? Gwande outlines several steps in “The Checklist Manifesto”

• They are not comprehensive how-to guides, whether for building a skyscraper or getting a plane out of trouble. They are quick and simple tools aimed to buttress the skills of expert professionals
• define a clear pause point at which the checklist is supposed to be used (unless the moment is obvious, like when a warning light goes on or an engine fails).
• You must decide whether you want a DO-CONFIRM checklist or a READ-DO checklist. With a DO-CONFIRM checklist, team members perform their jobs from memory and experience, often separately. But then they stop. They pause to run the checklist and confirm that everything that was supposed to be done was done. With a READ-DO checklist, on the other hand, people carry out the tasks as they check them off — it’s more like a recipe.
• Keep the list short by focusing on “the killer items” — the steps that are most dangerous to skip and sometimes overlooked nonetheless.
• The wording should be simple and exact, it should fit on one page. It should be free of clutter and unnecessary colours.

All this has been neatly summarised in the “Checklist for Checklists”

References

• Mauboussin — The Success Equation- Untangling Skill and Luck in Business, Sports, and Investing
• Tom Graves — http://weblog.tetradian.com/2012/07/23/checklists-and-complexity/
• Gwande — Checklist for checklists — http://www.projectcheck.org/uploads/1/0/9/0/1090835/checklist_for_checklists_final_10.3.pdf
• Gwande — The Checklist in The New Yorker https://www.newyorker.com/magazine/2007/12/10/the-checklist
• Gwande — The Checklist Manifesto — http://atulgawande.com/book/the-checklist-manifesto/
• WHO — Surgical Safety Checklist -http://www.who.int/patientsafety/safesurgery/checklist/en/

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