Tips for Better Checklists

I recently read Atul Gawande’s book The Checklist Manifesto–which I thought was fantastic.

I’ve been around quite a few checklists throughout my life (my wife is a pilot!).  But – even with that experience, I still learned a lot from Gawande’s advice.  Here are my takeaways:

A great checklist should…  

  • Be short.  No more than 5-9 items.  Any more than that will cause less use, which defeats the point.
  • Have an owner and one or more “pause points”.  With any checklist, there should be a defined moment (or set of moments) when it is used, and a person in the situation who is responsible for initiating it.  For a pilot, that could be a checklist for starting the engines, or beginning to taxi. Gawande mentioned specific physical objects that were used to enforce the pause point.  For example, some hospitals put a physical cover over the surgical equipment, that the nurse would remove, to remind the team to use the checklist before beginning.
  • Build team.  For both pilots and hospitals, a key part of the checklist is introduction, by name and role.  This improves communication, because people who know each other work together better.  But it also reminds people of their own roles on the team, which raises individual performance.
  • Cause an action OR a conversation.  I thought the most interesting part of the book was Gawande’s explanation of simple vs. complex tasks.  For simple tasks, a checklist for the steps is invaluable in helping everyone do the things they know they should do.  For complex tasks, where there is no known answer, a checklist should spark the right conversation.  It should allow the people in that situation to decide on the right actions, together, and take responsibility for making them happen.
  • Rely on expertise, not replace it.  A checklist should be a user’s guide or instruction manual.  Instead, it should allow experts to be better at their work by focusing on important, but easily forgotten, steps.  A great example of this comes from the engine failure checklist for a single-engine Cessna, where the first step is “FLY THE AIRPLANE”–as a reminder not to forget the basic (but difficult!) tasks in the midst of crisis.
  • Be tested and revised in the real world.  Sometimes, when I have written checklists in the past, I’ve worked to include everything.  Then I printed it out, laminated it, and never went back to revise.  Gawande reminds the reader that even the best checklists should change when they are used in real situations.  If your checklist didn’t need revision–it probably wasn’t useful or being used.

Dr. Gawande, along with Dan Boorman of Boeing, created a checklist for checklists, which can be found on the internet here.

I’m planning to experiment with checklists in the next few months, and I’ll post the results.  Stay tuned, and have a great day!

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