“Spectacles, testicles, iPad and watch” is a mantra I mutter to my-self every time I leave our front door. This simple checklist helps me make sure that I have with me the key items I need for the smooth running of my day; glasses, mobile, iPad, wallet and watch. The very act of reciting causes me to pause; think about what else I may need and, to check that I do indeed have everything with me.
Checklists are an informational aid. They help reduce failure by compensating for the human the fallibilities of partial memory, wandering attention (especially tasks that are considered mundane and routine) and skipping steps because they don’t always matter ….until they do. From simple “To do” lists to carefully honed Aviation flight checks, checklists lead to better outcomes.
Human’s fail because of ignorance or ineptitude. We have only a partial understanding of the knowledge required to influence a situation or we don’t how to apply the knowledge that is available correctly or consistently.
Most operations in production environments these days are determined and controlled by standard work as defined in step by step operating and inspection procedures. Team members are trained to follow out a series of tasks in a pre-determined manner and are regularly audited on their understanding of, and compliance with, standard work.
But increasingly higher level professional functions are adopting checklists. There is just simply too much stuff going on – commercial construction, medical surgery, investment banking – for any individual or team to ensure they are on top of all the facts and variables. In these complex often unpredictable environments, checklists are becoming the norm.
Checklists help “experts” remember how to manage a complex problem, make priorities clearer, and prompt people to function better as a team.
Checklists offer a cognitive safety net:
- help with memory recall
- clearly set out the minimum steps necessary in a process
- are explicit: Do-Confirm; Read-Do
- offer possibility of verification
- instil the discipline of higher performance
- force people to talk to each other
- Do-Confirm – team members perform their jobs from memory or experience, often separately, but then stop. They pause and run the checklist and confirm that everything that was supposed to be done was done.
- Read-Do – people carry out the tasks as they check them off.
- Team – defining what needs to be “checked” and establishing the checklist protocols and procedures is a team activity.
- Define the pause points – points at which the team must stop to run through a set of checks before proceeding.
- Cannot be lengthy – 5 to 9 items. After 90 seconds checklists become a distraction. People start skipping steps. Focus on “killer items” steps most dangerous to skip and often overlooked.
- Wording – simple and exact. Familiar to profession.
- Looks matter – one page, uncluttered (minimal colour), use upper and lower case (simple sans serif font). Test: ease of reading.
- Test in the real world and simulate – modify to fit local procedures, processes and language.
- Discipline – team respect for, and adherence to, checklist protocols and procedures.
Checklists can make the management of complexity a routine. They ensure the basic but critical stuff is not over looked and ensure teams pause, talk, coordinate and accept responsibility.
The biggest cause of error in business is the failure to communicate. The goal is not just to check boxes. The goal is to embrace a culture of teamwork and discipline.
The Checklist Manifesto by Atul Gawande
Surgeon Atul Gawande tells of substantial improvements in operation outcomes – lower infection rates, lower rate of second surgeries, better mortality and huge $ cash savings – just through introducing Aviation style chcecklists to Operating Theatres. Highly trained and experienced surgeons, anaesthetists and theatre staff all became converts recognising that checklists made for safer surgery, teamwork and better patient outcomes (particularly when the unexpected happened) with no increase in team member specific skills.