The Checklist Manifesto

If there is one topic that I have no natural affinity for, it is checklists. I don’t use checklists. I’m not interested in checklists.

Yet, against all odds, I read Atul Gawande‘s new book about checklists, The Checklist Manifesto in one sitting yesterday, which is an amazing tribute to the book that Gawande has crafted. Not only is the book loaded with fascinating stories, but it honestly changed the way I think about the world. It is the best book I’ve read in ages.

The book’s main point is simple: no matter how expert you may be, well-designed check lists can improve outcomes (even for Gawande’s own surgical team). The best-known use of checklists is by airplane pilots. Among the many interesting stories in the book is how this dedication to checklists arose among pilots.

Even more interesting are the stories about Walmart’s response to Hurricane Katrina, and the real reason why David Lee Roth used to demand that there be a bowl of M&M’s with all the brown ones removed in his dressing room backstage.


Philippe

Re: why David Lee Roth used to demand that there be a bowl of M&M's with all the brown ones removed in his dressing room backstage.

It was to be able to test to see if his contracts were actually read.

zoltan

I'm a professional magician - my list of equipment for any given show contains a list of all sorts of fiddly small items and a range of liquids, specific clothing, etc. Combustible liquids are stored safely in a metal box, some items must be stored in a freezer, or in their charging stand (for electronic gizmos)...I'd be lost without my pre-show checklist to ensure I have all the gear I need before a show.

Michael Scriven

Checklists have long been regarded as beneath the level of serious consideration by methodologists and others interested in the logic of the disciplines. But they are more sophisticated than they appear--and are perhaps the key methodology of those disciplines that really treat theory and practice as equals, e.g., surgery, engineering, neural and public economics, program and product evaluation. Recently some effort has been made to set this out: for more details about what may be the key methodology of the 21st century, see "The Logic of Checklists" first posted in 2000, at:
http://www.wmich.edu/evalctr/checklists/papers/index.html

Michael Scriven

James

I'm an academic, and frankly checklists don't seem that important to me, aside from the five-things-I-have-to-do-before-I-fly-to-Ohio variety. I can't even imagine how they could possibly improve my performance. I bet this is true of most academics -- if you forget something, you can always add it in later.

nick Grosvenor

This is why I read this blog. To get book suggestions from some of the smartest people around. Great!! I just went out and bought the book today.

Joe Smith

ISO quality control suggestions for business processes is all about checklists.

So called "expert" systems are computerized checklists in disguise.

Call it a checklist or a protocol, it reflects the accumulated experience of the discipline. Personally, I would like to see Judges use a explicit checklist in determining whether evidence is credible rather than just flying by the seat of their pants all the time.

David

To James:

I guess as an academic you can do tomorrow what you forget to do today, but for those who can not afford to miss something the checklist is important. I was never one for the checklist until I started to learn to fly. Then I became all about the checklist because the consequences of forgetting even the smallest item can be the difference between a good flight and a not so good flight; okay life and death. I guess to checklist or not checklist comes down to the penalty exacted for missing something.

Christopher Strom

"I can't even imagine how [checklists] could possibly improve my performance."

While I raise an eyebrow at the pride in limited imagination, I suppose the utility of a checklist is far more clear in fields where success and failure (and the work in general) is more clearly defined and therefore measured, such as surgery, engineering, or piloting aircraft.

I don't mean to single out academia - business management suffers this general problem as well.

Paul Harris

I too appreciate the book recommendation! Co-workers used to laugh at me for having the messiest office around, yet the key to my organizational skills was maintaining a checklist. And if I didn't finish something that checklist remained in my pants pocket to take home and to work on the next day. It truly works.

As an aside I need to read what the author says about Walmart during Katrina. As a California tourist trapped in the Superdome during Katrina the only thing I saw when leaving was that the Walmarts had the only guards/police protection of any businesses I saw.

Paul Harris
Author, "Diary From the Dome, Reflections on Fear and Privilege During Katrina"

Kahomono

I manage the financial reporting systems for an F100 company. We could absolutely never do a quarterly close if we did not follow a checklist to prepare for receiving and consolidating the numbers from all over the world.

For hings that seem "Duh!" in the calm of a Monday morning conference room, never underestimate how easily they can get lost in the heat of a Friday afternoon battle!

Mr T.

I am a fan of Dave Allen - Getting Things Done.

His argument is that the brain can only do one thing at a time. A checklist takes the need away for the brain to think about what to do next, and concentrate on what it is doing now. (there are some rules on how to use checklists that make this effective)

I have found this to help me tremendously.

AaronS

Most people miss the greatest value of checklists. They think it's all about performing with great efficiency, not failing to cross and t's or dot any i's. But the greatest value of checklists is that they serve as a stress reliever. Let me explain with a couple of scenarios....

When your spouse sends you to the grocery store to buy, say, eight items, well, that's easy enough...if you don't get distracted, or can't contact your spouse via cell phone and confirm the items.

Or what if you are taking a test and need desperately to remember four very complex formulas? If you're like me, as soon as the test starts, while the formulas are still fresh in your mind, you write them down on your scratch paper for future reference.

The point is that your mind can juggle only so much information effectively. If you have too much going on, things get lost in the shuffle. And when you have that nagging suspicion that you are forgetting something...well, that causes stress, tension, and so forth.

But a list serves as a sort of analog flash drive. It allows you to record information for later use, allowing your mind the freedom to wander as it will.

Imagine going to the grocery store and repeating, over and over, the 8 items your spouse wants you to purchase, trying to come up with mnemonics, visual connections, or what have you to memorize the list. You dare not turn on the radio or take a phone call--you might "drop" something.

Checklists take a great weight off of your shoulders. Anyone who claims they can't see how a checklist would improve their performance...well, they must have a very non-demanding job indeed.

Read more...

MITBeta @ Don't Feed the Alligators

I used to be a Nuclear Plant Reactor Operator and I can tell you that not a single switch, valve, operator, etc. is ever touched, let alone manipulated by one hand without a checklist (procedure) in the other hand. Our job was to follow the checklist unless our training, intelligence, experience, etc. told us that the checklist was wrong, in which case we STOPPED and got clarification and permission from the checklist writer, supervisors, etc. before resuming the procedure.

Much of our continuous training focused on how to properly use a checklist (circle and slash to keep your place...) and to drill this discipline into our heads to the point that it was second nature.

Chris

"Check-Lists" are standard in the pharmaceutical industry, although they are usually call "Batch Records". The batch record lists everything you must do and check (temperature, pH, drug concentration etc) as the drug is manufactured. Each step is typically done by one person and signed off by that person plus another. It just makes sense! And should be used in many other procedures/industries.

Jacib

Also really interesting is the new use of protocols (not really a check list in sense of "make sure i do this and this and this" but more of "if this then that") in the medical profession increasing doctors' adherence to evidence based medicine.

Steve

It is said that now more than 600 of Fortune 1000 companies use a Balanced Scorecard, a form of which has been adapted as part of the Malcolm Baldrige National
Quality Award Program. A Balanced Scorecard is a great example of a checklist that achieves measurable results because it combines objectives in multiple perspectives, a financial perspective, customer perspective, internal processes perspective, and growth & learning perspective. A checklist may seem a simple thing, but if it is a good list, and most important, you actually implement it along with a prototyping mindset that confirms its effectiveness while trying to modify it as needed based on cumulative experience-then it can be a wonderful thing.

bruce

I think the check-list should go on the unsung heroes of human progress list. Duck-tape, self-regulating incubators(this led to all manner of thermostatic devices), clock-escapements, crank-shaft, radiator hose-clamp, cordage, the list goes on. One major point about the check-list is that from its very inception it has saved lives.

I can't speak for other cultures, but I know that in European history there have always been memory aids. The multiplication table comes to mind, the alphabet. Rhymes were very common. I suppose we could dispense with the clip-board check-list and replace it with a rhyme....

bruce

Kimota94

To Do List:

1) Visit Freakonomics blog
CHECk!

2) Provide sarcastic comment, if possible
CHECK!

3) Create "To Do List"
CHECK!

Jim R

In my opinion, AaronS has done the best job of any commenter on "selling" checklists. I'm a highly paid professional and I use them to avoid costly mistakes. I haven't read the book, but I did read the New Yorker article on the same topic (perhaps by the same author?), and in my mind, in many cases it verges on arrogance to believe that a given profession is above checklists in certain situations. Pride goeth before the fall, but a checklist can go very far in preventing that fall.

Damian

James,

I am also an academic, and cannot begin to imagine how useful checklists could be for my work. I have not yet read the book, but heard the author on Diane Rehm this morning. The arrogant attitude of "I can't imagine how a checklist could help me" is exactly what he seeks to overcome. While it's true, unlike surgeons, we can always make up for oversights after the fact, wouldn't you rather do things right the first time? What struck me the most was the authors discussion of overload of information: there is simply too much out there for a human brain to handle. This is certainly as true in literary studies (for me) as it is in the medical world.