Gawande explains that we are up against two things when performing either a high volume of simple tasks or a variety of complex tasks. The first is that human memory and attention can fail you, especially when a bigger issue arises. This could be your participant being late and your data collection program freezing, making it easy to forget that you haven’t performed a baseline test. The second thing is that we skip tasks even when we remember them because nine times out of ten that step doesn’t matter. Never check to make sure your wires are plugged in correctly? If you’re the only one working in the lab maybe it doesn’t matter, but if multiple lab mates are cycling through the lab, this could be a bigger issue.
When it comes to checklist implementation, it is important to recognise that aviation checklists are integral to the normal workflow. The aircraft does not stop while the checklist is completed, and the timing of checklist completion is arranged so that it does not conflict with other essential flight activities. To that end, the checklist does not impose an additional burden or workload, but is actually perceived by aircrew as something that makes the flight easier. In contrast, the Time Out is performed before the case can begin, so essentially stands independently of the workflow. To that end, the Time Out is likely to be seen as something additional, and, unless it results in obvious time-saving downstream, will be perceived as an increase in workload. This mixture of purpose between checklist and briefing, in combination with implementation issues, may explain the range of outcomes as well as the range of enthusiastic to skeptical opinions about the mandated use of checklists in surgery.14–16
But the military still bought a few Boeings to experiment with. Some test pilots believed the Boeing bomber was a much more effective warplane and got together to figure out how they could get pilots to fly it. Instead of requiring more training, the test pilots implemented a simple pre-flight checklist. It spelled out all the basic tasks that were needed to fly the plane successfully, like checking to see if the battery switches and radio were on before taking off. By implementing the checklist, pilots flew the Boeing bomber 1.8 million miles without a single accident. Thanks to a “stupidly” simple checklist, the Army ended up ordering thirteen thousand Boeing bombers and the B-17 soared into the annals of wartime history.
Concerns have recently been fuelled by the disappointing results after implementation of the checklist in Michigan17 and large-scale mandated implementation in Ontario Canada.5 Interpretations of results are also complicated by reported differences between perceived and actual application of the checklist. In a recent US study, hospital documentation indicated 100% compliance with checklists, but observers found that on average only 4 of 13 checklist items were actually completed.18 Even strong advocates for checklists admit that full implementation of the WHO checklist is difficult and that improvements require more than the checklist, including strong institutional leadership, data collection, and monitoring, and training in teamwork.4 ,14
Mental checklists to improve thinking. Berkshire Hathaway vice-chairman Charlie Munger uses a mental checklist of biases and cognitive flaws that he reviews before making any big decision to ensure he’s thinking clearly about it. He’ll go down the list and ask himself if any of these biases are clouding his thinking and what he can do to mitigate it. Ever since I’ve learned about that, I’ve tried using something similar in my life. Crafting this list is still a work in progress for me, but here’s what I have so far:
We may not like to admit it, but many of us can describe a time when we’ve made a mistake during the progress of a study. These mistakes can range from mixing up wires or forgetting to turn on an amplifier to forgetting to collect an essential piece of information that either requires additional processing time or prevents you from analyzing a certain variable altogether. Increased computing power and technological advancements have also made it easier than ever to collect data.
You can leverage checklists in various areas of life. Are you going to get married? There is a wedding checklist. Is a business trip coming up? A travel checklist will help. Other options include inspection, security, packing, invitation, moving, shopping, etc. Most things are like that, your next or current project will definitely benefit from using this sort of process management tool.
Checklists seem simple, Gawande says, and are sometimes hard for us to accept as a necessity when we're in high-powered jobs that rely on our skills and knowledge. But humbling ourselves by using a checklist can improve our performance and help us achieve more consistent results. "They remind us of the minimum necessary steps and make them explicit," writes Gawande. "They not only offer the possibility of verification but also instill a kind of discipline of higher performance."
NO, I don’t. I call them “to do” lists. LOL! They’re very helpful, they keep me sane and keep stress away. For many years now, I keep a daily list prepped the night before; and a weekly list that’s prepped every Sunday. Keeps things smooth-sailing all the time. So at the end of the day, if all items are crashed-out (as in “done”!), I feel so good about myself. :)