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."
Every construction job begins with a massive checklist of tasks that have to get done and each task has an accompanying deadline. While that to-do list plays an important role in ensuring stuff gets done, an equally valuable checklist is also used. Called a “submittal schedule,” it centers on communication. The submittal schedule details which project managers need to talk to which project managers during a specific phase and about a specific process. The submittal schedule’s purpose is to get teams that are working on different yet co-dependent projects to regularly connect so they can discuss any potential sticking points. For example, there might be an item on the checklist for carpenters and plumbers to meet up at a specific time to discuss their progress on their respective tasks. Maybe a problem has come up with the pipes that affects when the carpenters can get started on their work, but perhaps there’s something the carpenters can do to help the plumbers. The trick is to keep each other in the loop so each respective team can take care of these “known unknowns” as quickly and as effectively as they can. Once the teams talk, they check the communication task as complete, and move on with their work.
Healthcare safety activists have looked to checklists to solve a myriad of problems, particularly with the current iteration of checklists that have been imported from aviation. Large-scale implementations with conflicting outcomes suggest that these tools are not as simple or effective as hoped. Scholars debating the efficacy of checklist implementation in healthcare have identified important reasons for varying results: that success requires complex, cultural and organisational change efforts, not just the checklist itself2; that results may be confounded by a mix of the technical and socioadaptive elements,3 and that local contexts may either augment or undermine the implementation's outcomes.4
Daniel Bryant sat down with Dave Sudia, senior DevOps engineer at GoSpotCheck, to discuss the benefits of PaaS; building a platform with Kubernetes as the foundation; selecting open source components and open standards in order to facilitate the evolution of a platform; and why care should be taken to prioritize the developer experience and create self-service operation of the platform.
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Daniel Bryant sat down with Dave Sudia, senior DevOps engineer at GoSpotCheck, to discuss the benefits of PaaS; building a platform with Kubernetes as the foundation; selecting open source components and open standards in order to facilitate the evolution of a platform; and why care should be taken to prioritize the developer experience and create self-service operation of the platform.

Non-boldface checklists are used to provide decision support when time is not critical. In complicated situations, such as multiple system failures, the checklist appears in the form of a flow chart or decision tree, helping the pilot(s) to navigate the process. In modern aircraft, the checklist is built into the electronic cockpit system, which leads the pilots through the appropriate steps on the screen. The steps are colour-coded for urgency and ranked in priority order. As steps are completed, they disappear from the screen. Checklist items are arranged in a systems operational sequence and are consistent with the patterns of motor and eye movements of the crew.
1. Checklists verify that the necessary minimum gets done. With increasing complexity comes the temptation to skip over the stupid simple stuff and instead focus on the “sexy” parts of one’s work and life. Because the stupid simple stuff is so stupid and simple, we often fool ourselves that it’s not important in the grand scheme of things. But as we’ve seen, it’s often our most basic tasks that can spell the difference between success and disaster.
When ideas are translated from one industry to another, the assumptions underlying the original concepts may be lost or diluted. As checklists are increasingly imposed through a variety of professional and regulatory mandates in North America,5 Europe6 and elsewhere,7 perhaps it is time to review the fundamental principles of checklist use, including why they might work and how we can implement them better.
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Though Gawande admits he didn't expect to see the checklist make much difference in his own surgeries, he followed it to avoid hypocrisy and was surprised by the results. The checklist saved a life in at least one case, where a mistake by Gawande led to a critical need for blood while the mistake was corrected. Thanks to the checklist, extra blood had been prepared ahead of time, despite Gawande's confidence in performing a surgery he'd done successfully many times before.

Sophisticated areas of focus like medicine, software development, numerous sorts of manufacturing, and others abound with complicated pipeline steps. Teams and departments interact to either complement or proceed with the production process in stages that require proper coordination. At first glance, the checklist's role is not remarkable. However, a deeper analysis shows that this tool stores trivial and easy-to-forget tasks outside your brimming-with-tons-of-data brain.


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