Investigators discovered the crash wasn’t caused by a mechanical malfunction, but rather pilot error. The problem was while the new bomber could carry more and fly faster and further than any other bomber in history, it was also an extremely complex plane to operate. To fly it, a pilot had to pay attention to four different engines, retractable landing gear, wing flaps, electric trim tabs, and much, much more. Because the pilot was so preoccupied with all these different systems, he forgot to release a new locking mechanism on the elevator and rudder controls. Overlooking something so simple killed the two men at the helm.

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.
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One thing to remember: your checklist doesn’t have to take the form of a list. One checklist I use every day is my Daily bookmark folder. It’s a bookmark folder in my browser (I use Firefox) that contain the sites I want to visit daily. Every day, all I need to do is opening the bookmark folder and it will automatically open all the sites I want. Simply by opening it I can be sure that I won’t miss anything.
In healthcare, we need to get back to the basics with checklists and reserve the tool for processes that are simple, easy to follow, standardised and (perhaps) time critical. Expanding the term to cover briefings and other tools more suited to complex and variable processes is confusing, and may require communication and advanced team skills to implement and sustain. It is appealing to embrace a single tool to improve safety, and checklists have been found to be effective in some settings.16 However, the complexity of quality and safety improvement in healthcare guarantees that solutions will never be singular, straightforward or simple to sustain.

The way I prepared for these tests was to take lots of practice exams under the same time constraints as the real deal. Professors often post their old law exams online so I used those. The most important part of these practice sessions was the review afterward. I’d look at my answer and compare it to the professor’s answer key. It allowed me to see which issues I missed and any analysis I forgot to include. After two or three practice exams I began to see patterns in my failures. I’d make the same mistakes over and over again, and it was often due to overlooking stupid stuff.
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
Lastly, the checklist involves a Time Out: this requires that everything stops and no one interrupts. In an emergency, or under extreme time pressure, it is difficult to get everyone on the team to stop what they are doing and attend completely. The loss of team discussion under time pressure has been described by some centres implementing the Safe Surgery checklist.6 ,13 These are the times when mistakes are most likely to occur, yet paradoxically also when the Time Out portion of the checklist (the briefing to support complex work) is least likely to be performed as intended.
It's primarally a to-do list app, but Wunderlist can also be a great tool to create checklists. It's free, runs on just about every device, and is incredibly simple to use. You can't duplicate lists, but you can make a list and share it a Public List. Anyone—on your team or around the globe—can then add the list to their account, check off the items, then add it again whenever needed. It's a workaround, one that might keep you from needing a new app just for making checklists.

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.
If you're a fan of writing in Markdown and using keyboard shortcuts, Checkvist is made for you. It's a web app that lets you create checklists that you can print or share with others, and even set up daily reports. If you need collaborative checklist management, or you want a checklist that integrates with your favorite services like Evernote, try Checkvist.
Reinforcement and sanctions surrounding tasks may distract performance from the intent of the checklist. In healthcare, there is often a need to adapt the procedure to the patient or the context. Recent findings show that the WHO checklist, for example, is often implemented differently within single organisations, depending on context. Clinicians may be discouraged from acting in a manner that is best for the patient if they perceive that they may be censured for not following the procedure ‘to the letter’.
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.
My interest in general checklists above and beyond the detailed lab notebook began after reading The Checklist Manifesto by Atul Gawande, a surgeon and Harvard Professor (he also is the author of a New Yorker column on the same subject). The purpose of this book is to describe how a basic checklist can help us perform complex tasks consistently, correctly, and safely. Much of the book is told from the point of view of eliminating errors during surgery, but Gawande also draws on stories on how checklists have benefited those in construction, aviation, and investing.
In healthcare, this type of operational check of equipment has evolved along with advanced medical technology. Since 1993, Anaesthesia Apparatus Checkout Recommendations have targeted the proper configuration of anaesthesia gas delivery systems.9 These recommendations are intended to be peer-reviewed, modified and updated for each specific type of manufactured anaesthesia equipment. Thus, prechecks are incorporated into manufacturing and inservicing of equipment and iteratively updated by the professionals using them. Operating room and anaesthesia workflows accommodate these prechecks.
To build a proper testing checklist you need to take into account not only the product requirements and user stories, but also cover a wider spectrum of implementation. At the same time, the test scope should be narrow enough to focus on a product’s functionality. It is also important to make separate tests for different parts or elements of activity. For example, a purchase activity on a website may consist of three parts - signing in, adding products to the cart, and signing out. Splitting your checklists for testing procedures will isolate test failures and keep the focus on the essential details.
Gawande in 2009 introduced a hospital surgery checklist for doctors and nurses as part of a program developed with the World Health Organization. The checklist was designed to ensure basic checks were always completed before surgery. Run through the list, and you'll make sure everyone in on the same page about the surgery to be conducted, aware of who else was on the surgical team, and knows their role in the procedure.
Accepting the fallibility of our memories and the overwhelming amount of information we need to manage and apply in our jobs is an important first step. Realize, as Gawande wrote, that "Knowledge has both saved us and burdened us," and recognize that the checklist can make sure your brain doesn't fail you—ever. Then, you'll be ready to create and rely on a checklist, one that that will help you perform better, and more consistently.
Clinicians have long relied on an analogous form of decision support such as lists or algorithms for differential diagnosis. When a patient presentation is unusual (non-normal but not emergent), differential diagnosis lists (whether in old-fashioned textbooks or new-fashioned handhelds) support clinical performance by serving as a cognitive aid. The practice of reviewing a complete differential helps overcome anchoring and confirmation biases and can be a forcing function to ensure that every critical, and treatable aetiology is ‘ruled out’. Unlike non-normal checklists that are built into cockpit workflow, differential lists are often not well-integrated into clinical workflow and this may undermine their use.12

Agile software development leverages a technique called the user story to get enough information for implementing software features from an end-user perspective. Shaping acceptance criteria is an integral part of this process that can be improved with a checklist's help. You can create a special format containing categories, point assessments, labels, names, etc. For example, a Definition of Ready can be transformed in Definition of Done category after changing the story specification. On the picture below, you can see an implementation plan, which is, in fact, a ToDo list containing guidance on how to handle the user story written in the description section.
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."
This week I made my first checklist for setting up one of my thesis data collections. I listed specific essential tasks and supplemented them with common errors I had either made or had encountered in the past. After making this specific checklist, I decided to see if I could make a general list that could be applied to all studies. Surprisingly, it was easier to do than I thought, although I’m sure it isn’t perfect. I was able to group many of my tasks together under one common point. What is not easy so far is trusting and not deviating from the checklist. It’s been easy to throw the checklist to the side when I get frustrated. In more stressful situations or even when things are running smoothly, I may forget that I’ve come up with a structured way to make sure I’m managing my data collection in the best way possible.
That brings us to the last point about checklists - they DO NOT replace knowledge. An investor interviewed for the book said it best when describing that the checklist is “not a fail safe thing…you still need expertise and insight into the process to be able to ultimately perform each step correctly”. These checklists wouldn’t help me if I didn’t know what I was doing to begin with. Rather than being a “Step by Step to Collecting Data”, people can perform a task however they want and the checklist makes sure that in the end that task was performed correctly.
Checklists let you put tasks in order so you can accomplish the most important things first. Once you have put things in writing though, you might feel pressured to complete the tasks in order. This can slow you down. Some people work better when they can jump from task to task and let their emotions guide them. A checklist might impede their emotion. However, if you truly need to finish certain tasks before moving to new ones, a checklist will keep you focused and on-track.

Checklists don't have to be boring. Pocket Lists is a fun, personal checklist iOS that lets you organize your checklists with icons. Organize the things you need to do, then add an icon to each checklist to make it easy to identify. It can manage your daily tasks, with due dates and notifications, and can also keep track of your more detailed checklists to help with your work routines.
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.
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.
Your job desperately needs to be structured with a checklist, but if your first checklist doesn't survive, don't despair. Just like best laid plans, checklists—at least first drafts—will often go awry in the real world. Even aviation and surgical checklists are constantly being modified to be easier to use, clearer, and more useful in real-world situations.
1. Investigate your failures and look for “killer items.” Take a look at your work or even your personal life. Are you less productive at work than you’d like to be? Does the house always seem a disaster? Examine why you aren’t getting the results you want. Look for failure or friction points in the tasks you do routinely. These failure or friction points will serve as the basis for your checklist.
Aviation checklists are designed for modern aircraft that are complicated, not complex; it is usually possible to define a single process path that offers optimum performance for each flight condition. These process paths are flight tested, endorsed (with minor modifications) by airlines when they purchase a new aircraft type, and published in procedural manuals and checklists. There are two categories of checklist used in the cockpit: normal and non-normal (or emergency) procedures.
‘Normal’ checklists are effective whenever there are advantages to standardising performance, time is not critical, the series of tasks is too long to be committed to memory (or there are likely to be interruptions to execution of the task that might interfere with memory retrieval), and the environment enables a physical list to be accessed and used.
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.
Whenever he went on business trips, my Dad would always write down the items he would need to take. His checklist would include articles of clothing, types of clothing to take, and personal hygiene items, along with the work-related items he would need. Although I cannot be certain, I strongly suspect he also included lists of work-related issues that he either knew about ahead of time or at the very least he would make a note of to bring up during the trip. That way, he would ensure that nothing would be forgotten by him or left to chance.
Because checklists provide a binary yes/no answer, they instill discipline in the person that uses it. Research shows that giving someone a checklist for a task increases his or her chances of completing it. There’s something about having a checklist that spurs people to get stuff done. Perhaps it’s the dopamine rush that comes with checking something off, or the concreteness checklists provide, or a combination of the two.
The way I prepared for these tests was to take lots of practice exams under the same time constraints as the real deal. Professors often post their old law exams online so I used those. The most important part of these practice sessions was the review afterward. I’d look at my answer and compare it to the professor’s answer key. It allowed me to see which issues I missed and any analysis I forgot to include. After two or three practice exams I began to see patterns in my failures. I’d make the same mistakes over and over again, and it was often due to overlooking stupid stuff.
In healthcare, this type of operational check of equipment has evolved along with advanced medical technology. Since 1993, Anaesthesia Apparatus Checkout Recommendations have targeted the proper configuration of anaesthesia gas delivery systems.9 These recommendations are intended to be peer-reviewed, modified and updated for each specific type of manufactured anaesthesia equipment. Thus, prechecks are incorporated into manufacturing and inservicing of equipment and iteratively updated by the professionals using them. Operating room and anaesthesia workflows accommodate these prechecks.
3. Decide if you need a “communication” checklist. Most checklists are likely procedural (they lay out things you need to do), but some tasks or projects are so complex that communicating with others becomes vital to managing all the moving pieces. In such a case, create a dedicated communication checklist and make sure it includes who needs to talk to whom, by when, and about what.
Being a professional implies constant education. Even top-notch experts have to nurture their domain knowledge to maintain their background. At the same time, can we claim that a high level of expertise guarantees lack of errors? The question is especially acute in software development where each error results in an increase in time and cost. Therefore, regardless of the chosen methodology - Agile, Lean, Rapid, Feature Driven, or others - striving to organize software development processes should be a top priority for project managers and other leaders. In that context, similar to the unsung hero, whose is not noticed by the public but crucial for the history, checklists come to center stage.
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