And the tragic thing is it’s often the “stupid” simple stuff that gets people killed or keeps them in the hospital for longer than they needed to be. I have an acquaintance who ended up in the hospital for two weeks because he got the wrong heart medicine. The problem was ultimately one of miscommunication — a basic thing you think would be a given, seeing as how hospitals can transplant human faces and whatnot.
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."
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 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.
Perhaps, we have a complete picture of leveraging checklists in such industries as aviation or manufacturing. However, how has this tool proved itself in a more complex workflow - software development? In fact, software teams that follow Agile methodology appreciate the implementation of lists as acceptance criteria solutions, definition of done, progress tracking tools, etc. Moreover, each separate development process has its own advantages.
What these stubborn surgeons fail to see is that checklists provide them more freedom to exercise their professional judgment. They don’t have to think about remembering to do the stupid simple stuff because there’s a checklist for that. Offloading the need to remember basic tasks frees up the brain to concentrate on the important stuff. For surgeons, this means they’re left with more mental RAM to focus on handling unforeseen problems that often come up when you’re slicing someone open.
Everything seemed fine, until the patient stopped responding and his heart rate skyrocketed. The patient's blood pressure was barely detectable. Nothing his medical team did improved it, so he was rushed to surgery. Only when he was opened up did the doctor finally realize the stab wound went much further inside the patient than he'd thought, cutting right into the aorta—the main artery from the heart. Although it seemed like a small knife wound, the patient had actually been struck by a bayonet—part of the assailant's costume.
2. Checklists free up mental RAM. People often bristle at using a checklist because it feels constraining. They want to be flexible and creative, and the checklist seems to take away their autonomy. For this reason, implementing checklists among surgeons has proven difficult, even though studies show checklists dramatically reduce the number of preventable, life-threatening errors. Surgeons feel that their work requires an intuitive judgment that’s born from years of training and experience and can’t be reduced to a simple checklist.
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
I started to brain storm other areas that checklists could be beneficial. In the construction industry, Gawande explains that checklists are used so that key points are discussed between those in different aspects of the building process. For research, are there things that you always need to talk about with other experimenters or your supervisor when it comes to a study? Maybe a checklist can help there too. Also, when editing manuscripts or proofs, you could have a structured set of points to assess such as, “check to make sure data in tables/figures is correct” or “make sure reference list is up to date”. These all seem so basic, but if taking the time to go over them and know that once you’ve handed in the manuscript that these things have definitely been checked, it could prevent you from having to submit an erratum due to something like an improper figure.
In healthcare, this technique is used in resuscitation procedures. Healthcare workers are trained and recertified, in low and high fidelity simulators, to commence procedures such as Advanced Cardiac Life Support without referring to a checklist. When the patient is not readily revived or responding as expected, the team will refer to their checklists or algorithms to make sure the steps have been executed properly, and that they have not forgotten anything. For this reason, healthcare workers often keep a cognitive aid (a ‘checklist’ of sorts) posted on emergency carts, tucked into pockets or loaded onto mobile devices. ‘Boldface’ checklists can be effective whenever there is a critical sequence to be completed but time is short, or the situation does not enable a physical list to be immediately accessed and used.
Checklists organize what needs to be accomplished so nothing is forgotten. If you're a detail-oriented person, then creating a checklist in the morning gives your day a definite path and direction. However, organizing a checklist might be too time-consuming. Some people get caught up in the details of the list when they should have been focused on actual work. If you find yourself too focused on list-making, try accomplishing a few of the tasks and then return to creating the list.
Billed as a notebook for lists, WorkFlowy is an app to manage all of your checklists. Everything's listed on one sheet, where you'll keep all of your separate lists and sub-lists in order. Select on a bullet-point to focus on a particular sub-list, or the minus button on the left to collapse a list. That makes it easy to organize long checklists and still be able to focus on just the tasks you need to complete right now.
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
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.
Checklists make it easy to delegate tasks if someone offers to help you. If you are lucky enough to have assistance, you can refer to your list and know what to ask them to do right away. You can even share your list with them and let them pick what appeals to them. The disadvantage to delegating in this way is losing control when other people choose what they want to do. If you are concerned about giving away easy tasks and getting stuck with the challenges, keep your list to yourself.
Perhaps, this benefit will be most appreciated by professionals that bear responsibility for other people’s lives as in aviation or medicine. Nevertheless, a disciplined employee is always a catch. With checklists, you have a chance to develop that attractive characteristic. A narrow scope of answers ("yes" and "no") is not a burden to complete. A regular list check instills discipline in those who use it.
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.