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."
6. Saving lives: Checklists can literally save lives. When the U.S. Army Air Corps introduced the B-17 bomber during WWII an experienced aviator crashed the plane during its second demonstration flight. After this tragedy the Army required that pilots use a checklist before taking off. This is the same type of checklist we see pilots use today that helps to avoid crashes.
As you can see, the power of checklists is not an illusory phenomenon. A famous surgeon, Atul Gawande, even wrote a book dedicated to this topic. Despite their simplicity, checklists give an extraordinary boost to organizing things in the most effective manner. Though, maybe their very simplicity underlies their power? Anyhow, you should try a few out. That is the only way to realize why you need checklists.
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.
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.
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.
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.
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.
Let’s take a simple example. When you get in a car, you can’t just drive because there is a set of specific operations to be done. These include fastening your seat belt, removing the handbrake, putting a transmission gear lever into neutral position, starting the engine, checking the indicators, etc. After you have checked and accomplished all these routine tasks, you can press the accelerator pedal and drive. Every driver has this checklist in his/her memory because of its regular use. If your set of tasks is bigger or varies frequently, it’s challenging to keep it memorized all the time.
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
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:
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