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.
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.
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.
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.
It’s likely that the bulk of the audience doesn’t need any explanation of what a checklist is. In a nutshell, it is a list of questions or bullet points that characterize the status/progress of a certain activity or process. The list may contain any essential data regarding your accomplishments or plans. Due to their versatility, checklists can be leveraged in any industry regardless of the business focus. But what is the purpose and benefit of using this process organization tool?
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’.
After impressive reductions of catheter-related blood stream infections (CLABSIs) were achieved with the implementation of a checklist bundle, checklists were promoted as evidence medicine should look to this safety solution.19 However, successful reduction of CLABSIs was not due to the checklist alone: multiple interventions addressing ICU safety were implemented at the same time, and it remains unclear what role the checklist specifically played in infection reduction.2 For example, the CLABSI checklist relies on nurse oversight. The changes in nursing behaviour can improve physician performance of line insertion in ways that are unrelated to the checklist: through the ‘Hawthorne’ effect, because the physician knows they are being watched; through empowering nurses and levelling the power gradient between physician and nurse and improving the safety culture; or, through formation of best practice as a habit as physicians insert lines the same way each time.
Our checklists and checklist templates are licensed for personal use only. However, to avoid a bunch of emails, I will also say that I am okay with you doing almost anything with these checklists except posting the checklist (or anything you have created using the checklist template) on the internet or selling it. That includes permission to print and distribute as many paper copies of your checklist as you need. Don't remove the copyright or hyperlinks that I've included in the spreadsheet, though.
To-do lists are definitely awesome for getting things done, but there’s another kind of checklist as well – what I call the “routine checklist.” With a routine checklist, you write down all the steps/tasks needed to complete a certain project or process. The list of tasks never changes. You use the same checklist over and over again, every time you do that particular process/project.
The crux of this problem is while the world around us is becoming more and more complex, we’re still stuck with a brain that hasn’t changed much in 100,000 years. Sure, we’ve figured out ways to off-load memory storage to books and computers so we can know more; we just haven’t figured out a good way to overcome our evolved biases, cognitive flaws, and intrinsic forgetfulness. And so, despite owning a brain brimming with ever more knowledge, we continue to make stupid mistakes.