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.
Most companies strive to arrange their best practices in the most convenient way. Checklists work well here. Providing essential information for repetitive tasks in the form of a list proves a company’s consistent approach to any level of activity. As an example, introducing specific rules and policies to new team members is quite practical when done through checklists.
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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.
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.
This isn’t a problem unique to medicine, of course. It exists across almost every domain of life, be it business or science or even just getting things done around the house or on your car. More and more of our work requires coordinating different teams to get a task done. If you work for a big corporation, you’re likely collaborating with a whole host of people to complete a project. And just as in medicine, you’ve likely seen projects delayed or even fail not because of lack of know-how, but due to head-scratching ineptitude.
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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.
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.