CHECK·LIST

/ˈCHEKˌLIST/

As I prepared lunch on a lazy Saturday morning with NPR (National Public Radio) blaring in the background, I was intrigued by the topic being presented by the host of Hidden Brain, Shankar Vedantam. The use of a “checklist”, something I take for granted in my field of practice namely project management – has saved countless lives in the field of medicine and surgery and is increasingly being adopted across many hospitals around the world to increase medical success. The link to the recording found here – makes for some interesting listening!

At the end of the broadcast, my interest had been piqued enough to google the story about the flight competition held by the U.S. Army Air Corps. This is the one where airplane manufacturers vied with one another to build the next long range bomber to be used in WWII. The first formal checklist was probably made popular by the U.S. Army Air Corps after Boeing Corporations “flying fortress” the Model 299, was entered into the U.S. Army Air Corpsflight competition on October 30th, 1935. On that eventful day, it took off, began a smooth climb then stalled and crashed, killing two of its five crew members. An investigation revealed that there was no mechanical problem what so ever. Instead, the crash had been attributed to “pilot error” – in other words a person made a mistake because “they didn’t make proper use of what they knew” as opposed to being confused or influenced by other factors. Substantially more complex than any previous aircraft manufactured by Boeing, the pilot had to attend to a number of new aviation features in the newly designed aircraft. While in the process of doing just that, the highly experienced pilot had forgotten to release a new locking mechanism on the elevator and rudder controls causing the plane to stall (the locking mechanism would not release after plane was in flight) and crash.

Although the Army declared Martin and Douglas the winner, they still, purchased a few aircraft from Boeing as test planes. A group of test pilots got together and considered what to do. They ruled out additional training (given the strict training program and flying experience required before anyone was placed in the pilot seat). Instead, they came up with a clever yet simple approach: they created a pilot’s checklist, with step-by-step checks for before starting the engine or engines, during warm-up, before takeoff, during flight, before landing, and after landing or taxiing. These checklists clearly outlined the pilot’s as well as the co-pilot’s duties. With the checklist in hand, the pilots went on to fly the Model 299 a total of 1.8 million miles without a single incident. By this point, the U.S. Army Air Corps had purchased several of these aircraft eventually calling them the B-17, which could carry five times as many bombs as the Army had requested, fly faster, and twice as far than the previous bombers. This range of the B-17’s gave the U.S. Army an edge during WWII. This is how the humble “checklist” was born! Today, these checklists are key to commercial aviation being significantly safer without having to leave complicated things committed to memory of any pilot or expert. Fast forward over a half a century later, checklists are used in all walks of life from teachers and administrators, to NASA, research, automobile industry, nuclear power, medicine and patient safety, college study, grocery buying and even Emergency Medical Safety to name a few. Smartphones today help you avoid drowning in a sea of tasks & get more organized using a selection of apps at your fingertips. Many of these sync up with your applications on your PC such as your digital calendar or even your smartwatch!We live in an era where experts in almost all fields have greater knowledge of the details that matter and an ability to handle the complexities of the job. However, we find that, with all the spectacular successes, we have also had failures, some which could have been easily avoided. What do you do when expertise is not enough?

Atul Gawande, MD, author of “The Checklist Manifesto”, begins by making a distinction between errors of ignorance (mistakes we make because we don’t know enough), and errors of ineptitude (mistakes we make because we don’t make proper use of what we know). Failure in the modern world, he writes, is really about the second of these errors. He is of the opinion that even the most experienced and highly trained professionals are prone to errors as the expertise they often carry around with them is vast and many times committed to memory. He feels that in many instances, professionals enter what he calls the “B-17 phase” (alluding to the crash due to human error) because memory is fallible. One solution to preventing “human error” is to have a simple checklist. Gawande observes that in high-powered jobs the very notion of relying on a checklist is lampooned. It is hard for us to accept them as a necessity especially when individuals have spent years studying and being trained to be experts in their fields.

So why have a checklist? In his broadcast, Shankar elaborates on a few reasons, while I have added my own to his list below.

  1. First, they capture the critical number of necessary things that must be checked/verified.
  2. They help you combat your blind spots. Checklists help you focus on the things that aremost likely to trip you up – over time helps prevent the most common errors thatadversely impact successful results.
  3. Consider a checklist as your “Safety Net”. They help to ensure consistency andcompleteness in carrying out a task.
  4. Details are important in any job. Checklists help you ensure you don’t overlook anything.Checklists cover tasks that to the trained eye seem mind numbingly obvious, routine. Nevertheless, they act as a reminder and ensure you follow step-by-step and not overlook them (if executed well).
  5. Checklists prevent you from doing things on the fly.
  6. People screw up not because they are incompetent but because they are very good – sogood that they are over confident they have it all covered. They don’t feel the need to slow down and “go over the basics”. Checklists allow you to do just that.

You are not wrong if you think that it is absurd, that checklists in themselves will fix all problems. Creating a checklist is the first step. The second step is to get team members to keep you honest when stepping through the checklist. Thirdly, getting people to use them and to use them consistently is key to getting consistent results. However, how do you get people to use them?

  1. You have to make it easy for someone/team to use & comply with. Do a sanity check with the people who are expected to use the checklist. Are the items on the checklist sound and can they be done consistently? Is there anything that is glaringly missing?
  2. Co-create the checklist so there is buy-in (if others have skin in the game adoption becomes easier).
  3. Explain to the team not only why using the checklist is important but also how to use the checklist.
  4. If checklists are long and complicated, they become self-defeating. You should be able to run through a checklist in a reasonable amount of time – about 5-10mins.
  5. In his broadcast, Shankar Vedantam suggests that checklists should reflect only the critical items that might trip you up.
  6. Be alert as to how the checklists are rolled out to a wider audience. Mandatory versus voluntary garner different responses in people in terms of adopting checklists.
  7. You should expect some amount of push back and be prepared to reason why the use of the checklist helps the team function at a higher level of perfection. Help them understand the background that would help them get ready for the unexpected.

A notepad given to me as a Christmas present last year had a quotation that I feel compelled to share here: The biggest lie I tell myself is “I don’t need to write that down. I’ll remember it”. LOL!

No matter on which side of the argument you are on, it is a virtuous cycle: the more a checklist is used, the more productive people become and the more the checklist is used. The main reason for that is, individual members who contribute to the checklist, keep each other honest when evaluating and stepping through each line item and help reduce missed steps or potential errors by a very high percent (in some instances by 75% as observed by Gawande).

In some industries or areas, using a checklist might be a huge paradigm shift but one that increases the performance of a team/organization - because in the end we are only human!