how to write a checklist

26 Jan, 2010 • posts i've written • 8 comments

Yesterday I finished Atul Gawande’s inspiring book, The Checklist Manifesto – I know what you’re thinking, inspiring, checklist, these words do not belong in the same sentence.

Oh but they do.

Dr. Gawande walks through many examples of when checklists have saved hundreds of lives: from Captain Sully and the geese strike, to a checklist he helped create for the World Health Organization that increased survival rates among surgical procedures by 47%, to his own hospital and his own patients.

The book is a fast read. The first half lays the ground work for why checklists are so necessary and the latter half discusses the development of the author’s own checklist, the results from that experiment, and some exploration of why checklists are generally refused by experts even when they dramatically prove their own worth.

In fact, the book has all the reasoning behind a checklist, without actually providing direct instruction, for obvious reasons: the creation of a checklist is a labored process of identifying failures, considering the role of the checklist, then testing, refining, and further testing.

But after a bit of hunting, I did manage to find this checklist for checklists created by Dr. Atul Gawande, the Brigham and Women’s Hospital Center for Surgery and Public Health Dissemination Team, and Dan Boorman of Boeing.

click here to visit the checklist site for a pdf

A few notes from the book in addition to the chart:

• A checklist is not a set of instructions – the role of the checklist is to help identify and correct common and severe errors during a procedure
• A checklist should be simple, measurable, and transmissible
• A checklist manages actions AND communications between team members; one of the first steps in many checklists is for every member of the team to introduce themselves to the group to facilitate open conversation during a crisis
• A checklist is either READ-DO or DO-CONFIRM; a READ-DO checklist is meant to be read aloud as actions are being performed, a DO-CONFIRM checklist is meant to be used before pause points to ensure all previous checklist items were taken or considered by the team
• Often several checklists are needed for complex procedures – in these cases, it’s critical to identify pause points to start and stop checklists
• Be explicit about who reads the checklist to the team – in aviation, this is the ‘pilot-not-flying,’ in medicine it is often a nurse; choose someone not directly in charge of the actions and afford this person the authority to intervene in the situation when called for
• Test, re-test, and refine your checklist – measure its efficacy, look for items to cut, and areas to be more explicit

How do checklists written for the B17 bomber, cancer surgery, or investment funds relate to my work? Well, I work for some of the largest brands in the world that have created for themselves empires of complexity. Much of what I do is the study of process. And our own internal work is a series of procedures assessing complex systems – from the competitive landscape, to target research, budgeting, agency relations, and so on. One small routine error on our part can easily become a virulent infection once inserted into our client’s day to day operations.

It behooves us to try a checklist.

reading list: the checklist manifesto

07 Jan, 2010 • posts i've written • No comments

I’m eagerly awaiting the arrival of Atul Gawande’s The Checklist Manifesto and from the substance of two interviews I’ve seen, I already recommend this book.

From Malcolm Gladwell’s review,

Gawande begins by making a distinction between errors of ignorance (mistakes we make because we don’t know enough), and errors of ineptitude (mistakes we made 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, and he walks us through a series of examples from medicine showing how the routine tasks of surgeons have now become so incredibly complicated that mistakes of one kind or another are virtually inevitable: it’s just too easy for an otherwise competent doctor to miss a step, or forget to ask a key question or, in the stress and pressure of the moment, to fail to plan properly for every eventuality. Gawande then visits with pilots and the people who build skyscrapers and comes back with a solution. Experts need checklists–literally–written guides that walk them through the key steps in any complex procedure. In the last section of the book, Gawande shows how his research team has taken this idea, developed a safe surgery checklist, and applied it around the world, with staggering success.