Book of the Week: The Checklist Manifesto
29 May 2016
This week I read The Checklist Manifesto by Atul Gawande, MacArthur Fellow and professor at Harvard Medical School. I’ve heard about the results of having a checklist, but I’ve never read the source. Everyone should use checklist, because they help when dealing with extreme complexity.There are four expectations of learned occupations: selflessness, skill, trust-worthiness and discipline. Discipline is hard, but checklist help with that. I bet you can imagine the pilot not flying going through the pre-flight checklist. Now imagine this applied to everything else. He goes over how checklist are use in flying, cooking, construction, investing, and surgery. Metrics Dr. Gawande worked with the World Health Organization (WHO) to develop checklist to save lives. There are four big killers in surgery: infection, bleeding, unsafe anesthesia and the unexpected. The first three killers can mitigated with checklist. [youtube https://www.youtube.com/watch?v=DOGJMOMHDJk&w;=420&h;=315] Here are some metrics from studies using checklist in surgery.
- Reduced 10-day line-infection rate from 11% to zero.
- Decreased central line infection rate at Michigan’s ICU by 66%.
- Saved $175 million in costs and 1500 lives in first 18 months of Keystone Initiative.
- OR nurse turnover dropped from 23% to 7%.
- Employee satisfaction rose 19%.
- Major complications for surgical patients fell 36%.
- Deaths fell 47%.
- Infections fell by half.
- Number of patients returning to operating room after original operation fell by 1/4th.
It is hard to argue against using checklist in surgery. Makes you wonder what else they can help with. Checklist There good checklist and bad checklist. These are some guidelines for creating a checklist of your own. It takes a few iterations to check the checklist right.
Bad checklist are vague and imprecise. They are too long; too hard to use; they are impractical. They are made by desk jockeys with no awareness of the situations where they are to be deployed. They treat people using the tools as dumb and try to spell out every single step. They turn people’s brains off rather than turn them on. Good checklists, on the other hand are precise. They are efficient, to the point, and easy to use even the most difficult situations. They do not try to spell out everything—a checklist cannot fly a plane. Instead, they provide reminders of only the most critical and important steps—the ones that even the highly skilled professionals using them could miss. Good checklists are, above all, practical.
There are two kinds of checklist: DO-CONFIRM and READ-DO checklist. READ-DO checklist are like following a recipe, while DO-CONFIRM checklist make sure you take a pause to make sure they are doing everything they are supposed to be doing. The checklist should help you confirm that you are switching to a tube of the right inner diameter. I wish everyone used checklist. Purchase The Checklist Manifesto on Amazon.com or check it out from your local library.