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Checklists: A Simple Tool with Complex Benefits

The volume and complexity of our knowledge has exceeded our ability to deliver its benefits correctly, safely and reliably. Checklists can help us navigate this complexity and avoid harmful mistakes.

July 2014 By Wes Friesen
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"Everywhere I looked, the evidence seemed to point to the same conclusion. There seemed to be no field or profession where checklists will not help."

—Atul Gawande, author of The Checklist Manifesto

Looking for a simple tool that will drive your operation to higher levels of efficiency and effectiveness? The checklist may be what you are looking for.

I recently read Atul Gawande's book The Checklist Manifesto, which inspired me to read real-life examples from the medical, construction, aviation and finance fields to show how checklists—coupled with timely and effective teamwork—can vastly improve the quality and effectiveness of what we do. In some cases, they can make the difference between life or death.

Gawande is a surgeon, and he shared how he and his team developed a two-minute checklist that covered some basics for surgery (e.g., do we have enough blood and antibiotics?), as well as some basics for good teamwork (e.g., does everyone in the operating room know the name of each person in the room?). They then tested these lists in eight different hospitals. The results were stunning. When they took the time to make introductions and follow the checklist, they had a 35 percent decline in deaths and complications related to surgery.

The problem is that mistakes are being made that harm people and our organizations. Why? The reality is that our know-how and sophistication have increased remarkably across almost all our realms of endeavor, and as a result so has our struggle to deliver on them.

You see it in the frequent mistakes authorities make when hurricanes, tornadoes or other disasters hit. You see it in the increase in lawsuits against attorneys for legal mistakes—the most common being simple administrative errors, like missed calendar dates and clerical screw ups, as well as errors in applying the law. You see it in flawed software design, in foreign intelligence failures, in our tottering banks—in fact, in almost any endeavor requiring complexity and significant amounts of knowledge.

The communication world—including print, mail and e-communications—has not been exempt from errors. We have recently seen a large company mistakenly mail out thousands of mail pieces with sensitive customer information. Unfortunately, information was sent to the wrong customers and a security breach transpired. Sad to say, this example within our industry is not an isolated one.

Avoidable mistakes are common and persistent, not to mention demoralizing and frustrating. And the reason is increasingly evident: the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely and reliably. Knowledge has both saved us and burdened us. We need a tool to help us navigate complexity and avoid unnecessary and harmful mistakes.

The Solution: Checklists

Checklists by themselves are not the proverbial "silver bullet" that will eliminate all mistakes, but they will help reduce mistakes and improve our quality and effectiveness. I have had multiple teams earn quality certifications like the MPTQM (Mail Processing Total Quality Management) from the U.S. Postal Service and ISO-9001. A key component to earning these certifications and ensuring consistent quality in our operations is the use of checklists. Our ultimate goal is not just to have people ticking boxes on a checklist. Our ultimate goal is to have our teams embrace a culture of teamwork, discipline and quality—and checklists can be a useful means to that end.

Benefits of Checklists

Here are some of the benefits they bring. Checklists:

1. Help with memory recall and clearly set out the necessary steps in a process. This provides verification and helps ensure consistency.

2. Establish standards of good performance and help ensure proper execution.

3. Help defend everyone—even the experienced—against making mistakes. They also help combat complacency.

4. Serve as a "cognitive net." They catch mental flaws inherent in all of us—flaws of memory, attention and thoroughness.

5. Serve as a great training tool to help ensure people are completing tasks correctly.

For me the bottom line is that checklists can help eliminate "stupid" mistakes. In some fields like medical, aviation and construction these avoidable mistakes have not only cost organizations millions of dollars, they have also cost people their lives. In our industry normally lives are not at stake, but service to our customers, avoiding risk, making money for our shareholders and creating a high-performance culture for our employees are all on the line.

Checklist for Developing Checklists

A key to successful checklist development is participation, especially with the end users of the checklist. Participation builds buy-in and support and will result in better quality end results.

You can go to atulgawande.com and download Gawande's "A Checklist for Checklists" and also see a few sample checklists. Let me share some key questions (guidelines) for building effective checklists:

Step One: Development

• Do you have clear, concise objectives for your checklist?

• Is each item: A critical step and in danger of being missed? Not adequately checked by other mechanisms? Actionable, with a specific response needed?

• Have you involved all relevant team members in the checklist creation process?

Step Two: Drafting

• Does the checklist: Utilize natural breaks in workflow (pause points)? Use simple sentence structure and basic language? Have a simple, uncluttered and logical format? Fit on one page? Minimize the use of color?

• Is the font: Sans serif? Upper- and lower-case text? Large enough to be read easily? Dark on a light background?

• Is the date of creation (or revision) clearly marked?

Step Three: Validation

• Have you tested the checklist with front-line users (in a real or simulated situation)? Have you modified it in response to these trials?

• Does the checklist: Fit the flow of work? Detect errors at a time when they can still be corrected?

• Can the checklist be completed in a reasonably brief period of time?

• Have you made plans for future review and revision of the checklist?

Checklists aren't the total solution to eliminating mistakes. They are, however, an important tool for helping us and our team members stop making those "stupid" mistakes—which are so easy to make when we're working hard and trying to keep up with the many details of getting the work done.

Good luck to you as you expand the use of checklists and lead your team to an even higher level of quality and performance.


 

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