I recently read a book called The Checklist Manifesto. For years, I have been looking for a study that validated the importance of creating and completing effective checklists. Atul Gawande did the work for me. A New York Times article summarized it beautifully:
“The study… results were startling. Without adding a single piece of equipment or spending an extra dollar, all eight hospitals saw the rate of major postsurgical complications drop by 36 percent in the six months after the checklist was introduced; deaths fell by 47 percent. In every site, introduction of the checklist had been accompanied by a substantial reduction in complications,” he writes. “In seven out of eight, it was a double-digit percentage drop. This thing was real.”
One might think with these results, hospitals and doctors would adopt the use of checklists immediately. The cost is minimal and if using a checklist saved just one life, wouldn’t it be worth it? Obviously not, because after this study was released in the New England Journal of Medicine, almost no hospitals are using a checklist.
While Doctors seem to be believe that using checklists are beneath their education and experience, airline pilots would not fly a plane without them. Why is that? The answer is obvious; airline pilots are in the plane, they are committed.
Airlines are not the only industry using checklists. Actually most companies that serve consumers including restaurants, convenience stores, hotels, retailers, and others extensively use checklists pinned to their walls, floating on clip boards, et cetera. What is disturbing is that a lot of companies are starting to wonder if using a checklist is effective and maybe they should eliminate its use. You have to wonder why companies are making these decisions, especially in light of reputable in-depth studies such as done by Atul Gawande. This study should convince everyone that checklists are a critical element to a company’s success and efforts should be made to improve these checklists, not eliminate them.
One issue is that most companies don’t know how to build an “effective” checklist, and once the checklist has been created they are rarely updated or managed to. We have seen instances where a company has checklists that are more than five years old. They are obviously outdated, containing items that are no longer valid. Companies then wonder why their managers are not completing them or don’t find them useful. Companies also tend to make checklists disparate from other key communication, planning and evaluation tools. The most effective systems consolidate all of these tools into one place so it effectively becomes the creedfor the organization.
The other issue is checklists are not cool—not a good reason to not put in place tried-and-true tools that are known to improve performance. I’m betting you have some sort of checklist that you are running off right now.
The fact is that most good managers use checklists and similar tools to help them run their operations. Not only does it ensure that everything is getting done, but it helps their management team coordinate efforts and effectively communicate with each other. Creating systems of accountability has always been a time tested approach to strong management.
Last, changes are being made at such an accelerated rate, checklists are more important than ever to successfully run an operation. Keep them current, make sure they cause specific action and consolidate them so they are easy to find and review. You’ll find you are getting things done at record pace and on strategy.
Greg Thiesen, Chief Executive Officer, Red Book Solutions