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A Checklist Can Do What?

I recently watched an interesting talk given by Atul Gawande, whose book The Checklist Manifesto has reached the New York Times nonfiction bestseller list this year, talking about some interesting benefits of using a checklist and how such a seemingly insignificant and low tech idea can do wonders in many disparate fields.

In this video, Atul starts off with an interesting explanation of how a skyscraper is built. In the old days of construction, a master builder was the central control with thorough knowledge about each detail of the building and responsibility for coordinating every operation.  Modern buildings have gotten so complex that it becomes impractical for a single person to attain that amount of knowledge.  Instead, today buildings are built by a team of skilled craftsmen; involved in up to 16 trades.  The project manager would rarely know much about any of the trades involved.  Atul asked the question, how is it that a group of specialists with a manager who isn’t an expert in any of these fields can build a complex structure and meet a very strict safe code.  It’s interesting to find out that the secret lies in two checklists, which are essential in the success of the construction business.  One checklist details every task that needs to be done in the short term for scheduling and coordination.  Another checklist involves the necessary parties required to communicate when problems arise.  Problems arise in construction just like in any other fields and the problems are always unexpected, otherwise, they wouldn’t be problems to start with.  The second checklist doesn’t try to make cookie-cutter solutions, but simply makes sure that the appropriate parties are involved when problems arise.  As a result, dynamic group decisions can be obtained for each problem based on inputs from all shareholders.

Atul further goes on to talk about the “Miracle on the Hudson” an emergency landing made by US Airways Flight 1549 last January.  He argued that the real miracle in this case was the entire crew acted as one and followed procedures (another word for checklists) in this situation.  Sure, luck was on their side, but by following procedures and going through the checklists designed for such situations, the crew ensured the best survival chances.

Atul finally went on to discuss his experience of implementing a checklist in the OR at 8 different hospitals around the world.  The result is significant.  By following a simple 19-step list, some steps being as simple as introducing surgeons and nurses, teams who followed the checklist was able to reduce complications by 30% overall.

Come to think about it, it made intuitive sense.  A checklist enforces the user to be regimented and diligent about the process and thus, has the effect of minimizing human errors when these regiments are implemented.  Another example that I can think of where a checklist is vital is during space shuttle launches.  I’m sure everyone has heard those familiar announcements such as “T minus 10: heater control exit; T minus 9: pressurize first tank; … T minus 0: blastoff”.  What NASA does is follow a monster checklist to ensure that every aspect of a shuttle launch has been checked.  If the rocket scientists think checklist is worth using, Atul might be onto something here.

The video is a bit long (74 minutes), but I’d recommend it since it provides food for thought.  Have you read the Checklist Manifesto?  Do you agree with Atul?  What other scenarios do you recognize that benefit from using a checklist?

Lei Zong


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