How strategic checklists can increase your productivity and efficiency
Back in the 1990s, when “quality” was the buzzword and organizations trained people in total quality management (TQM) or continuous quality improvement (CQI), a manager’s aim was to optimize service or manufacturing systems. We used checklists to collect data, but not often to improve the quality of our processes.
A light bulb went off after I attended one of Dr. W. Edwards Deming’s groundbreaking management seminars. He challenged us by saying that managers and leaders, not the workers, own the system of improvement in their organizations. If this is true, and managers are responsible for effectiveness and efficiencies, how might we use checklists to help?
Dr. Atul Gawande’s New York Times bestseller The Checklist Manifesto: How to Get Things Right (Metropolitan Books, 2009) contains a powerful argument for changing the way we do business. He writes that the problem in medicine is “making sure we apply the knowledge we have consistently and correctly,” arguing that failure results not so much from errors of ignorance as from errors of ineptitude. Surgeons don’t necessarily make mistakes because they don’t know how to perform a surgery. They make mistakes because medicine has become so incredibly complicated that they’re unable to properly apply what they know. With growing medical complexity, the world’s most competent doctor can forget a key step or neglect to ask an important question of a patient.
Gawande examines how the airline, financial and construction industries successfully use checklists. He discovers that, even for well-trained experts like pilots, well-planned checklists—adhered to with discipline—can improve results.
Armed with this knowledge, Gawande and his surgical team developed a checklist that significantly reduced surgical complications. He makes the case that just as his surgical team saved lives by using checklists, other teams could use such tools to guide them through the important steps of any complex procedure.
What Do I Do Next?
All of us are familiar with those instances in our jobs when we’re in danger of succumbing to the chaos of the moment. So, how can a checklist help in those critical moments when we might lack discipline or knowledge?
They remind us of what we already know. Gawande’s premise is that today’s businesses are hugely complex; no one human can know all she needs to know about a topic. Essential pieces of the puzzle fall through the cracks, not for lack of care about the business, but simply because no training program, no matter how comprehensive, can prepare us for every eventuality. A checklist, ever-impartial and objective, can remind us of those essential pieces.
They save time. In my work with a large regional accounting firm, I saw the effective use of checklists for their associates doing audits. In a simple one-page checklist, the associate checked for commonly made errors, communicated findings and wrote reports using the checklist as a guide. When I asked what the results were, the manager said, “If I told you how much money we saved our clients, you wouldn’t believe me. Just know that without this little tool, we’d spend way too much time and lose our profitability.”
They keep us disciplined. My own personal investment advisor uses a checklist to evaluate investments. She says it keeps her disciplined and keeps her from “falling in love” with a given product.
Contending With Resistance
Unfortunately, there is great resistance to implementing checklists, especially in professional work. Highly trained professionals often believe a checklist somehow diminishes their expertise or even their power. I know a charge nurse in a large peri-operative unit who believes a checklist would be a valuable addition to post-operative care. Unfortunately, her nurses have put up great resistance to doing “one more thing” during their already-busy shifts.
Managers not only need good persuasion skills, but they must also demonstrate how spending three minutes doing a checklist will eventually make work simpler, safer, more efficient and easier. In the case of healthcare, it may mean saving lives, too.
How to Build a Better Checklist
Good checklists have some common attributes:
1. They are short—usually no more than nine items on one page. I recommend focusing on the “critical few.” These are the elements that, if not checked off, would derail the process or cost people their lives, money or jobs.
2. They keep the essential elements at the top of your mind. A manager’s checklist isn’t just a daily “to do” list; it is, in fact, a way to keep the most important tasks right in front of you.
3. They are simple. Gawande quotes a Boeing executive who makes aviation checklists as saying that wording should be simple and exact, using the language of the profession. There is no need for clutter, a lot of color or any other distracting element.
From my own experience, your first draft of a checklist will not be your last. It requires review and revision by the people who will use it, and it always needs a pilot phase to tell if the checklist works as intended. People often come to respect what they help to create, so gather people around who have a vested interest in the outcome of the work. Ask for their help, listen to their suggestions and let them assist with data collection. Give your team input into what is critical enough to make the final checklist.
Checklists can be used to manage difficult handoffs, often the very times when things fall apart. In shift changes, machine re-tooling, operating suite turnovers, equipment calibration and the like, there are opportunities to use checklists so that quality and efficiency are maintained or enhanced.
Dr. Paul Batalden, former head of quality for HCA and now at Dartmouth, says, “If you don’t understand the way things work and you try to change them, it won’t be sustainable change.”
Checklists help manage our understanding of the way our systems work. The world is too complex to know everything about a topic, but the use of checklists can help us manage more skillfully.
To learn more about checklists, visit Atul Gawande’s site: https://gawande.com/the-checklist-manifestoShare Email