The Checklist Advantage

To ensure that extremely complex tasks–tasks too complex even for “super-specialists”–are performed effectively, accurately and with minimal mistakes, checklists are an invaluable tool, suggested Atul Gawande in a 2007 article in The New Yorker (and everywhere else since, it seems).

Gawande illustrates (in an inordinate amount of detail) how seemingly unnecessary checklists can make huge differences to our effectiveness in completing the most complex (and simple) of tasks by looking at how Peter Pronovost dramatically reduced infection rates (from 11% to 0% in some cases*) in hospitals throughout America.

So how do you actually manage [immense] complexity? The solution that the medical profession has favored is specialization. […]

We now live in the era of the super-specialist—of clinicians who have taken the time to practice at one narrow thing until they can do it better than anyone who hasn’t. Super-specialists have two advantages over ordinary specialists: greater knowledge of the details that matter and an ability to handle the complexities of the job. [But] what do you do when expertise is not enough? […]

It’s far from obvious that something as simple as a checklist could be of much help in medical care. […] Mapping out the proper steps for each [patient] is not possible, and physicians have been skeptical that a piece of paper with a bunch of little boxes would improve matters much.

In 2001, though, a critical-care specialist at Johns Hopkins Hospital named Peter Pronovost decided to give it a try. […]

The checklists provided two main benefits, Pronovost observed. First, they helped with memory recall, especially with mundane matters that are easily overlooked in patients undergoing more drastic events. […] A second effect was to make explicit the minimum, expected steps in complex processes.

Gawande notes how Pronovost enabled the widespread use of checklists by persuading hospital management to actively encourage and take the side of those lower down in the professional hierarchy (i.e. nurses) to challenge those above them (i.e. consultants) without recriminations.

via @zambonini

*The checklist used was extremely simple and contained only five steps. It was so simple that it was resisted by almost every employee. With the checklist actually being consulted readily, it turned out that at least one step was either missed or not implemented correctly in many cases.



One response to “The Checklist Advantage”

  1. Gawande’s book “The Checklist” is awesome. Best book on psychology I have read in a while. Too bad it wasn’t written by a psychologist.
    It elegantly compares complex problems where they have used checklists effectively, such as airplane pilot decision systems, and construction projects with operating rooms and other health scenarios.
    What it amounts to is that a checklist can be a great way of complementing human decision making, but that it is an applied science, by which I mean that there are a few general principles, but to really be effective it has to be tailored to that individual situation. This is why the people who design pilot’s checklists do a new one for every model of airplane.
    Anyways, I highly recommend that book, even if you have read all of the New Yorker articles.