I’ve just finished reading The Checklist Manifesto by Atul Gawande (Cancer Research UK affiliate link). It’s been on my reading list for a while. In my work I’ve written quite a few checklists to help capture best practice or to provide advice. So I was curious about whether I could learn something about creating better checklists.
I wanted to write down a few reflections whilst they’re still fresh in my mind.
The book explores the use of checklists in medicine, aviation and to a lesser extent in business. Checklists aren’t to-do lists. They are a tool to help reduce risk, uncertainty and failure. Gawande uses ample anecdotes, supported by evidence from real-world studies, to illustrate how effective a simple checklist can be. They routinely save people’s lives during surgeries and are a key contributor to the safety of modern aviation.
Gawande explains how checklists allow teams to perform better in complex situations. They protect against individual fallibility, and can help to transfer best practice and research into operational use. He explains that checklists aren’t a teaching tool. They are a means of imposing discipline on a team. Their goal is to improve outcomes.
He also explains why he thinks they’re not being used more widely. In particular, he highlights the tendency of professionals to feel like they’re being undermined or challenged when asked to use simple checklists. A “hero culture” contributes to this problem, something that is very evident in surgery. It’s also something that the tech industry struggles with as well.
Gawande explains that checklists help to address this by re-balancing power within teams. For example, by giving nurses the permission to halt a surgical procedure if a checklist hasn’t been completed to their satisfaction. A hero culture might otherwise silence the raising of concerns, or deter team members from pointing out problems as they see them.
The book highlights that a common pattern that occurs in many successful checklists are specific steps to encourage and make time for team communication. These range from simple introductions and a review of responsibilities, through to a walk-through of expected and possible outcomes. These all contribute towards making the team a more effective unit.
Throughout the book I was wondering how to transfer the insight into other areas. Gawande suggests that checklists are useful anywhere that we have multi-disciplinary teams working together on complex tasks. And specifically where those tasks might have complex outcomes that might have serious impacts.
I think there’s probably a lot of examples in the data and digital world where they might be useful.
What if teams working on data science and machine learning had “preflight checklists” that were used not just at the start of a project, but also at the time of launch and beyond? Would they help highlight problems, increase discipline and allow times for missteps or other concerns to be highlighted?
The ODI data ethics canvas, developed by Amanda Smith, Ellen Broad and Peter Wells is not quite a checklist. But it’s a similar type of tool, aiming to address some similar problems. Privacy impact assessments are another example. But perhaps there are other useful aids?
The book also raises wider questions about the approach we take in our societies towards ensuring safe outcomes of our work, research, etc. There is often too much focus on the use and application of exciting new research and technologies, and not enough on the discipline required to use them safely and effectively.
In short, are we taking care of one another in the best ways we know how?
Creating better checklists
There’s some great insight into creating checklists scattered throughout the Manifesto. But ironically, they’re not gathered together into a single list of suggestions.
So, for my own benefit I’ve jotted down some points to reflect on:
- Checklists need to be focused. An exhaustive list of steps is not useful. Trust people know how to do their job, just ask them to confirm the most critical or important steps
- Think about how the checklist will be used. There are READ-DO checklists (where you perform each item and check it off) and DO-CONFIRM checklists (where you carry out an activity, and then review what you have done)
- Checklists can be used to help with both routine situations (pre-flight) and emergencies (engine failure)
- Make the checklist easy to use. A good user experience can help embed them into routine practice
- Consider who is leading use of the checklist. A checklist can help to balance power across a team
- Include team communications. Teams perform better when they know each other and understand their roles. Ask them to explain what will happen and what the expected outcomes might be. This helps teams deal with items not on the checklist
- Test and iterate the list
- Let people customise it, so they can adapt to local use
- Measuring success and impact (e.g. by measuring outcomes, or even just identifying where they have helped) can help encourage others to adopt it