A Life-Saving Checklist (2007)
newyorker.com
newyorker.com
I was mortified by how little attention most professors and students paid to this problem. Something like half the data collections I was helping on (as a lowly first-year PhD) had some problem with the data collection.
I read The Checklist Manifesto and used it to design my own checklist -- and crucially, checklist procedure -- for my data collections and it made a huge difference. Not only did I collect much better data, but I was able to do much more sophisticated multi-step experiments without making mistakes.
The biggest takeaway for me was that checklists are not a piece of paper; they're a system. It's not enough for the surgeon to have a checklist, they'll just glance at it and think "oh of course I did these things". They only work when the nurse reads the checklist, item by item, aloud to the surgeon (I later realized this is exactly what SpaceX and NASA are doing during launch countdowns). Additionally, the checklist itself needs to be iterated on many times, removing unhelpful items and adding things you miss. And the checklist MUST be one page, no more.
If I ran an experimental lab of any kind, the book would be mandatory reading.
Those countdowns are verifying that a bunch of launch blocking gates have not been closed. The key difference is that it’s not a reminder for people of stuff that needs to be done. It’s more like a roll call to make sure they have a unanimous vote to go from all teams that have a stake.
Consequently, I've come to have a much greater regard for simple checklists that make sure that we're doing basic stuff, we do it right. My favorite example: switching the fire engine's engine from driving the transmission to driving the pump. It's basically 3 or 4 steps, but when you only do this (at most) once a month (typically), remembering the steps is challenging, and it is even harder to remember to do the mandatory 2-3 second pause between each one.
The contrast with my life as a C++ developer for 35+ years is telling. In that world, almost everything is memory, and what isn't is both (a) look-up-able online (b) not time- or life-critical.
The brief time I've been a firefighter has made me very aware of a totally different side of my cognition - no, Paul, you actually don't remember most things at all - and has given me a great deal of respect for checklists to help prop up our minds in one of their weakest areas.
[0] truth is, I doubt that even the career firefighters in a lot of departments get enough daily experience for most things to become memorized, certainly not without many, many years responding to calls.
I understood this when I read about plane pilots checklists. It's revolutionary even for everyday life. Every time we fail at something (for example leaving the vacation home with coffee still in the coffee machine), it goes to a checklist.
When something failed because it wasn't on a checklist, we say (wife and I) we lacked precision. And that thing now goes to the checklist.
Having to buy a new fridge because you arrive and something stayed in the fridge for x months ain't fun (not to mention you're left without any fridge for potentially two days [e.g. if you arrive on a late saturday evening]). It's on a checklist now.
Ever had to do a U-turn and lose one hour because wife forgot the phone at home? Checklist.
Weirdly enough checklists allows you to be more sloppy, not less. It's literally taking stuff out of your minds.
Ticket you receive at a toll? Checklist: "I gave you the ticket, do you confirm you received the ticket?" / "I confirm you gave me the ticket".
It's fun too. We all learned, including my kid, the NATO alphabet. It is precise.
We've got digital backups of our recurring checklists.
Saved our arses sooooo many times.
Unfortunately, the people I work with aren’t that interested in creating checklists or keeping the ones I create updated. But I trudge along hoping that sometime in the future they may get some value from it.
When I'm doing poorly, I have a hard time functioning as an adult. So, I use checklists and phone reminders a lot, even for simple things. I use them to start the day with things like:
-make coffee.
-check calendar for schedule
- block out time / add reminders as needed for the day
-plan morning (I have a list of mandatory and optional morning activities, along with the time it takes to do them)
- pack lunch.
- take meds.
-pack for work: (laptop, id badge, work phone, headphones, sunglasses, phone charger/cables)
- make breakfast for kids (along with a recurring reminder to start this by 06:45)
-wake up kids (reminders at 07:00)
Etc, etc. You get the idea.
I can't make my brain remember to do basic activities, and I naturally vary my routine, and at the same time I really struggle to remember to do things unusual to my routine. But I can use my engineering side to work the problem. When my brain is performing poorly, these checklists are essential.
‘Brush teeth’
‘Drink water’
‘Take vitamin d’
‘Feed dogs’
And I’m basically helpless without the reminders at the bad times.
My severe adhd is cyclical too.
And then something changes and no one knows how to do anything but follow the checklist that doesn't work anymore....
Yes we have a list of things to do, and we know that if we don't do all those things then bad things can happen, but the most important thing is to know why we are doing those things... Because when bad things start to happen despite following the list, you need to know why you are doing those things so that you have some hope of making it better.
It kind of worked the way you described. Everyone kind of stopped thinking and just became checklist apes.
It wasn’t until a few years later that I realized a major factor about checklists the book mentioned, but that management conveniently ignored: the checklist must only be one page. Any longer and people ignore it.
Critical step that our management ignored. They just saw it as a big, never ending, ever growing list of rules. Which isn’t the right way to think about it.
For some reason the fact that they've obviously been produced locally gives me more confidence that they've done the hard yards; professionally printed ones would instead make me think they're only up there because management wanted to raise awareness.
Atul Gawande is the author of several books, the most familiar being "The Checklist Manifesto"
I hope he'll return to writing.
One of my most abused pieces of advice to professionals and teams is to make checklists. This has even spilled into my family. I get my daughters, The Anxious Generation, to create checklists.
That's not being suggested. What is being suggested is that the book could have been condensed into a mere article to begin with.