As a former transactional attorney, I was trained to use checklists. The transactions were too complicated to keep track of everything in my head. I also needed to communicate with the rest of the transaction team. In The Checklist Manifesto
I had put off reading this book because I’m already a fan of checklists. I didn’t need to be sold on their effectiveness. But I was still floored by the effectiveness Gawande reported in his studies.
In using a checklist for placing a central line, the ten-day infection rate was reduced from 11% to zero. He cites many other examples and studies that show that checklists can improve the performance of highly-trained workers.
“In a complex environment, experts are up against two main difficulties. The first is the fallibility of human memory and attention, especially when it comes to mundane, routine matters that are easily overlooked under the strain of more pressing events…. A further difficulty, just as insidious, is that people can lull themselves into skipping steps even when they remember them. In complex processes, after all, certain steps don’t always matter.”
I was particularly happy to see Gawande cite the correct story about Van Halen’s use of M&M’s as a compliance checklist tool. (See my prior post: Compliance Van Halen and Brown M&M’s.)
If you haven’t already read The Checklist Manifesto you should add it to your reading list.
Other’s thoughts on The Checklist Manifesto:
- The Value of Checklists by Mary Abraham in Above and Beyond KM
- KM is not for looking pretty by Jack Vinson in Knowledge Jolt with Jack
- The Checklist Manifesto and the Smarter Lawyer by John Gilies in SLAW
- Don’t leave home without pants- the Checklist Manifesto by Kyle Maikath in the Building Engines Blog
I thought it was an excellent book as well. It raises another important theme from a compliance perspective – addressing entrenched methods of doing things that are no longer best practices from a compliance perspective. In spite of pretty substantial evidence showing the effectiveness of checklists in the operating room, Gawande describes the difficulty in getting other surgeons – highly trained professionals who are accustomed to acting independently – to use the checklist. It demonstrates the difficulties of getting everyone on board with any compliance program that may result in a change in established procedure, especially at the professional/executive level.
Robert –
I see two conflicting points. One is to prevent a checklist or business process from getting entrenched so that it’s resistant to improvement. Good checklists (and compliance program) should be refreshed and re-evaluated on regular basis to improve effectiveness.
The second point is proving value. Gawande spent lots of time gathering data to prove the effectiveness of checklists. His findings were very impressive.
Of course, with surgeons improved effectiveness saves lives. Doctors want to save lives.
Lots of compliance is hard to prove as being effective in the same way. It’s hard to show that compliance is creating revenue or reducing costs. Often, the direct costs attributed to compliance may be a loss of revenue and an increase in costs.
That doesn’t mean we should not try. We just need to keep in mind ways to prove value.
It’s a great book. I’m reading it now (on my iPad!). And Gawande is such a good writer and storyteller.