How Checklists Save Lives, Enhance Teamwork and Enrich Leadership

Posted by on Nov 3, 2013 in Perry's Blog | 0 comments

[This quest column ran in the Augusta Chronicle on Nov.3, 2013]
By Perry Smith

On October, 1935, at an military air base near Dayton Ohio, a competition took place that changed the course of aviation history. An experimental long-range bomber took to the air. It took off, turned out of the traffic pattern, rolled over and crashed. The pilot was the most experienced test pilot in the Army Air Corps.

The accident investigation showed that flying this new airplane using one pilot and no checklists could and did lead to disaster. Hence, it was in 1936 that the use of checklists in the cockpits of airplanes became the norm. The test airplane, built by Boeing, that crashed that day was to become the B-17, the most successful long-range bomber in the war in Europe.

This story of airplanes and checklists is outlined in a brilliant new book. The Checklist Manifesto: How to Get Things Right by Doctor Atul Gawande.

Taking the aviation lessons of the 1930s and applying them to the medical profession, Doctor Gawande has gained some important insights. He has demonstrated that operating rooms, which routinely use standardized checklists in a sophisticated way, have a much lower error rate and death rate than those operating rooms which don’t use checklists, use them only occasionally or use them haphazardly.

According to Doctor Gawande, a big breakthrough in the use of checklists in operating rooms came at the Johns Hopkins University Hospital after using standardized checklists for a period of time. The leaders of this hospital, often ranked as the best hospital in America, made the decision to give nurses the power to remind doctors when they had missed a step in the checklist. To quote Doctor Gawande, “The new rule made it clear: if doctors didn’t follow every step, the nurses would have backup from the administration to intervene.”

Another area where the systematic use of carefully crafted checklists can lead to better safety and more efficiency is in the construction of very large and very tall buildings. In this area, the checklists are largely focused on communication tasks. The sixteen (or more) leaders of the building trades are required, on a tightly scheduled basis, to meet and make decisions on when and how to go forward. The vital lesson here is that when key leaders are required to communicate the result is better teamwork, fewer work stoppages and greater productivity.

The use of checklists to enhance safety in airplanes, hospitals and construction sites is only part of the story. Checklists, by enhancing communications, teamwork and productivity, ultimately enhance leadership. Leaders can better exercise a key element of leadership—trust—if they know that the use of well designed checklists are an essential element of the work of every employee and associate.

When Jeff Foley and I worked together this past year to produce the 4th edition of Rules and Tools for Leaders, we felt it essential that this practical guidebook should include handy, easy-to-use checklists. Hence, in this book there are checklists on introspection, hiring, firing, making decisions, handling crises, thanking associates, conducting meetings, managing electronic devices, and dealing with the media. There is even a twenty- five-step checklist on fund raising.

So how can this discussion be of help to you? If you are about to raise money for a good cause, examine a fund raising checklist. About to be interviewed for a new job and want to anticipate the questions you may be asked, study a hiring checklist. Dealing with a crisis in your job, your family, or your church, take a look at a crisis management checklist. One caution—checklists, if used too rigidly or not kept up to date, can lead to bureaucratic “checklist management”. Hence, everyone should monitor checklists and their use to insure they don’t become counterproductive.

Checklists are wonderful tools. They are used when servicing cars, inspecting homes, building machines, conducting medical evaluations, preparing babysitters, getting ready for vacation travel. They help train, certify, verify, and validate, They help us remember critical items when time and chaos are competing for our attention.

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