Checklists saves Lives and Dollars

 

Okay, okay I am a convinced.

"To what?” You ask.

To the importance and the necessity in today’s complex world of #Checklists.

There very existence has directly affected our freedom, the way we travel and our and our families’ health, big time.

Please let me explain. Beginning with a plane crash.

On October 30, 1935 at Wright Air Field in Dayton, Ohio a prototype military aircraft took off captained by Boeing’s most experienced test pilot, Major Ployer Hill.

This was no ordinary bomber. Nor was it just a run of the mill test flight (if there is such a thing).

The new super bomber was powered by 4 powerful engines, which would allow it to fly faster and twice as long than previous bombers and carry 5 times more bombs than the military requested. But this major advancement would come at a supreme price in that it was far more complex than any comparable military aircraft flown.

The flight was a trial to win the lucrative contract to be awarded by the US government at the lead up to the second world war.

The bomber crashed shortly after take off killing the experienced test pilot and another of the five member crew. Seemingly putting an end to the bombers possible inclusion in the US air force. In a subsequent inquiry it was deemed the aircraft with its four engines to complex for ordinary human beings to fly irrespective of their experience and capability.

End of story. Not quite.

A group comprising Boeing engineers, and a group of experienced test pilots, addressed the idea of complexity advocating and later to be adopted the measure of a checklist to overcome the frailty of the human memory and ability for the brain to operate in a high pressure environment. The result was the advent of the pre-flight checklist. The forerunner of what we all know and what gives us comfort in knowing that before each flight, there is a group of people at the pointy end running through a check list.

“Okay we have two engines, check, two wings-a starboard and a port, check…” Maybe not to that extent but those items critical to the well being and safety of the souls aboard.

Just like the many commercial applications that have spurned from the aviation and space industry you would have expected the Checklist to be another common day application in the making (remember plastic, teflon, navsat came from such developments).

Not so.

Fast forward 75 years.

The explosion of surgical operations worldwide (in 2004 230 million operations annually) resulting in 3-17% complication rate leaving 7million disabled and one million dead.

And has not seen an improvement from such scaling up the explosion in surgical operations. It was of such concern that the World Health Organisation wanted to address this major problem, but with no budget.

Hmm! Big problem. The question was how could surgery become safer but without the resource of money to promote the idea.

Enter a young surgeon with Bollywood  looks, not only the Brad Pit of his game but a fellow professor at Harvard Medical School.

Atul Gawande ( @Atul_Gawande), the learned professor, come surgeon had been seeking the answer why there were so many injuries and death from surgery.He saw that errors came in two forms. The first from insufficient knowledge and the second from incompetence, or ineptitude as he phrases.

Further training and better equipment could address the first. However the complexity of surgical operations resulted in the flourishing of ‘dumb’ errors by skilled surgeons and their surgery team who should have known better. It was in the ‘dumb stuff by experienced theatre staff that this proportion of theses errors were outgrowing the first of insufficient knowledge.

Atul began to develop on the idea of a Checklist adopted into surgery in early 2000 by surgeon Dr Peter Pronovost. The concept borrowed from Boeing, the sophisticated TO Do List and Project Management tool builders used to create the complex Skyscrapers , and dated back to the 1935 Boeing bomber prototype crash.

With WHO support and encouragement Gawanda arranged a trial run in 8 hospitals
 globally- spread over developed nations and poor countries. 

With no budget it relied on the goodwill and visionary of both Gawanda and the respective hospital management. The results were outstanding.From these initial results the Checklist program has rolled out globally and still the results outstanding, and an obvious success.

His greatest challenge was the ego, and gravitas of the surgeons and their teams who saw the Checklist as below them and challenged that they weren’t experienced to know what they were doing. On the contrary it was that they were highly skilled and experienced that they used short cuts and overlooked boring incidentals and the most basic but critical decisions and process. Even Gawande admits to mistakes he made while surgery that nearly killed a patient only saved because his surgery team followed the checklist.

The Checklist is more than a To Do List, it is concise list of key (i.e. Gawende calls killer steps) that must be followed.

It is surprising that it has taken three quarters of a century to be broadly adopted by the business community.You will ask: Has its application to business and management realised the sort of benefits experienced by the aviation and medical sector? You betcha.

It is has as much potential to affect productivity and decision making just as when Bethlehem Steel owner Charles Schwab parted company with serious money to reward a consultant to review how the steel work process can be improved. And the humble spiral note book become the 'it ‘ business accessory of the day.

Where else could the Checklist have relevance and major impact? Just about every aspect of life when applied. It has the potential to increase results, save money and has been shown save lives.

Such a tool when adopted could help close more sales, reduce rework, increase health and safety effectiveness , improve the performance of athletes, even help improve the results of investment decisions (as outlined by Gawande). And more, only limited by our imagination.

So what is the secret to developing a Checklist:

• It is simple and concise ( with no more than 7 items)
• Unlike a To Do list it only lists the critical points that must be undertaken ( Gawanda calls these killer items)
• Ideally used in groups of 2 or more people relies on people knowing each other and their roles
• Must be user friendly
• Can be Check and Do or Check then Do, in its form
• Takes 90 seconds to 2 minutes max. to complete
• Tested and refined in real life situations
• Can be done at specific pause points ( planes do it before they push back from the terminal then just before they rumble down the tarmac)

In summary the complexity that we now find ourselves apart has gone beyond the capability of one human being ( irrespective of how smart he or she could be).

Without an aid such as Checklist to human frailty and fallibility of the human memory. As Atul in his book #Checklist Manifesto makes mention the Checklist can best be used when there is humility by the decision makers in critical and complex stages and no longer the domain of one superhuman being.

If you are a leader in any area of the economy and looking to quantum improvement, and want to reap the reward of not relying on major investment or cost. With an effective communication and implementation program the Checklist is a no brainer. Even 75 years later after the initial Checklist came into use, it is still the potential force majeure.

Even in writing this blog using a Checklist:

• Identify topic
• Research and draft key points
• First draft
• Final Draft , sub edit, proof, spell & grammar check
• Headline- test
• Image- test

Seems okay . Now press Publish.