A checklist for checklists

It’s easy to say, “Make a checklist for your complex process and use it”. It’s another thing altogether to actually make a checklist that is good and that works.

One of the things that I like most about The Checklist Manifesto is that it recognizes and addresses the challenges inherent in designing a good checklist. In fact, a good part of the story revolves around making the WHO surgical checklist a good one. In the acknowledgements section of the book, Gawande credits Boeing engineer Dan Boorman (who is also mentioned in the book) as an “essential partner” in the ongoing development of new checklists, and from the looks of it they’ve been hard at work.

Most relevant to my ongoing thread here is the Checklist for Checklists, pictured below. If you have decided that checklists can help you, this is an excellent place to start as you begin the process of developing your checklists.

Simplifying the execution of complexity

My review of Atul Gawande’s latest book The Checklist Manifesto focused, by design, on the broad scope of the book. Within that “big picture” lesson, though, are many smaller, more specific lessons to be learned.

For example:

No, the real lesson is that under conditions of true complexity – where the knowledge required exceeds that of any individual and unpredictability reigns – efforts to dictate every step from the center will fail. People need room to act and adapt. Yet they cannot succeed as isolated individuals, either – that is anarchy….

[U]nder conditions of complexity, not only are checklists a help, they are required for success. There must always be room for judgment, but judgment aided – and even enhanced – by procedure.

During this discussion, he refers back to what he had learned from the skyscraper-building industry, that they had figured out how to put an understanding of complexity into a series of checklists. That they had, in Gawande’s words, “made the reliable management of complexity a routine.”

What makes this even more fascinating is how the checklist, the lowly checklist that Steven Levitt had no interest in (until reading this book), can help simplify the execution of complexity even when the team members have never before worked together.

Just think what they could do for a team that works together all the time.

Navigating complexity with checklists (a book review)

Atul Gawande’s latest book, The Checklist Manifesto: How to Get Things Right is an incredible book that I highly recommend to anyone that works in a complex environment, especially if that involves working with multi-discipline teams. And most especially if this involves frequently working with people you have never worked with before.

I picked the book up not really knowing what I was in for. Talking about checklists, I thought maybe it would be a discussion of how to document and implement best practices, or something similar. Boy was I wrong.

At the surface, the book is the story of how Gawande, as part of a World Health Organization initiative to reduce surgical complication rates around the world, discovered the power of checklists to help avoid “avoidable failures.” Looked at more closely, it is a study of the importance of team building, team work, and communications between team members as they tackle the complex problems we all face today.

The first chapter, titled “The Problem of Extreme Complexity”, sets the stage. Later chapters build on this problem statement and uses examples from many diverse fields including aviation, construction,  and the operations of corporations and government. The common thread through each of these examples is the checklist – the lowly, simple checklist.

The challenges face by Gawande and the WHO team were (are) two fold: figuring out how to take what worked in these other industries and translating it into the needs of the surgical community; and getting past the culture of surgery and surgeons. The former was a relatively simple matter of trial and error, see what works and give it a try (in simulation first, where possible). The latter, on the other hand, remains a significant issue.

Part of the resistance is, according to Gawande, a misconception about what checklists are and the purpose they serve. This is a lesson he learned as he worked with engineers from Boeing in trying to understand what makes a good checklist:

It is common to misconceive how checklists function in complex lines of work. They are not comprehensive how-to guides, whether for building a skyscraper or getting a plan out of trouble. They are quick and simple tools aimed to buttress the skills of expert professionals. And by remaining swift and usable and resolutely modest, they are saving thousands upon thousands of lives.

As a systems engineer I recognize many of the issues, challenges, and solutions that Gawande discusses in the book. I was (am) quite appalled at how little of this systems type thinking seems to exist in the world of surgery and am quite hopeful that the idea of checklists catch on at all hospitals. If I ever have to go in for surgery, one of the first questions I ask the surgeon and his team is going to be, “Do you have a checklist prepared for this procedure?”

Perhaps the greatest insight about checklists in the book is that checklists – a lowly, simple, well crafted checklist – can take a group of individual experts and quickly turn them into an expert team.

All you have to do is use it.

Update: For more on the book, links to various media interviews, and some examples of effective checklists, visit Atul Gawande’s website.

The futility – and value – of planning

In his recent article Planning is very important…. It doesn’t work, Jack Vinson has this insight into planning:

If they hadn’t planned, there is no chance they would have been able to accomplish what they wanted to do.  At the same time, if they had decided that the plan was exactly what they were going to do, they would have never made it either.

This is a lesson I learned very early on in my military career, and something I wrote about back in March 2005 (has it really been that long?) while digesting the ideas in Malcolm Gladwell’s then-new book Blink.  The following is a slightly edited version of those original thoughts.

– – — — —–

Have been spending a lot of time “adjusting” plans lately. A colleague made the following comment today in one of our many (many many) sessions:

He who plans early, plans twice.

Which got me thinking about the apparent futility, and the obvious value, of planning.

The aphorism “No plan survives first contact with the enemy” is absolutely true. Proper preparation, though, can make that fact largely irrelevant. The very act of planning, and rehearsing that plan, involves preparation that enables you to effectively react to most any situation that may arise. In other words, proper planning allows you to IMPROVISE.

“What?” you say. “Improvise? That’s fine for comedy and music, but military operations? Business? I don’t think so. The whole purpose of planning is so you know what is going to happen, and when it is going to happen. Not to just wing it.”

In an Industrial Age setting, I may have agreed with that. But in the Information Age, I strongly disagree. If you tie yourself too tightly to a plan, and stick to it no matter what, you are doomed to fail.

As an example, consider a football (American) team – or any other team sport, for that matter. It is possible to develop a detailed game plan that dictates every play you will use, and when you will use them in the game. You could make a simple list of plays: On the first play, do this; On the second play, do that. etc. Or you could have a more detailed plan: If it is second and under 5 yards, and we’re in the red zone, we do this. etc. You could even take it a step further and include separate options that take into account the opposition’s activities. Of course, the more contigencies you identify, the bigger the play book you have to carry around and the longer it may take to figure out exactly what to do.

What actually happens is that the team develops a basic game plan ahead of time and rehearses the execution of that plan. By doing this, the focus of the team becomes achieving the goal of winning the game, and not just simply executing the plan.

I was inspired to write this post partly by a few key passages in Malcolm Gladwell’s new book Blink , in which he uses the obvious example of an improv comedy troupe (which in turn cites as one of their references a basketball team) to support the concept of “thin-slicing,” the ability to parse a given situation into the minimum information required to deal with that situation.

Parent as student

I have had a lot of teachers throughout my life. Some taught me because they were paid to, some because they were supposed to, and some because they wanted to. Many of the best teachers in my life, though, had no idea that they were teaching me. (Or, perhaps more accurately, that I was learning from them.)

At the top of this list of unintentional teachers are kids, especially my own.

When the relationship between parents and their kids is discussed, “parent as teacher” is a common interpretation. There is no doubt that parents need to teach their children. But if we only see ouselves as teachers, whether it is because we are supposed to or because we really want to, we are missing out on some of the greatest learning opportunities we will ever be given the chance to experience.

This is especially true if your kids are different from you, or different from what you expected them to be. For example, if you are a “jock” and your kid a “geek” ( or vice versa). Or your kid is disabled and you’re not.

If you are a parent, take the time to learn from your kids. You’ll be amazed at what they can teach you.

There's always something to learn

On the TV show NCIS the main character, Special Agent Gibbs, has two primary passions: catching bad guys and building boats. Not just any kind of boat, but hand made wooden sailboats. Which he builds in his basement. (A running gag on the show is the question of how he gets the boats out of the basement.)

In one episode, an old friend and mentor visits Gibbs for the first time in several years and sees a boat in progress in the basement:

“What’s this, number 3?”

“Four.”

“I thought you’d have enough practice by now.”

There’s always something to learn.

Truly words to live by, even if they do come from a fictional character.

There’s always something to learn

On the TV show NCIS the main character, Special Agent Gibbs, has two primary passions: catching bad guys and building boats. Not just any kind of boat, but hand made wooden sailboats. Which he builds in his basement. (A running gag on the show is the question of how he gets the boats out of the basement.)

In one episode, an old friend and mentor visits Gibbs for the first time in several years and sees a boat in progress in the basement:

“What’s this, number 3?”

“Four.”

“I thought you’d have enough practice by now.”

There’s always something to learn.

Truly words to live by, even if they do come from a fictional character.