Never Overlook a Checklist’s Power to Improve Performance

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What does assisting with surgery in a hospital operating room have in common with servicing a stock car in the heat of an intense and noisy 500-mile race? For starters, both endeavors involve people with specialized skills doing precise tasks accurately in time. Also, both tasks require checklists of “must-do” procedures.

Never overlook the value of checklists. They are as vital for your business success as they are for winning the Daytona 500 — or for reducing operating-room deaths.

Let’s start in the operating room thanks to a six-minute TED talk given by Atul Gawande, a charismatic and highly skilled surgeon and writer.

Briefly, Gawande’s presentation goes like this. The World Health Organization asked him and his team to find a way to reduce deaths during surgery. They started by looking at other high-risk industries ­— skyscraper construction, aviation, etc. — and what these industries do to reduce fatalities. One of the things they discovered, the use of checklists, was so simple it is often overlooked. Not that designing checklists is easy; it’s not, cautioned Gawande.

“You have to identify the moments in a process when you a catch a problem before it’s a danger and then do something about it. You have to identify this in a ‘before-takeoff’ checklist,” says Gawande.

Gawande’s research led them to develop a 19-question, 2-minute Surgical Safety Checklist with “pause points” between items. They then implemented the checklist with surgical departments in eight hospitals around the world.

The results were startling.

Complication rates in the hospitals adopting the checklist fell by 35 percent and death rates by 47 percent. “This was bigger than a drug,” Gawande shares in his short presentation. In spite of these encouraging results, the idea of using well-thought-out checklists during surgeries is still not commonplace in hospitals.

“There is deep resistance because using these tools forces us to confront that we’re not a system. Forces us to behave with a different set of values – humility, discipline, teamwork. This is the opposite of what we were built upon – independent, self-sufficiency, autonomy,” says Gawande.

“In every field knowledge has exploded but it has brought complexity. It has brought specialization and we’ve come to the place where we have to recognize that, as individualistic as we want to be, complexity requires group success. We all need to be pit crews now,” he adds.

This comment brings us back to NASCAR, one of America’s biggest sports. While the action on the track is hot and noisy, it’s no less hectic on pit row. It takes a six-man NASCAR team crew somewhere between 12 to 15 seconds to change four tires, fill the car with fuel and make a host of other small adjustments to maintain the 800-horsepower machine’s performance. The extra second or two of non-racing downtime saved on pit row is often crucial in winning a 500-mile race lasting an entire afternoon.

In a very real sense, business is a sport, too, and no less competitive than NASCAR or any other sport where winning and losing is measured in seconds or a point or two. Never discount the power of developing and using checklists to keep your business team in the thick of the action.

Thanks to Dan Pressetto of SOD Inc. and Michael Mills of Business Design Corporation for sharing the inspiring and instructive Atul Gawande TED talk.