Burning guitarI think most people understand the basic concept of the checklist. Find a process that needs to be done – write it down. Check it off as you go. But the problem is understanding when you need a checklist and what needs to go on it (not every step is always essential nor is it necessary to be reminded of it – sometimes you just do it automatically). Then comes the hardest part, getting people to use it, particularly people who feel infallible – like some surgeons.

Such was the problem for Atul Gawande – getting highly skilled doctors and surgeons to use a checklist. He outlined his research and his journey to get the medical community on board in The Checklist Manifesto: How to Get Things Right. A significant part of getting buy-in was (a) support from upper management and (b) demonstrating the effectiveness of the checklist in reducing mistakes and wrongful death lawsuits. But ultimately the selling point came when they asked the surgeons if THEY would rather be operated on by a team using a checklist, rather than a team who was not. They decided they’d take the team using the checklist.

Checklists are great for small level tasks, but what about for high level projects such as building skyscrapers? Not only will you need many checklists you will also need them to ensure the various entities involved in the construction are communicating each critical step of the way.

A modern building is like the human body (Gawande 57). It has a skeleton (the framing), a vascular system (plumbing), a breathing system (ventilation system) a nervous system (electrical writing), with each element requiring a specialist or a team of specialists (Gawande 57). The building industry used to use a Master Builder concept whereby a single individuals was in charge of the entire project, from design, engineering and through construction, right up until the certificate of occupancy was issued (Gawande 58). But in today’s complex and super massive buildings, its too much for one person to handle.

Today, buildings are constructed using teams and checklists. There are checklists for specific projects and action items, but there are also checklists to make sure that the various teams (architects, contractors, plumbers, etc) are meeting at certain critical times during the construction process to discuss the project (Gawande 62).

I saw this same dynamic when Anthony Robbins first debuted his Rapid Planning Method (RPM) of time management (or life management as he called it). Within the outcomes, the “why’s” for each outcome and the specific action items, there were also communication pages (back when most planners were actual paper). Each communication page was used for an individual or team, with key outcomes or messages that needed to get across to that individual or team. I found it very useful in the days before email as I would jot down the various items I needed to discuss with that team member, subordinate or boss, then be able to discuss them all when I saw them. Email and texting has sort of taken the place of this process to a certain extent for individual communication but for large multi-team projects it still works effectively.

Communication checklists work in a multi-team environment because:

  • The various builders believe in the wisdom of the group rather than relying on the wisdom of one individual (Gawande 67)
  • This checklist/communications concept allows for the lowest level workers to participate, identify problems and propose solutions that may have otherwise been lost in the normal chain of command (Gawande 69-70)
  • Builders know better to rely on individual abilities to get everything right, trusting instead on one set of checklists to make sure simple steps are not missed or skipped, and another set of checklists to make sure that everyone talks through and resolves hard or unexpected problems (Gawande 70).

Man is fallible, but maybe men are less so, Atul Gawande (67).

This is a fundamental problem in most industries. Whenever there is a risk or a threat authorities tend to centralize power and decision-making and then start dictating instructions to those in the fields who are actually doing the job (Gawande 72). However, what works is pushing the power of decision-making away from the center, thereby giving people room to adapt based on their experience and expertise, and all you ask is that they talk to one another and take responsibility (Gawande 73). That is what works.

Remember Katrina?

Most anyone alive at the time remembers the massive failure of FEMA during Hurricane Katrina. A once proud and capable agency was saddled with inexperienced leadership and organized under a new and Department (DHS) that was more focused on bureaucracy than on getting the job done. A few agencies did respond rapidly – these agencies were used to pushing authority out to those in the field such as the Army and Air National Guard, the United States Coast Guard and oddly enough Walmart, which all became priority resources during one of our nation’s largest natural disaster.

Within those entities senior officials concentrated on goal-setting and measuring progress while maintain lines of communication but allowing field personnel to make the decisions necessary to achieve the goals (Gawande 77). Many processes (such as roof rescues with people and their pets) had to be created from scratch but once created, checklists were rapidly developed so that the process could be successfully repeated.

Coast Guard crews from all over the country immediately descended upon New Orleans while many other government agencies sat around waiting to be told what to do. From Alaska to Key West, aircrews were pieced together but they were all able to understand each other and work effectively together because of the standard operating procedures (checklists) and the standard vocabulary all of the crews shared. Checklists help achieve effectiveness and in this case, saved lives.

Today, there are checklists everywhere. Even for rock bands. The story is now quite well-known, how David Lee Roth with the band Van Halen, had a clause in the contract that specified that a bowl of M&Ms must be provided backstage but every single brown candy must be removed. Failure to do so would result in forfeiture of the show with full compensation to the band and at one point Roth followed through, canceling a show in Colorado when Roth found brown M&Ms in his dressing room (Gawande 79-80). It wasn’t an example of rock star excess, but an ingenious ruse to get promoters to read the contract (Gawande 80). The M&M checklist paid off one night in Colorado (apparently the same show) when the band found that the local promoters had not read the weight requirements and if Van Halen would have set up their equipment the staging would have fallen through the arena floor.

Even Van Halen had a checklist to ensure that people communicate.

Gawande, Atul. The Checklist Manifesto: How to Get Things Right. New York: Metropolitan, 2010. Print.


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