Author: Atul Gawande

Information has increases exponentially along-with the complexity of tasks involved. Limitation on human memory and concentration causes us to make seemingly stupid errors.

The key idea is to identify those aspects of the tasks which are simple/dumb but success depends heavily on their correct execution. Checklists can then be ensured to get these things done.

Another key idea is to “push the power of decision making out to the periphery away from the centre”. You need to make sure that they talk to each other and take responsiblity.This is because command and control system does not work in critical complex situations as often complete information is not available and decisions have to be made quick.

The larger lesson is provided by the construction industry example which provides two sets of checklists:

1. Make sure that the dumb but critical stuff is not overlooked
2. Checks to ensure that people talk and coordinate and take responsibility ( they had a whole chart which mentioned who was supposed to meet whom after each step and discuss what before proceeding. Also a system where even frontline worker could raise an issue and email all the concerned)

Some quick anecdotes:

• Surgical staff was required to take a minute at the beginning and make sure that everyone knew everyone’s names – > this was shown to improve team work during the operation substantially.
• Also in a team meeting -> it is better if everyone is given an opportunity to make their case turn by turn -> allows people to open up, feel more confident
• The nurses were supposed to run through the checklist ( shifting the power) and would call out each item

Tips on making the checklists

• Decide whether it is Read-Do or Do-Confirm checklist
• Should indicate clear pause point when it is supposed to be used.
• Should have 5-9 items
• Keep only killer items . Ideally should not take b/w 60-90 sec to go through it
• Wording should be exact and simple
• Should contain terminology of the profession
• Sentence case, Helvetica
• Should be tested in the real world and iterated
• IMP: These are not comprehensive How-to guides , but simple quick tools to help expert professionals. Should only contain steps which are easily missed by professionals
• TIP: To identify the killer items for checklists- >Identify the key items and how big a impact they have and how frequently are they missed
• It should not encourage mindless automation, but allow the expert to get away with the dumb-stuff and allow him to focus on the harder problems