The checklist manifesto for business

Here’s a little survival tip for consultants. Do NOT suggest that a middle market company adopt a new procedure. No one likes new procedures. By extension they do not like consultants who bring up new procedures.

However, there is an alternative, courtesy of the Harvard Medical School and The New Yorker. What do Harvard Medical School, The New Yorker, and middle market business have in common?

Usually very little, but courtesy of a remarkable book by a public health authority I can make a meaningful connection that you will find profitable.

The book is The Checklist Manifesto — How to Get Things Right by Atul Gawande.

Gawande is just your normal, run-of-the-mill magazine writer, surgeon, Harvard professor, and leader of an important World Health Organization initiative. He is an accomplished man, one with demonstrable medical knowledge and one who has asked and answered a provocative question: What do you do when expertise is not enough?

The question arises from Gawande’s experience as a physician of feeling helpless after losing a patient. The natural reaction is to ask, “What else might we have done?” Occasionally, the answer comes back that you should have done something different, and something that is standard in the medical practice.

Putting it another way — occasionally, even a heroic doctor messes up.

Gawande and his colleagues then came up with a surprising conclusion — maybe doctors should think less like heroes, and model themselves after another life-and-death profession: pilots.

As tempting as it is to see pilots as instinctive masters of the complex, the truth is that we have the safest civil aviation system in the world because pilots don’t think that way. They have the good sense and training to see that in order to address complexity, we mere mortals need help — like in the form of a checklist.

That’s why you see pilots intensely reviewing their instruments, equipment, and settings before a takeoff. 

Gawande’s insight brought checklists to operating rooms worldwide. Based on some early efforts in a number of hospitals, he devised a list of 19 checks that have been found to reduce the main killers in surgery, which are infection, bleeding, and unsafe anesthesia. In short, he found that using checklists makes for dramatic improvements in outcomes worldwide.

Why? Is it because checklists directly address complexity? My answer is no, because if that were true the checklist would be millions of lines long.

The effectiveness of the checklist is not because the checklist has power, it’s because the people working in the operating theater have power. One of the first points in the operating room checklist is that all participants introduce themselves by name, mentioning their role. “Hi, I’m Joe, and I’m an OR nurse.” This gives clarity to all participants on who does what. It also permits any participant to clear their throat and feel free to say, “Excuse me, but we haven’t completed point five of the checklist.” This would otherwise be hard to do when faced with a towering ego draped in an antiseptic gown (i.e., the surgeon).

In other words, it’s about making sure every participant gets the opportunity to be heard. Not because their ego is important, but because the mission at hand is too important to permit key items to be skipped.

That’s where the checklist comes in for business.

All of us have faced a towering ego in business. Sometimes the ego is draped in the mantle of the CEO. Sometimes it’s wrapped around the purchasing agent.

In many companies, personality trumps process. In the minds of some egotistical but otherwise small-minded professionals, it ain’t Haines ‘til I say it says Haines.

“I want to do this…” they say. “I don’t want to do that.”

They say “I” so much they should go to the “I” doctor.

Bring in the checklist. 

Say you’re an employee at a food processing co-packer. It’s a pressured business, essentially custom-manufacturing using natural ingredients, adding heat and other transformative elements, then wrapping in a limited supply of packaging materials.

Usually there’s a truck waiting to take the batch away. There is no time added in to the process for re-dos.

So co-packing is a field that values expertise in how to make all of this happen on time, and this usually comes in the form of a demanding executive who may have started on the manufacturing floor before you were born.

Unfortunately, even us old guys sometimes make mistakes. Rather than relying on us to pick up our cell phones and tell the staff what to do, how about we set up a checklist?

A checklist doesn’t have an ego and it doesn’t have an owner. If the job needs product, production time, and packaging, it doesn’t make sense to start until all ingredients are complete, does it? But in the name of expediency (and, we suspect, one person’s egotistical drive to demonstrate control) it often happens that jobs get rushed, partially completed and set aside, or scrapped for quality issues, all because the checklist was not followed. In other words — quoting Gawande here — sometimes expertise is not enough.

Luckily, everybody understands checklists, and everybody sees the value of highlighting the responsibilities of other executives to ensure quality, timeliness, and safety.

We embrace checklists. I suggest we all use them, in whatever time-pressed business we engage in.

Just don’t call them “procedures.”

Click here to sign up for the free IB ezine – your twice-weekly resource for local business news, analysis, voices, and the names you need to know. If you are not already a subscriber to In Business magazine, be sure to sign up for our monthly print edition here.