Book Review – The Checklist Manifesto

I’d heard this book referenced many times so it was time to check it out. Here are the highlights. It is a pretty quick read and has some interesting stories. I’d recommend the read.
I found of particular interest, the points that give instruction on how to create effective checklists (points 10 – 15). Enjoy.

  1. There are 2 reason why we fail. The first is because we lack knowledge in a certain area. The second is because we have the knowledge but fail to act (or forget to act)
  2. Human progress has bought a higher level of complexity to what we do. For instance when planes were first invented there were few controls to manage. Now a Boeing 787 has hundreds of controls. The volume and complexity of what we know has exceeded our ability to delivery it correctly, safely or reliably.
  3. Successful organisations have realized that when they don’t delegate authority, things fail. And to delegate without procedure and structure is a recipe for disaster.
  4. Under conditions of complexity, not only are checklist a help, they are required for success. There must always be room for judgement, but judgement unaided – and even enhanced – by procedure.
  5. Following the recipe is essential to making food of consistent quality over time.
  6. Several studies by the author (a surgeon) revealed the inconsistency of procedures which were believed to be consistent. An example was appendectomy patients of one particular hospital failed to receive the necessary antibiotics over one third of the time. This is a very standard procedure. After the implementation of a simple checklist the results were as follows. After 3 months 89% of patients received the correct dosage at the correct time. And after 10 months 100% was achieved. The author noted the need for the checklist to become habit over time. Don’t expect 100% success the first day you put it in place. It requires work
  7. Sometimes it requires a mix of task and communication checklists. Task checklists on their own can be limiting for more complex scenarios. A communication checklist is more like a prompt to discuss certain issues with a team. I.e. “what are the key issues we see with this project?”
  8. There is a common illusion that a level of training and expertise brings consistency in execution. This overconfidence in ability is a common reason for mistakes. Even the best miss the most basic of steps. This is the exact reason no matter how many times a pilot has flown a plane, before take off, they ALWAYS review the take off checklist.
  9. Much of the following points on ‘how to’ create a checklist came from Daniel Boorman, a veteran pilot working for Boeing and the technical lead for the development of the 787’s pilot controls, displays and system of checklists.
  10. You must define a clear pause point at which the checklist is supposed to be used (unless the moment is obvious like a warning light coming on). You must decide whether you want a DO-CONFIRM checklist or a READ-DO checklist. With a DO-CONFIRM checklist team members perform their jobs from memory and experience. But then they pause and run over the checklist to make sure they captured everything. With a READ-DO checklist, on the other hand, people carry out the tasks as they check them off – it’s more like a recipe.
  11. The checklist cannot be lengthy. A rule of thumb some use is between five and nine items which is the limit of working memory.
  12. If a checklist takes more than 60-90 seconds at a certain pause point, it often becomes a distraction and people start taking shortcuts.
  13. The wording should be simple and exact and use the familiar language of the profession.
  14. Even the look of the checklist matters. Ideally it should fit on one page. It should be free of clutter and unnecessary colour. It should use both upper and lowercase text for ease of reading. A sans serif font like Helvetica is best.
  15. Your checklist must be tested in the real world which is inevitably more complicated than expected. First drafts always fall apart and one needs to study how, make changes and keep testing until the checklist works consistently.

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