The Checklist Manifesto

At ‘Blue Sky Dubai’ when Josh Phegan, somewhat tongue in cheek, described ‘The Checklist Manifesto’ by Atul Gawande as “a history of the checklist” he really wasn’t selling it very well – but he didn’t need to, as Malcolm Gladwell, author of ‘The Tipping Point’ and ‘Blink’ says on the cover, “It has been years since I read a book so powerful and so thought-provoking” – this to my mind is an important book.

As well as an author, Atul Gawande is a surgeon and associate professor at Harvard Medical School, and his book highlights some of the incredible advancements in medicine during this early part of the 21st Century, many of which are as a consequence of the checklist. For example, at John Hopkins Hospital in Baltimore, Peter Pronovost, a critical care specialist, wanted to reduce the number of infections caused by central (intravenous) lines. By ticking off on a checklist the process that is already meant to happen in every operating theatre in the world, (1. wash hands with soap, 2. clean the patient’s skin with antiseptic, 3. put sterile drapes over the patient, 4. wear a mask, hat, sterile gown and gloves, 5. put a sterile dressing over the insertion site once the line is in), infections reduced from 11% to zero after 10 days. Over the next year this prevented 43 infections, 8 deaths and saved $2million in costs in this one hospital alone.

According to a 2004 report by the World Health Organisation, (WHO), there are 230 million major operations each year – one for every 25 people on the planet – and worldwide, at least 7 million people a year are left disabled following surgery and at least 1 million die annually. Following the incorporation of the checklist, (expanded to 19 points to include 7 for administering anaesthesia but taking just 2 minutes to complete), in the 2008 WHO update on the checklist programme, results from the 8 participating hospitals showed that major complications caused by surgery had fallen by 36% and deaths by 47%.

Gawande and others developed this life saving checklist approach following research into the airline and construction industries, two that have implemented the use of the checklist perhaps more than any other. However, what they found was that the resistance surgeons and other medical experts initially showed to the checklist, “what do I need that for, I’ve been doing this for 20 years”, had also been prevalent amongst pilots and builders until they also found the results to be unarguable, dramatically reducing aircraft crashes and structural problems with buildings.

My belief is that every business can significantly benefit from checklists, particularly for those activities that occur daily rather than just the exceptional or rare. That’s because people get lazy and forgetful when doing repetitive tasks and tend to cut corners and wing it believing their experience will carry the day. The Josh Phegan Company, The Property Academy and LeadersINC are developing checklists that we will be sharing with our members later this year – I’m convinced they will have the same impact on your businesses as Atul Gawande’s has had on healthcare.