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May 05 2015
The Checklist Manifesto

The Checklist Manifesto: How to Get Things Right, by Atul Gawande, has had a much greater impact than simply on the field of clinical medicine, its birthplace.  As was noted by one of its reviewers when the book first came out in 2009, it represents a potential "game changer." That is, job aids offer the potential for improving performance with extreme cost-effectiveness, in this case literally saving lives.

The author, an incredibly accomplished medical doctor, writer and MacArthur Fellow, points out that in our time it is impossible for anyone to know everything they need to perform their best in complex jobs and activities of daily life. He says that we suffer from increasing information overload, complexity and accompanying errors and problems of execution.  His field, medical practice, is particularly susceptible to this problem because lives are at stake.

The book introduces the idea that checklists, or what we call job aids in the performance improvement field, offer the potential for clearly documenting and guiding performance in both simple and complex tasks, including those in the fast-paced, high stakes world of patient care.  Studies show that they can dramatically improve medical safety and patient outcomes.  However, we tend to resist use of such job aids, for many reasons summarized by the author, including the belief that we can and should know everything (Master of the Universe mentality), that checklists oversimplify complex tasks, and that they are too rigid and discourage creativity and broader awareness.

Surveys show that many medical professionals resist the idea of using checklists to guide their performance, although 93% of those surveyed say that if they were the patient, they would want their medical professionals to use checklists to ensure best practices treatment.  There is this conflict between our obvious need to support our own performance with clear, specific tools and information resources, and our pride of knowing – all the ways that we resist actually using job aids.

In the context of The Six Boxes Model, this is known as a "box 2" issue because it involves "tools and resources." As we have learned from our mentors such as Tom Gilbert and Joe Harless, and as we try to communicate to our colleagues and clients in every way we can, job aids can be among the most cost-effective means of improving performance.  Job aids such as checklists and decision tables are often less costly and more effective ways of supporting knowledge-based performance than training – or at least a way to significantly reduce the time required and the results obtained from training.

So this book and its message are close to our heart.  And by receiving as much positive attention as it has, we hope that it will help to deliver the message that non-training tools and resources should be one of the very first places we look to improve performance, reduce errors, and in some cases dramatically improve human safety and well-being.

by Carl Binder

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