On the advice of Judy Brown, I picked up The Checklist Manifesto, and I have to say it’s a must-read. This is a short, well-written, and mind-changing book. Frankly, it ranks up there with Don Norman‘s Design of Everyday Things, and that’s saying a lot.
Atul Gawande is a medical doctor who’s also an eloquent writer. In the course of his work he’s become interested in reducing errors, and has looked deeply into how to minimize them. And he’s had the opportunity to put into practice and test his ideas, refining them until they work. This book documents his explorations, developing a thesis that he recognizes has applicability far beyond medicine. And that’s important for us, if we care about improving outcomes both professional, personal, and societal.
He breaks up flaws in execution into those where we don’t have knowledge, and those where we make errors despite having the requisite knowledge. And he explores eloquently how likely the latter are in the real world. Demonstrably smart and knowledgeable people, acting in complex situations, regularly make mistakes. Those who have heard me speak about how our minds work know that there’s some randomness built into our system. Frankly, we’re not really good at doing rote tasks. He doesn’t go into the cognitive architecture, but rather documents it via stories and explanations of complexity. And he develops a particular approach that is striking in it’s simplicity and powerful in it’s effects.
Not surprisingly, given the title, the solution are checklists. He has two types, ones that help us execute those rote steps that are critical to success, and another that helps connect us at critical times. He categorizes, in a way I find reminiscent of Van MerriÃ«nboer’s elegant task analysis in terms of the knowledge you need and the complex problems you apply it to, the benefits of both remembering those crucial but empirically overlooked steps and of having people build a quick rapport and share the critical information at critical times. He illustrates with flight and large-scale architecture examples as well as medical,situations where performance literally is life-or-death. The clear implication is that if it saves lives there, it can save dollars or more anywhere.
And, refreshingly, he admits you’re not going to get it right the first time, and you need to trial, iterate, and refine again. He recognizes that it must be quick, easy to use, and tuned for the context of use. This is no quick fix, but it ends up providing small easy changes that actually save time as well as reduce error. It’s really about performance support, and it’s not complex, and it can work. It’s also a natural match to mobile delivery, which I’m sure is one of the reasons Judy pointed it out.
This short, eloquent book holds the power to make significant improvements in many fields. I strongly recommend it.
Trina Rimmer says
Clark, I share in your enthusiasm for this book. Not only is it an engaging read, it really has refined and reshaped my approach to working with my clients. I’ve found the biggest obstacles to implementing checklists as performance support are 1) breaking through the assumption that the risk or cost associated with a performance problem must have an equally costly solution, 2) gaining buy-in for refinement. Checklists are so simple and yet, like any tool, they require some tweaking to make them truly useful.
Thanks for spreading the word!
Kelly Smith says
I loved this book. Atul Gawande is an eloquent writer and he respects his readers by citing a great deal of research (like the author of this blog). I spent time reading the research he mentions. Gawande looks beyond his experience and provides examples from other industries. In addition, he says something about teams with the details he provides on implementing the checklists.
Hal Christensen says
Clark, yes this is an outstanding book. Just the story about how checklists reduced, by 66%, the instances of hospital-induced infections in a group of Michigan hospitals, saving $175 million in costs and 1500 lives in only 18 months, is enough to make Gawande’s case. The book details even more work environments in which checklists have played a vital role–including Captain Sullenberger’s landing of his plane on the Hudson River.
What is surprising is that the book, which started out as a New Yorker article three years ago and became a NYTimes best seller a year and a half ago, has received almost no attention from the learning profession. Can anyone point to a training instance–formal, informal, virtual, social, eLearning, classroom, you name it–that has ever produced anywhere near the benefits that those elegant little Performance Support checklists have brought to hospital ICUs? I suggest that everyone read Gawande’s book and then imagine the impact your L&D department could have on your organization if it stopped defining its roles as feeders-of-the-LMS and instead aimed its talents at providing the knowledge and tools people need precisely when and where they need them in the workplace. Mind-changing indeed.
Kay Wood says
Hear, hear. Atul Gawande wrote what in my mind is a manifesto. Checklists work in any field of endeavor and should be a part of every project plan. Breaking down a learning project into a series of checklists can actually work much better than using project planning software.
If you get a chance to read another of his books, Better, do. Gawande instructs on almost every page.
Miriam Phillips says
My team at work read this as our book club selection and when done created a checklist that has had significant impact to what we do! it’s been hard to find a book to follow this one!
Dan Roddy says
Great Post. It’s worth drawing direct attention to this checklist site that is linked from the bottom of the page you linked to – a great resource: http://www.projectcheck.org/