Even if you've read an alarming story about medical procedures gone wrong, you still book doctor appointments to address ailments. You go with confidence, too, trusting that your physician won't make a mistake when it comes to your case.
But doctors do make mistakes. Nurses do, too. Even the very best medical professionals in their fields make mistakes.
These mishaps, according to Atul Gawande, MD, author of The Checklist Manifesto, are due to the incredibly complicated nature of doctors' jobs. The same goes for engineers, lawyers, and pilots: anyone who has to carry around an enormous amount of knowledge and experience and apply it effectively, is prone to make mistakes sometimes.
"We have accumulated stupendous know-how," Gawande writes in his book. "We have put it in the hands of some of the most highly trained, highly skilled, and hardworking people in our society. And, with it, they have indeed accomplished extraordinary things. Nonetheless, that know-how is often unmanageable."
As more of us take on "knowledge worker" roles, where our livelihoods rely on collecting, interpreting, and applying huge amounts of information, we're becoming more prone to these same errors. There's only so much we can carry around in our heads without forgetting something.
Gawande believes the answer to this problem is to use checklists. Yes, a simple little checklist can save lives and stop buildings from crumbling. It can make you better at your job and save you time. This top doctor even has evidence to prove it.
Why Checklists are So Effective
In The Checklist Manifesto, Gawande tells a story about a patient treated by his friend, a doctor in San Francisco. The patient came into the emergency room one night with a stab wound from a Halloween party. The doctors and nurses involved did a thorough check of the patient and scheduled him for surgery.
Everything seemed fine, until the patient stopped responding and his heart rate skyrocketed. The patient's blood pressure was barely detectable. Nothing his medical team did improved it, so he was rushed to surgery. Only when he was opened up did the doctor finally realize the stab wound went much further inside the patient than he'd thought, cutting right into the aorta—the main artery from the heart. Although it seemed like a small knife wound, the patient had actually been struck by a bayonet—part of the assailant's costume.
"Your mind doesn't think about a bayonet in San Francisco," Gawande later heard from his friend. Asking about the weapon used is a normal practice—it just got missed this one time.
Had a checklist been followed, the patient wouldn't have been left in the ER to await surgery for a small knife wound, but would have been rushed to surgery immediately when his doctors realized how deep his wound went.
Checklists seem simple, Gawande says, and are sometimes hard for us to accept as a necessity when we're in high-powered jobs that rely on our skills and knowledge. But humbling ourselves by using a checklist can improve our performance and help us achieve more consistent results. "They remind us of the minimum necessary steps and make them explicit," writes Gawande. "They not only offer the possibility of verification but also instill a kind of discipline of higher performance."
(Checklists) not only offer the possibility of verification but also instill a kind of discipline of higher performance.
Atul Gawande, MD, "The Checklist Manifesto"
Gawande in 2009 introduced a hospital surgery checklist for doctors and nurses as part of a program developed with the World Health Organization. The checklist was designed to ensure basic checks were always completed before surgery. Run through the list, and you'll make sure everyone in on the same page about the surgery to be conducted, aware of who else was on the surgical team, and knows their role in the procedure.
Though Gawande admits he didn't expect to see the checklist make much difference in his own surgeries, he followed it to avoid hypocrisy and was surprised by the results. The checklist saved a life in at least one case, where a mistake by Gawande led to a critical need for blood while the mistake was corrected. Thanks to the checklist, extra blood had been prepared ahead of time, despite Gawande's confidence in performing a surgery he'd done successfully many times before.
At other times, the checklist ensured patients with allergies weren't given medications that would have caused a reaction, which would have been administered as a matter of course in most cases. It also prevented mistakes in administering anaesthesia by ensuring everyone was aware of special requirements before the surgery began.
The checklist worked. It saved lives, ensured the best possible outcomes, and kept Gawande's surgical team prepared every time.
"It's tempting to believe that no one else's job could be as complex as mine," writes Gawnde. "But extreme complexity is the rule for almost everyone." Your job may not involve life-and-death outcomes, but you'll get the same benefits by using a checklist to organize your most crucial tasks.
Using Checklists in Your Workplace
Before you create checklists, it helps to know what makes a good checklist. After all, you want it to be useful and save you time in the long run.
Creating a unique checklist for yourself is an important place to start, since this gives you ownership over the process. In Gawande's program, doctors were forced to use his surgical checklist by hospital administrators or the chief of surgery, which often made it seem like an intrusion.
"Just ticking boxes is not the ultimate goal here," Gawande says. Rather, the goal is to embrace "a culture of teamwork and discipline." Using a primary checklist as the base can be helpful, but teams then need to customize it to fit their exact workflow.
Creating your own checklist also means you can use it in your work and refine it based on how it fares.
Gawande says a good checklist is precise, efficient, and easy to use even in the most difficult situations. It should provide reminders of only the most important steps, rather than trying to spell out everything—after all, a checklist can't do your job for you. And above all, a checklist should be practical.
Your own role and the company you work for will determine what kind of checklists help you most. Generally, a checklist is best suited to work that's repeated often, and in a predictable order.
A good checklist is precise, efficient, and easy to use even in the most difficult situations.
An example from my own work is the process of creating a new blog post. Although I usually remember the steps of creating the content because it's part of my writing process—writing an outline, doing the research, drafting, and editing—there are plenty of other steps that I can easily forget. Adding images, working through multiple headline options to find the best one, and making sure image credits are correct are all standard tasks that are easy to overlook.
Content promotion can also be a repetitive process with many steps that are easy to forget. My content promotion checklist would include sharing the post on Twitter, Facebook, and Google+, sending it to anyone who's featured in the content, and letting the author (if not me) know the content is live.
it's tempting to believe that no one else's job could be as complex as mine. But extreme complexity is the rule for almost everyone
Atul Gawande, MD
I'm sure you can think of plenty of other areas of your work that could benefit from checklists. Here are some other ideas that might apply to you:
Networking: follow up with new people you meet, adding them to your contacts list, following them on social networks, and more.
Admin: completing reports, backing up important files, and other tedious tasks not part of your daily job
Financial: tasks like reporting tax, scanning receipts, and reviewing spending
Household: chores that either need to be completed individually or collaboratively
Security: a list of accounts to change passwords regularly, and backups to check on (when you need a backup is not the time you want to realize it stopped running)
Checklist Tools for a Fast Start
Rather than relying on pen and paper to create your checklist, there are dozens of apps and templates available for a quick start. Use an app to make your checklist, then you can duplicate it each time for a quick run-through. Here are some great options—and remember, even your todo list app can often be a great place to make a simple checklist.
Checklist (iOS, Android, Web)
Checklist makes it easy to get started using checklists, with a built-in repository of checklists submitted by users that you can browse and use. You can find lists for almost anything here, from SEO to property inspections to camping. Add the lists you need to your account, or build your own checklists from scratch, and you can get started organizing your workflows without much hassle.
Checkvist (Web)
If you're a fan of writing in Markdown and using keyboard shortcuts, Checkvist is made for you. It's a web app that lets you create checklists that you can print or share with others, and even set up daily reports. If you need collaborative checklist management, or you want a checklist that integrates with your favorite services like Evernote, try Checkvist.
Create a Checkvist List Item from an Evernote Note
Add an Evernote Note when You Create a Checkvist List Item
Tallyfy (Web)
If your business needs checklists for various tasks or departments, Tallyfy might be the best solution. It lets you create master checklists that act as templates. You can then create a "run," or an instance of that master checklist, with its own name. Each run can be tracked, so you can see how your checklists are progressing, and you can have multiple runs of the same master checklist going at once. You can also invite your team to work on a checklist run, making it simple to manage team processes.
Manifestly (Web)
Manifestly is another team-focused checklist tool. It includes commenting and @mentions so you can discuss a checklist with your teammates as you work through it. It also has built-in reporting to tell you how long your checklists are taking to complete, which ones are being used, and by whom.
Checkli (Web)
For a really simple, free, personal option, Checkli is the checklist app to pick. It lets you create checklists, download them in PDF formats, and share read-only versions. There's no frills or extra features—just enough to help you organize your tasks.
Pocket Lists (iOS)
Checklists don't have to be boring. Pocket Lists is a fun, personal checklist iOS that lets you organize your checklists with icons. Organize the things you need to do, then add an icon to each checklist to make it easy to identify. It can manage your daily tasks, with due dates and notifications, and can also keep track of your more detailed checklists to help with your work routines.
Wunderlist (iOS, Android, Windows, Mac, Web)
It's primarally a to-do list app, but Wunderlist can also be a great tool to create checklists. It's free, runs on just about every device, and is incredibly simple to use. You can't duplicate lists, but you can make a list and share it a Public List. Anyone—on your team or around the globe—can then add the list to their account, check off the items, then add it again whenever needed. It's a workaround, one that might keep you from needing a new app just for making checklists.
OmniOutliner (iOS, Mac)
OmniOutliner is a popular tool for making outlines and simple spreadsheets, but it—or any other outlining app—can also be useful for building checklists. Write out the items you need to do, drag them into the order needed, then share your outline file with others in HTML or PDF format so they can view the list on any device.
Microsoft Word, OneNote, Evernote, and almost any other note or writing app can also be used for building basic checklists. They may not have as many checklist-specific features, but they're easy to use and handy on almost any computer.
WorkFlowy (iOS, Android, Web)
Billed as a notebook for lists, WorkFlowy is an app to manage all of your checklists. Everything's listed on one sheet, where you'll keep all of your separate lists and sub-lists in order. Select on a bullet-point to focus on a particular sub-list, or the minus button on the left to collapse a list. That makes it easy to organize long checklists and still be able to focus on just the tasks you need to complete right now.
Made a Checklist? Now Rely on It.
Knowledge has both saved us and burdened us.
Atul Gawande, MD
Your job desperately needs to be structured with a checklist, but if your first checklist doesn't survive, don't despair. Just like best laid plans, checklists—at least first drafts—will often go awry in the real world. Even aviation and surgical checklists are constantly being modified to be easier to use, clearer, and more useful in real-world situations.
Accepting the fallibility of our memories and the overwhelming amount of information we need to manage and apply in our jobs is an important first step. Realize, as Gawande wrote, that "Knowledge has both saved us and burdened us," and recognize that the checklist can make sure your brain doesn't fail you—ever. Then, you'll be ready to create and rely on a checklist, one that that will help you perform better, and more consistently.
What checklists do you keep and how do you maintain them? Please let us know in the comments!
Credits: Surgeon photo courtesy Phalinn Ooi. Heart monitor photo courtesy Tony Webster. Pocket Lists screenshot via Sandra's Ark.
