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The Checklist Manifesto

The Checklist Manifesto

by Joe · 72 things on Twos

Too much potassium can stop the heart. Which is how the state executes prisoners.
We talk about our great saves but also our great failures, which we all have.
Much of the world and universe is, and will remain, outside of our understanding and control
Two reasons we fail
Ignorance
Things we do not know how to do yet
Ineptitude
Things we do know how to do and do incorrectly
Eptitide: making sure we apply the knowledge we have consistently and correctly
Failures carry an emotional valence that seems to cloud how we think about them
Failures of ignorance we can forgive.
But if the knowledge exists and is not applied correctly, it is difficult not to be infuriated.
It is not for nothing that the philosophers have failures such an unmerciful name - ineptitude
Or negligence, heartlessness
Every day there is more and more to manage and get right and learn.
Avoidable failures are common and persistent, not to mention demoralizing and frustrating, across many fields.
And the reason is increasingly evident: the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably.
Knowledge has both saved us and burdened us
That means we need a different strategy for overcoming failure, one that builds on experience and takes advantage of the knowledge people have but somehow also makes up for inevitable human inadequacies.
And there is such a strategy: though it will seem almost ridiculous and it’s simplicity, maybe even crazy to those of us who have spent years carefully developing more advanced skills and technologies. It is a checklist.
What do you do when expertise is not enough?
It is far from obvious that something as simple as a check list could be of substantial help
We believe our jobs are too complicated to reduce to a checklist
In a complex environment (life), experts (people) are up against two main difficulties.
The first is the fallibility of human memory and attention, especially when it comes to mundane, routine matters that are easily overlooked under the strain of more pressing events.
Faulty memory and distraction are a particular danger in what engineers call all-or-none processes.
Do it all or you might as well have done nothing.
A further difficulty, just as insidious, is people can lull themselves into slipping arteries even when they remember them.
“This has never been a problem before.” Until one day it is.
[Lists] help with memory recall and clearly set out the minimum necessary steps in a process
[Lists] establish a higher standard of baseline performance
Checklists seem able to defend anyone, even the experienced, against failure and many more tasks then we realized
They catch mental flaws inherent in all of us - flaws of memory and attention and thoroughness
By the middle of the 20th century the master builders were dead and gone
In a fire, the metal can plasticize - lose its stiffness and bend like spaghetti. That is why the world trade center buildings collapsed
In the face of the unknown, the always nagging uncertainty about whether under complex circumstances, things will be okay - you can trust in the power of communication.
Communicate with yourself through things, to solve your problems
Under conditions of complexity, not only are checklists a help, they are required for success
Activation phenomenon: Giving people a chance to say something at the start seemed to activate their sense of participation and responsibility and their willingness to speak up.
Good checklists are precise. They turn people’s brains on rather than off.
They are practical
From the beginning of flight school, pilots are trained that their memory and judgement are unreliable and lives depend on recognizing that fact.
Do-confirm checklist is for making sure you carried out all necessary procedures
Read-confirm checklists are for carrying steps out one by one (like a recipe)
Keep checklists between 5-9 items
Which is the limit of working memory
Wording should be simple and exact
Checklists are not comprehensive how-to guides, they are quick and simple tools aimed to buttress the skills of expert professionals
They remain swift, usable, and modest.
If information is dense and pages long for every new thing, it will become unmanageable and non-useful.
An inherent tension exists between brevity and effectiveness
We have an opportunity before us, not just in medicine but in virtually any endeavor
Pg. 158 pp2
Just ticking boxes is not the ultimate goal here. Embracing a culture of teamwork and discipline is.
[Checklists] prospect pushes against the traditional culture of medicine, with its central belief that in situations of high risk and complexity what you want is a kind of expert audacity
[Value investors] do intensive research, look for good deals, and invest for the long run. They aim to buy Coca-Cola before anyone realizes it’s going to be Coca-Cola.
Neuroscientists have found that the prospect of making money stimulates the same primitive reward circuits in the brain that cocaine does.
“We know you will have to do your research and please go ahead. But if you choose to pass we politely ask you Share what you find because we do our research every day”
With a good checklist in hand, he was convinced he and his partners can make a decision as well as human beings are able.
“I got pushback from everyone. It took my guys months to finally see the value [in checklists].”
Finding a good idea is apparently not all that hard.
Finding an entrepreneur who can execute a good idea is an entirely different matter.
We want an investor that takes the airline captain style of thinking.
Methodical, check-list driven approach to their tasks. Studying past mistakes and lessons from others in their fields and building formal checks.
We don’t like checklists
The fear people have about the idea of adherence to protocol is rigidity
They imagine mindless automatons, heads down in a checklist, in capable of looking out of their windshield and coping with the real world in front of them.
But what you find, want to checklist as well made, is exactly the opposite.
Checklists get the dumb stuff out of the way, the routines your brain shouldn’t have to occupy itself with, and let it rise above to focus on the hard stuff.
In the end, a checklist is only an aid. If it doesn’t aid, it’s not right. But if it does, we must be ready to embrace the possibility.