Every weekday morning after I wake up to my cell phone alarm, I complete 36 or so tasks before driving my car to work. I consider 12 of these tasks to be critical, e.g. put money clip in back pocket (yes, all wise guys carry a money clip), put reading glasses in cover and in laptop bag. One particular task is mission critical. If I forget to take my laptop to work (has happened a few times over the years), I'd have to drive back home from work to get it. The rest I can improvise. If I forget my watch, I'll check the time on my cell phone or laptop. If I forget my cell phone, I'll call people using my work phone. If I forget my money clip, I'll borrow cash from coworkers. Last Monday morning, I forgot to put the trash out; a rarety. So I gave my mom and sister a full trash bag each time they visited during that week. The following Monday night, I put the remainder trash overflow in my unsuspecting neighbors' trash bins where there was excess capacity.
I've been going through this routine for years, and consider myself a "super specialist" at carrying them out. Yet, I consistently fail at 1-2 of the 12 critical tasks once or twice a week. After years of what feels like groundhog day (the movie), I should be able to sleep walk through these 36 mundane tasks. I fail because I'm under a time pressure, and the tasks are too many for an hour of allotted time (shower, shave, iron shirt are just 3 of the 36). So there is a level of complexity from the sheer number of them. According to Mr. Gawande, a check list of the 12 critical tasks can be of substantial help. This check list is short (12 of 36), and should contain the tasks that are prone to memory lapse with a history. I will not include "eat breakfast" to this list, because unless I suffer from Alzheimers, I will never fail to perform this step.
Now, should I really create a check list to remember to put my sneakers in my trunk along with the rest of my gym attire (when I forget this task, I have to skip working out at the gym on that day)? Not really. But imagine if failure at any of these tasks means putting someone's or hundreds of people's lives in danger. The stakes are that high in the surgical and airline pilot professions, with mind boggling complexity. Mr. Gawande, himself a highly esteemed general surgeon discusses case studies demonstrating consequences of inconceivable failures at the highest professional levels in a multitude of industries, and how a simple idea such as a checklist has proven undeniably that critical failures can be reduced significantly. It is unfortunate that resistance to this idea is rampant. From page 173 of the hardcopy, "We don't like checklists. They can be painstaking... But I don't think the issue here is mere laziness. There's something deeper, more visceral going on when people walk away, not only from saving lives but from making money. It somehow feels beneath us to use a checklist, an embarrassment. It runs counter to deeply held beliefs about how the truly great among us - those we aspire to be - handle situations of high stakes and complexity. The truly great are daring. They improvise." Adapt to the environment, Darwin, expletive happens, I Ching, whatever man, we gotta roll with it (appropriate and timely "Collateral" Tom Cruise quote inserted). "They do not have protocols and checklists."
The checklist is a brilliant and simple idea that is picking up steam thanks to the efforts of Mr. Gawande and those like him. This book should be mandatory reading in colleges and professions with serious health consequences.
I agree with Mr. Gawande. I sometimes make a paper checklist and always throw the to-do items that I might forget on my calendar (computer and blackberry). It really helps... and there's something very satisfying to crossing out the items on the checklist. Gives me a sense of accomplishment :)
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