I have recently read Atul Gawande’s The Checklist Manifesto. It is a few years old now (2009) but it still has a lot to say about the way the world works as well as Gawande’s aim of helping experts perform consistently.
Do Experts Really Need Checklists?
Gawande is a doctor and his main area of focus is improving medicine. It is an important aim, who doesn’t want their surgery to be done consistently well? To improve medicine he looks to lessons from other fields, most notably airline pilots and construction/architecture. All these fields have experts but all can benefit from something as simple as a checklist.
The point of the checklists that Gawande discusses isn’t to instruct those who don’t know how to do something. Instead, the checklist is about stopping those who know what they are doing from making silly errors. It is about helping experts perform consistently,
Helping Experts Perform Consistently
Getting the right checklist is important. Just jotting a few stages on a page is not going to cut it. The checklist should be short enough so it doesn’t interfere with operations (in the case of surgery literally). That said, it also needs to cover the areas where the errors are likely to occur. Doing this requires an understanding of the type of errors that are generally made and ensuring that people who know better don’t forget to do what they are supposed to. Searching out where the errors tend to slip in is a vital skill.
Experts push back on this sort of thing a lot. In finance everyone is supposed to be motivated to do a great job every time but they seemed resistant to procedures that could make them better. You can see the expert’s point — they typically know their stuff why do they need a little bit of paper to tell them to do something they already know? Yet, even the greatest expert doesn’t get it right every time. Gawande talks about the management of very complex tasks. There are many people involved and no one can possible know everything and micro-manage everything. So the checklists can help make sure that everyone knows that everyone else knows what is going on. People won’t just assume that a team member had been told something when there is a checklist item — “have you shared {X information} with {Y person}?”
Mistakes Happen
The experts Gawande discusses are well-trained. They are pilots, nurses, doctors, builders, and architects. Each of them has a relatively small chance of making an error on any single task. While there are hard tasks the problem isn’t just those, even simple things trip people up, The challenge with the complex tasks is that there are many simple tasks that need to follow other simple tasks. There are also simple tasks being done by a large number of people. While the chance of error by any one person on any one task is low if you put lots of tasks being done by lots of people together the sheer volume of potential errors means that the chance of error in a procedure starts to become quite significant.
Indeed, Gawande discusses how as we have gained more knowledge we have pushed back ignorance. Experts can do more and more. Yet, this just gives them more chances to underperform how we could do if all went well. People find it really hard to accept mistakes from an expert but everyone understands there remain things that even the greatest expert cannot do given our current knowledge of the world. Failure when it should go right is much worse than failure when you never had a chance.
I was struck by how greatly the balance of ignorance and ineptitude has shifted. For nearly all of history people’s lives have been governed primarily by ignorance….But sometime over the last serval decades… science has filled in enough knowledge to make ineptitude as much our struggle as ignorance.
Gawande, 2099, page 8
Fonts Matter
Putting together a checklist requires great attention to detail. This even goes down to fonts and other choices that make it easier for all to read, such as sans serif fonts. This reminded me of a recent problem I have encountered. When I came to Georgia I thought I’d be clever and create all my materials into Georgia font. (Times New Roman and Arial are pretty boring). I was then looking at the accessibility of fonts and got the recommendation to use sans-serif fonts. My teaching materials might not be as important as a surgical checklist but might as well do better. I converted everything back to Arial and if I had possessed an accessibility checklist it might have saved a lot of time . (BTW I’m looking for better ideas on accessible fonts as Arial is really dull).
For more on the performance of experts see here and here.
Read: Atul Gawande (2009) The Checklist Manifesto: How to Get Things Right, Metropolitan Books.