I’ve never really paid much attention to checklists. They’ve just seemed trivial and mundane. However, checklists were a topic of discussion this week, particularly when they should/shouldn’t be used. Below is an exert from a paper I had to write on the subject. Enjoy.
Checklists break down complex tasks into a step-by-step procedure. They are useful for performing tasks that are well ordered and stable. In many industries the complexity of some tasks has grown beyond the capacity of an individual to perform them with precision. In these instances where expertise is not enough, they have turned to checklists. In 2001, John Hopkins Hospital instigated a checklist trial1. Their goal was to reduce the amount of line infections in patients by implementing a simple five-step check list. Whilst seemingly simple, the ten-day line infection rate went from eleven to zero percent in the period of a year1. Expanding checklists into other departments, such as patients on mechanical ventilation, saw similar results. The amount of patient deaths reduced 21% compared to the previous year1.
Checklists have their limitations though. Their usefulness is depended on a number of factors. When the context of a process changes, the procedure itself can change as well2. Checklists are limited in their ability to capture the unexpected – there are only so many possibilities that can be captured. In these situations, it is the intuition and tacit knowledge that professionals use to judge what needs to be done2. For example, pilots in fighter jets during air to air combat determining how they should fly against invading airplanes2. Likewise, in these situations where advancing expertise is necessary, checklists can be detrimental by breeding a culture of complacency2. Additionally, as practices evolve, procedures need to be updated. Therefore the viability of a checklist depends on its ability to capture the most recent knowledge2. This is not possible in fast changing environments. Similarly, if checklists can’t capture a complex process in a simple and concise manner, their usability is also weakened and individuals use their own judgment instead2. On this note, it is worth considering what happens when checklists are ignored. Are those individuals reprimanded despite a successful outcome?
By considering these factors you will begin to understand that not all procedures warrant a checklist. More so, their integration can be detrimental to an organization’s performance despite their intention.
1. Atul Gawande, The Checklist, The New Yorker, December 10, 2007
2. Gary Klein, Streetlights and Shadows: Searching for Keys to Adaptive Decision Making, MIT Press 2009, Chapter 2.