
A Life-Saving Checklist (2007) - deegles
https://www.newyorker.com/magazine/2007/12/10/the-checklist
======
dctoedt
In his book, The Checklist Manifesto, Gawande reports that at the end of a big
checklist pilot project for the World Health Organization (IIRC),
participating surgeons were surveyed.

• One of the survey questions was, in essence: _Would the use of checklists
improve your surgical practice?_ Most of the surgeons responded _no._ This was
consistent with the resistance that Gawande encountered: _I don 't need no
stinking checklist; I'm a_ good _surgeon!_

• But the more-telling survey question was this: _Would you want_ another
_surgeon to use a checklist if operating on you or one of your family
members?_ Something like 93% of the surgeons surveyed responded ... _yes._

~~~
vertexFarm
Wow. That's such a supreme indicator of overconfidence--the belief that _I and
I alone am so competent that I don 't need safeguards._

I would not have hoped that a high percentage of surgeons have that trait. I
wonder if I am guilty of it as well. Something to examine in the mirror in our
future endeavors.

~~~
supertrope
I like to use the term Dunning-Kruger instead of over-confidence or hubris to
describe it. Everyone thinks they demonstrate above average skill. During the
2007-2009 financial crisis every single financial services firm justified
their executive bonuses by claiming their personnel were above average. Very
few car drivers consider themselves below average.

Before germ theory gained acceptance or was even understood, physicians and
surgeons considered themselves above hand washing as a gentleman's hands are
always clean. Ignaz Semmelweis discovered that washing hands and tools in
chlorine solution reduced childbirth deaths. But he was unable to convince
others.

In modern times doctors have answered a survey on the effect of pharmaceutical
representatives visit. The overwhelming majority responded that they are not
swayed by drug saleswomen, but that other docs are susceptible to choosing a
prescription drug because of salesmanship instead of only efficacy & risk.

~~~
inimino
These are examples of illusory superiority[1], or the "Lake Wobegone effect".

[1]:
[https://en.wikipedia.org/wiki/Illusory_superiority](https://en.wikipedia.org/wiki/Illusory_superiority)

Dunning-Kruger is something more specific, that people with lower skill in an
area overestimate their skill, because they are unable to distinguish
competence in that area.

------
sp332
(2007)

This probably got posted in reaction to the news that the author, Atul
Gawande, was announced to be the CEO of a new healthcare company.
[https://news.ycombinator.com/item?id=17355346](https://news.ycombinator.com/item?id=17355346)

~~~
mcrady
It seems like these two articles are more relevant:

[https://www.newyorker.com/magazine/2009/06/01/the-cost-
conun...](https://www.newyorker.com/magazine/2009/06/01/the-cost-conundrum)

[https://www.newyorker.com/magazine/2015/05/11/overkill-
atul-...](https://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande)

------
treetoppin
I think a key element of checklists, and checklist discipline, is coordination
between members of a team. What checklists allow you to do is have
accountability across differences in experience/authority/expertise and also
track a process over time.

In my work as a naval aviator (caveat, I'm still a student), we use checklists
in the cockpit to coordinate all sorts of functions such as engine start,
takeoff, landing and emergencies. These ensure that we start the engine the
same way, verify we are ready for landing, and also handle emergency
procedures in an approved way. When there are rank and experience differences
in the cockpit these checklists help equalize the disparity, and let less
experienced or junior members hold senior members accountable. Before each
flight we also follow a briefing checklist, and that includes human factors
such as any possible issues relating to
illness/medication/stress/alcohol/fatigue/eating. Doing so ensures that there
is always a place for people to vocalize anything that the team should know.

Previously I worked on a Coast Guard cutter, and we used similar checklists to
ensure we were prepared to get underway, enter port, or complete a complex
evolution like tow another vessel. For these checklists the main value was in
verifying between multiple changes of team personnel that everything was being
completed to meet the timeline. The checklist served as documentation that the
person before you had collected the necessary information, made proper
notifications, and started/finished processes.

It has baffled me when I hear that medical personnel dont use checklists for
these exact reasons. They perform time critical, high stress procedures that
have a fairly documented set of steps. They require a team of personnel that
have different scopes of expertise, experience, and authority. There are
frequently changes in the team's composition over the duration of the patients
care, and it seems like the patient will be handed off between different teams
that specialize in their own respective areas of patient care. For us in the
military it is pretty easy for authority to mandate we use checklists, and the
buy in come from accident investigations revealing that checklists were
ignored or skipped. Is there an equivalent medical authority that can pass
this information down, or does this have to emerge independently from each
hospital system?

------
toss1
"The checklists provided two main benefits, Pronovost observed. First, they
helped with memory recall, especially with mundane matters that are easily
overlooked in patients undergoing more drastic events. . . ."

Indeed, benefits of checklists can be huge. this reminds me of a US Army study
I read about some time ago which examined the effects of sleep deprivation and
stress in demanding environments.

What they found was that, in general, the high-level strategic capabilities
stayed intact -- the people could still analyze complex situations, make and
execute battle plans, etc.

What was lost was the smaller, mundane functions, which could add up to
critical failures, such as forgetting to refill one's water can or refuel the
vehicle before going out, etc.

Interesting lesson

~~~
vertexFarm
I've always hated my bad memory, and I learned a long while ago that simply
trying to remember through sheer force of concentration did not work. It was
as hopeless as praying for rain. Only external memory tools and strategies
planned in advance can solve it for me.

I have to build a system to keep me from forgetting, because if I leave it up
to my future self alone then he will forget 100% of the time.

------
howard941
I have a dumbass problem where after I've driven away from home I can't
remember if I locked the front door or closed the garage door so I turn around
and go back home to check. I've managed to fix this by saying out loud, "door
locked - check" and "garage door down - check" when I've done it. Now I just
need a checklist to remind me to do a checklist.

~~~
newlunarfire
It might sound dumb to you but your solution is used by Japanese train
engineers before leaving at a station and trains in Japan are really efficient
and on-schedule.

[https://www.allaboutlean.com/pointing-and-
calling/](https://www.allaboutlean.com/pointing-and-calling/)

------
upofadown
People are generically bad at reliably setting states. The problem isn't so
much that someone failed to do something (an action) but that they failed to
notice that the action was not done (the state was wrong).

Often times people forget the "check" part of the term "checklist" and treat
them as a list of things they must do. The result is less reliable because it
is easy to skip a step, even if you end up ticking a box. A checklist involves
two steps, first doing the thing (possibly from memory) and then consulting
the checklist to see that the appropriate state is set.

This is a particular issue for programmers as programmers are constantly
involved with lists of actions that are performed in sequence. As a result
there is a tendency to let the list run the human in a way similar to how a
computer runs a program. Computers are way better at states than humans are
however...

~~~
krallja
My coworker just fixed an unset state of mine— I checked the box, but did not
perform the related action, three weeks ago.

Thankfully, Trello keeps a log of most changes, so it was easy to see where in
the process my eyes had glazed over. We’ll get around to automating those
steps someday, too.

------
jimnotgym
I am an avid checklist user. I have a number of complex processes which are
repeated monthly, quarterly or yearly. When the office is calm and I am
feeling good I don't need them and find myself ticking them off having already
done the stage. When I am feeling less-good, the office is noisy and I keep
being interrupted the check-lists are the reason I succeed.

Yet still I find almost complete resistance to them by colleagues. They seem
to think it is somehow demeaning to reduce their work to a fixed process.
Perhaps it takes the mystique out of it, and gives the idea that _anyone could
do it_.

~~~
drdrey
Can you give some examples of the kind of complex processes you are referring
to?

~~~
jimnotgym
Accounts preparation at a mid size multi-channel, multi cost and profit centre
business.

------
beaconstudios
Does anyone know of a good cross-platform checklist app? There's a million and
one todo list apps but I can't seem to find a good checklist one. I use my
phone's memo app for checklists but it doesn't help me with staying consistent
over time, and doesn't scale as I use the same app for note taking, ideas, a
scratch space and so on.

Oh, and if you're thinking "I don't need no stinkin' checklists, what would
you even use them for?" here's what I have currently:

\- Code review key checks

\- Code review smells and anti-patterns

\- Out-the-door checks (got my keys, entry pass, grabbed lunch from fridge
etc)

\- Gym gear list

\- Traits to work on a la Benjamin Franklin

\- Self-care list for when I'm stressed/anxious (relief suggestions e.g. drink
a glass of water, go for a walk, mindfulness, organise workload on paper, etc)

\- Carry lists for a couple hobbies

I would likely have more but the poor form factor limits how practical it is
to keep many lists.

~~~
nanomonkey
Markdown or Org-mode are both cross platform compliant and as text files are
easy to generate just about anywhere.

~~~
beaconstudios
it's not so much the text formatting as the ability to set reminders,
physically check off the list and have a record per-day/instance/whatever of
completing the list, that kind of thing. The main reason I use checklists so
much is because my memory is extremely bad, so prompts make a huge difference
to me.

------
miguelrochefort
Peter Pronovost Checklist Protocol

    
    
        Checklist doctors should follow:
    
        1. Wash their hands with soap.
        2. Clean the patient’s skin with chlorhexidine antiseptic.
        3. Put sterile drapes over the entire patient.
        4. Wear a sterile mask, hat, gown and gloves.
        5. Put a sterile dressing over the catheter site.

------
jwilk
Translation for metric units users:

66 °F ≈ 18.9 °C

+10 °F ≈ +5.6 °C

98.6 °F = 37.2 °C

------
segmondy
After reading this article when it came out, I ended up reading the book
"Checklist Manifesto" and have incorporated checklists into my professional
and even personal life. I highly recommend it.

~~~
Pamar
One question (for you or anyone else with relevant experience, really): the
more negative reviews on Amazon say that the book is mostly a collection of
anecdotal evidence about how great checklists are. Assuming this is true, and
that one is already sold on how useful a checklist is, can you suggest more
practical hands-on books on how to build effective checklists? (If you think
that the reviews are wrong, and the book provides actual practical advice,
this would also be useful information, thanks).

~~~
segmondy
This is the only I've read. It was good enough to convince me.

------
ALee
Literally everything we do can be boiled down to checklists. Atul Gawande is a
national treasure and I highly recommend his book Being Mortal as well.

------
yial
I’m super curious to read this, but I can’t seem to get past the paywall on
mobile.

~~~
mikestew
It's a long-winded argument for using checklists, later to be turned into a
book and a major motion picture. (Long-winded, but worth a read, assuming you
can get past the paywall, if you haven't read _The Checklist Manifesto_.)

~~~
yial
I’ve read the checklist manifesto, so I understand the gist now! Thank you.

