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The Simple Genius of Checklists (nuclino.com)
323 points by zzaner 20 days ago | hide | past | web | favorite | 87 comments



I have been a flight test and rocket test engineer. Checklists were life, especially in the rocket world. The fantastic thing about checklists is that they both keep you accountable and free your mental resources so that when something happens that one of your checklists don't cover, you know you've at least tried all the sane/expected things. I personally found that backstop freeing and allowed me to use my creativity when it was demanded by things going wrong.


It took three generations of flight training for checklists to become an essential part of aviation.

Note that a flight-training generation is less than a human reproductive generation; it's the time from first lesson taken to first lesson taught (plus some). It had to wait for the older instructors to retire.

We are still in transition, in medicine. Many physicians have not yet cottoned to hand-washing, yet.


I don’t know about that last part. My dad is a fairly old physician and the way he tells it hand washing has been mandated by the feds for decades and the last cohort of old docs who refused to change in that respect retired circa 1990. But the culture may be different in other parts of the US or world.


Currently work at a hospital.

- The CEO's semi-monthly emails have either contained a) reminders to get the flu shot in flu season and b) statements about washing hands.

- Thirty minutes of your new employee orientation is used to discuss handwashing with some funny stories about diarrhea and they go around to every single person to make sure they're washing them correctly.

- Upon entering a patient room, anyone entering is supposed to wash their hands

- Anyone can call out a doctor and ask if they've washed their hands and there are signs to make patients comfortable asking them to do so as well.

So yeah, 2019 and people still need all that as reminders.


I liked how in Freakonomics (I think), they interviewed someone who worked at a hospital, and would regularly and randomly take culture samples of nurses' and doctors' and administrators' hands. The results of the culture were shown on a screensaver.

This feedback and public transparency was both amusing, and enforcing of the necessary handwashing.


Ah... you're in for a nasty surprise. [1]

Among this cohort, the mean self-estimated handwashing rate was 73% (range, 50%-95%), compared with the covertly observed rate for this cohort of 8.6% before and 10.8% after patient contact, with an individual mean rate of 10% (range, 0-33%).

[1] https://www.mja.com.au/journal/1996/164/7/teaching-hospital-...


I liked how in Freakonomics (I think), they interviewed someone who worked at a hospital, and would regularly and randomly take culture samples of nurses' and doctors' and administrators' hands. The results of the culture were shown on a screensaver.

This feedback and public transparency was both amusing, and enforcing of the necessary handwashing.


Maybe -- and this is just my own opinion/speculation -- this is because in my lines of work, the results of failing to follow a checklist can be at worst catastrophic and relatively immediate. In medicine, some classes of failures might be more subtle and harder to notice.

Anyone with medical knowledge, feel free to inform me if that idea is totally off-base.


Also in medicine, it's often not the practitioner who suffers the consequences, which even if we ignore the moral aspects, means the feedback loop isn't closed tightly, making learning more difficult.


> Many physicians have not yet cottoned to hand-washing, yet.

What?!? How many generations has it been since Louis Pasteur?


Actually, Ignaz Semmelweis.

And about 150 years, so 4-5 generations of surgeons. Not exactly many.


Surgical generations, like pilot generations, are quite a lot shorter than reproductive generations.


I have bad news for you. I have been seeing a lot of doctors for the last five years or so.

Two or three are absolutely fastidious about hand washing.

The rest are not.


> Many physicians have not yet cottoned to hand-washing, yet.

This isn't really true. They know it's important.

1) Have you ever washed your hands 12 times a day for a week? Think about what your hands would be like.

2) Washing hands properly takes somewhere around 2 minutes. That's a significant fraction of an hour--just spent washing your hands.

Given this, disposable gloves seem like a much better answer.


I started seeing the utility of checklists in the military where we have big books of checklists (battle books or tactical aides) carried in your pocket. The contain everything from how to put in a section in attack to how to call in a helicopter. They are really incredible and so useful under pressure.

It gave me the idea to great a free open source mobile app called Umbrella. It's a free, open source app with dozens of best practice lessons and checklists on digital and physical security. The idea being to help people at risk (travellers, journalists, aid workers, activists etc) have somewhere to turn to in an emergency. Everything from sending a secure mail to dealing with a kidnap. You can read more about it at https://www.secfirst.org or try the checklists for yourself https://itunes.apple.com/us/app/umbrella-security/id14537153... or https://play.google.com/store/apps/details?id=org.secfirst.u...


Can anybody recommend a good checklist app for Android? When I search for "checklist" I only find ToDo-List apps that call themselves "checklist" app.

What I'd like is something where you can set a per-checklist timeout after which the list resets everything to unchecked and maybe allow two different ways to view each checklist (or modes): 1. All at once with little check marks that you can check in any order 2. Strictly ordered checklists where you only see the current task and check it to get to the next, ideally with a "3/14" indicator or progress bar to know how far you've got through the checklist.

Which apps can you recommend?


Workflowy is the gold standard for me on any platform: it's just a simple, infinitely deep outliner, with minimal features by design.


This sounds like a fun afternoon project for a web or mobile dev.

If nobody replies with a quality app that does this, I'm going to make it for myself and share it here.


This is my weekend project this week, ha. I'm reading Checklist Manifesto and decided there wasn't any good app for it. I'll post back here when it's done.


Advice (or warning?): I use Checklist Wrangler for iOS.

Checklist templates that repeat based on day of week; auto-archive after X days. Tools for organization into groups, subgroups, etc. A way to view completion over time.

I use it for daily things (daily autocreate, daily autoarchive), weekly things, monthly things, and things I do in order but without a set time (manual creation and... autocreation after completion? no i dont think that's a feature).

Wonderful app for implementing checklists and it's a cornerstone is my toolbox for making sure I'm living my life with intension.

Yet, it's long abandoned and I dont know if it's still for sale in the app store. Probably made little money in a sea of Todo apps.


Nice! If you decide to add NFC sticker capability (scanning a sticker opens a checklist directly) please coordinate with the other person in this thread who might also create an app. I think the NFC data should be the equivalent of "checklist://cessna172cockpit" i.e. it should just contain a reference to the checklist, not the checklist itself. OTOH having the checklist in the NFC sticker, complete with a "last modified" date might be awsome as well, if there are multiple people who use the checklist. Assuming that the whole list even fits in a sticker. Hm...

Cool! I was going to do the same. Reach out to me if you want help, code review, or a tester.


Love to try it out.


Nice! If you decide to add NFC sticker capability (scanning a sticker opens a checklist directly) please coordinate with the other person in this thread who might also create an app. I think the NFC data should be the equivalent of "checklist://cessna172cockpit" i.e. it should just contain a reference to the checklist, not the checklist itself. OTOH having the checklist in the NFC sticker, complete with a "last modified" date might be awsome as well, if there are multiple people who use the checklist. Assuming that the whole list even fits in a sticker. Hm...

Have you seen this site: http://todomvc.com/ Pick your JS framework and it's done.


Making a checklist isn't the novel or useful part. It's having recurring lists that reset each day or week.



Far from what you require, but OurGroceries is pretty flexible and could meet requirement 1 quite easily. I use it for my travelling checklist every time I go on weekends away (as well as for shopping) https://www.ourgroceries.com/overview


I just use a text editor.


To add to this: I do the same. Actually checking the items off of the list is less important than having the checklist written down.


I started using a checklist when flying internationally. I got tired of forgetting the right plug adapter, for example, and paying $$$$ for a replacement at the airport store. Or having to find a store that sells cuff links.

I often bring two plug adapters, as there's always another guy at the conference who forgot his :-)


Trello can do this repeating checklist to an extent, and it has the progress bar that shows on cards as you complete items.

https://blog.trello.com/trello-card-repeater


What is the timeout that resets the list use case? I'm generally curious.


Just laziness on my part, when you are done with the checklist, get interrupted and start 15 minutes later you might want to still see all the check marks still there, but on the next day, you might be doing a different task.

This needs to be configurable because it depends on task frequency and how long a checked checklist stays relevant.

It might be overkill, just having an easily accessable (but not to easy?) reset button for each list might work as well.

Also, I haven't read the book yet, so my requirements might not be the best.


Check out wunderlist. It also syncs to your computer. You could set up a template list and just duplicate from that for each needed instance.


YAGNI. Just use whatever Notepad-like app that was pre-installed on your device.


Google notes works for me as a simple checklist


Now that I said it is useful I hope Google doesn't shut it down!


The problem here is Google.


Surgical Safety Checklists are crucial for preventing what used to be a really shocking number of wrong-patient and wrong-side procedural errors.

Taking the good kidney out instead of the diseased one is practically murder.

https://www.who.int/patientsafety/safesurgery/checklist/en/


That is a really nice check list. I think it is color coded as well to present information clearly.


But where does one begin to identify the parts of life where a checklist would reduce cognitive load?

In IT, some cases are obvious (such as deploying new releases). However, if a process is so repeatable that you could have an accurate checklist, then you could probably automate the process and eliminate the need for the checklist.

I would love to know what parts of my life I could relegate to checklists so I could free my mind to focus on just the things that I excel at...


> However, if a process is so repeatable that you could have an accurate checklist, then you could probably automate the process and eliminate the need for the checklist.

The checklist is (a key part of) the documentation for the automated solution, and would not, as such, stop being necessary just because the automated solution existed; it would be a key resource for change management.

Automation eliminates the need for the people acting on the checklist, not the checklist itself.


> However, if a process is so repeatable that you could have an accurate checklist, then you could probably automate the process and eliminate the need for the checklist.

To flip this on its head though, writing (and following) a checklist for a process is perhaps a good first step to automating it.


In critical situations where the a bad outcome is really, really negative, checklists are fine.

I've seen checklists abused, however, in project management. Where some folks are apt to generate a "one-size-fits-all" checklist for every project large or small. It ends up becoming boilerplate, and worse, people take their tasks less seriously if trivial, nebulous or non-applicable stuff is grouped onto the same footing as things which take hard work. Everything ends up being a checklist item with check-box and a date on it.


I have mental checklists I use all the time for routine tasks I could forget. I losealot fewer things. I get lost less frequently.

First getting up in the morning

Leave the house

Leaving the garage

Parking in the parking lot

Starting work in the morning

Leaving work

Parking in the garage

Arriving in gym locker room

Leaving gym locker room

Packing for a trip

Unpacking from a trip

The bugaboo is an interruption that could make you forget a step. Or forget to memorize something.


Packing for a vacation or camping trip is a very good candidate. If you live in a winter climate you can create a good winterizing checklist. Weekly home upkeep is another.


Yes! I used to forget something every time I traveled. After reading Gawande's book in 2010 I started making a checklist. It took about five trips to converge on a stable list and these days travel is a breeze. Print out checklist. Do stuff on checklist, in sequence. Enjoy stress-free travel.


Packing for anything is perfect candidate for checklists. I even made one for going to the gym which which is something i do regularly but still very often manage to forget some mundane thing like shampoo, padlock, member card, socks, water bottle.


Ironically for packing before travel.


After my partner read The Checklist Manifesto by Atul Gawande, he set out to help other organizations improve outcomes via the use of checklists. Together, we built https://www.manifest.ly

My main feedback from having witnessed thousands of organizations set up their checklists is that they can be used to help teams succeed and they can be used in an oppressive way to "ensure people do what they're supposed to do". Almost always they contain too many steps compared to what they should have and that is usually because the people creating/editing the checklists are often not the users of the actual checklist. When the users and editors are the same people, then the quality of the checklist goes up. We use our own tool on a daily bases for processes that have high risks or for processes that we don't do very often. They are great safety nets.


I really enjoyed http://atulgawande.com/book/the-checklist-manifesto/. Very interesting and at times frustrating. You ask yourself why more hospitals can't implement success described in this book.


I'm about 2/3 into the book, the idea is convincing, but did he put any example checklist in the book? He referred to many extant checklists, but there is no "Figure 1: a bad checklist" and "Figure 2: a good checklist, improvement for the one in Figure 1".


They are at the end, in appendix format. The final checklist is a checklist for checklists:

http://www.projectcheck.org/uploads/1/0/9/0/1090835/checklis...


That's strange, my edition doesn't have appendices. Thanks for the page though.


Very good book. This book came to my mind the moment I saw this post.


Atul Gawande is brilliant! He also gave a series of wonderful lectures for the BBC in 2014. They're still avaliable online if interested.

https://www.bbc.co.uk/programmes/b00729d9/episodes/player?pa...

EDIT: I pressed "update" with my sausage fingers before I wrote anything coherent.


I hate checklists. I've just done an information security checklist at work, 200 questions, lots of them irrelevant, many are very vague, often require evidence that is time consuming to put together. Next week I have a release that I have to put a change ticket in for - another 50 boxes with questions and combos. I'm ready to quit. Don't let checklists turn your company into a bureaucratic hell hole.


That sounds like a bad checklist.

Some improvements that can be done:

1. Divide the checklist into "required", "lower priority" and "optional" sections. Will help in just focusing on "required" for time critical implementations, and tackle the rest later if needed.

2. Eliminate requiring evidence and start trusting. If trust is broken (found via audit) then take action. Don't penalize everyone for the mistakes of a few.

3. Add examples for vague cases. Having pre-polulated dropdowns are better than open ended questions. Just add a comments column / field if needed.

4. 200 questions? Seems like overkill. And if all are necessary, then make sure management knows the time that it will take to fill, verify, rectify and submit that sheet.


I would got so far to say that you're not even dealing with checklists anymore. Almost all my checklist items are yes/no. Is X done? Yes/No. Is a value between Y-Z? Yes/No. Checklists are not meant for vague questions.

Questions that irrelevant should be removed from the checklist. When things are found that have been missed, they should be added.

When used properly they do remove stress and free up mental space. If you travel a lot, making a checklist of what to pack makes it so much easier to leave the house.


Checklists used in aviation do not have questions or anything else that needs much thinking. They are lists of bullet points for tasks that need to be done in a particular order without missing any steps, eg: IGNITION - OFF, FUEL LEVER - CUTOFF, BRAKES - SET, BATTERY - OFF.


So what you actually hate are "bad checklists".


Do you have a good checklist for writing good checklists?


The Gawande book (Checklist Manifesto) contains one. A few points from my notes:

- distinguish Read-Do- - Pause-Points - Read-Do vs. Do-Confirm - 5--9 items - Only killer items - No clutter and unnecessary colors - Wording simple and exact - Use language of the profession - Fit on one page - Has to be tested in the real world - Also don’t forget Communication checks


Last time checklists came up on HN someone linked to a talk by Atul Gawanda about the checklist manifesto: https://www.youtube.com/watch?v=dfl8Xt8W09A. He differentiates good and bad checklists: sounds like those are bad checklists you’re working with. But not all checklists are bad.


Defense?


Also worth mentioning the power of engaging our bodies physically and verbally to ensure we're engaging with checklists: https://en.wikipedia.org/wiki/Pointing_and_calling


Checklists were life in the USAF working on heavy bombers and the nuclear PRP program.

I’ve done a procedure 100 or a 1000 times? Still going down the checklist in the Tech Manual every single time.

Humans can’t multitask well and if you miss a step, people can die and planes could crash.


Warren Buffett and Charlie Munger are big fans of checklists,too.[1]

Obviously, in a field like investing no checklist is perfect but at-least it'll help you avoid common pitfalls.

Source: Many of their shareholder's letters contain references to their approach. I found another one online.

[1]https://hurricanecapital.wordpress.com/2016/08/12/the-buffet...


Tom Limoncelli had a nice article about how documentation/checklists is the beginning of automation in an IT setting.

Manual Work Is A Bug: https://queue.acm.org/detail.cfm?id=3197520

Makes a lot of sense and something I advocate for in my department.


Reminds me of Chernobyl, where some steps within the safety system test checklist had been crossed-out for an unexplained reason and they had to essentially guess what to do. Not that a properly maintained checklist would have necessarily prevented it.


I actually don't know if that detail is true or if it was added for dramatic effect in the HBO series. The official record seems to state that they simply didn't follow the approved procedures for the test: https://en.wikipedia.org/wiki/Chernobyl_disaster


There are all sorts of ways they messed up with that test, the design of the system in general, etc.

A lot was learned, some of it costly stuff that we as a species really didn't need to pay for again, and some things that were new and valuable as a result of failure that ethnically could never be intentionally replicated.

One of the better lessons might be to avoid deviating from pre-planned test procedures, and for every major step to have an 'abort' path (or two) for safely entering either safety or normal operating procedures.


I've invested enough time in a personal checklist for a daily process to get to the point where I feel like the checklist is "helpful", "minimal" and "complete". If I had a printer, I would print out a stack of them and record my compliance on paper. I don't have a printer, and I'm not buying one just for this. What's the electronic equivalent for recording checklist compliance?


What is the name of the font on that B-17 checklist? It is that mid-century engineering font that I love so much.


The article reminds me of Brendan Gregg's talk, "Performance Checklists for SREs".

https://www.youtube.com/watch?v=zxCWXNigDpA


I cannot recommend this book enough. It is a great read due to good writing and interesting case studies, and the underlying message is immensely valuable.


Would it help me identify when checklists would be effective, and then how to build a useful checklist?

Or is it more about why checklists are good?


Both are covered. It specifically talks about two categories of problems, for which checklists are and aren't useful. Different sorts of checklists and what should and shouldn't be on there is also covered.


People share some IT-related checklists on GitHub already. It would be cool to see more checklists on non-IT subjects.


While I agree with the overall message, Boeing would not be my first choice for best practices on safety


Especially after reading this: https://news.ycombinator.com/item?id=20290449


Has there ever been a platform for experts to build and share checklists and for every/any task?


Not that I know of but I came across this curated compilation of checklists: https://github.com/huyingjie/Checklist-Checklist


Any arguments why this would or wouldn’t work?


I'm probably the smartest guy in Romania and can tell you I got my certification that I can do 99% by making sure my usual cognitive load stays at 1%.

I was also poor, which means there was no way to enforce my internal policy which means today, 20 years later, I'm using 99% of my brain power to solve issues a simple state/high-powered enforcement checklist would do.

At my 90%+ I still dreamed of a better future. Now I only wish my own death. Tomorrow I hope and make sure you all die.


> I'm probably the smartest guy in Romania

[citation needed]




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