The construction of a checklist, however, is not as simple as it sounds. “The checklist,” Kay writes, “is not a substitute for experience but a distillation of it.”
Aviation is the signature example of the power of the checklist. Not only in the preparation for take-off and landing; in an emergency, the flight computer will immediately display a checklist of observations to make and actions to perform.
Mr Gawande discovered that the good checklist is short but not too short. If the list is long, none of the items on it are taken very seriously. You can easily persuade people to agree to things when you ask them to mechanically click or tick their way through a list of questions. Consider the lack of attention you give to the many privacy questions asked by websitesor questions on an immigration form. It turns out you can easily persuade people to declare their involvement in genocide or intention to subvert the constitution of the US by inserting the relevant question in a long list of immigration queries, all of which expect the answer yes.
So the good checklist is selective – it doesn’t cover mistakes that are rarely made; no one goes on holiday without their suitcase. Or mistakes that don’t matter – toothpaste is available almost everywhere.
Flying – and surgery – lend themselves to checklists because there is a large element of routine, and because the consequences of an elementary error can be devastating. The first factor makes it possible to compile a useful list, the second encourages people to use it.
But Mr Gawande’s most important discovery was that the power of the checklist came from a less obvious source. The list empowers members of a team to monitor each other. Adherence to the list allows the nurse to correct the surgeon, the co-pilot to review the captain. The successful travel list is likely to be a family rather than an individual endeavour.
Captain Chesley Sullenberger knows the value of checklists. He’s the one who, along with co-pilot, Jeffrey Skiles, safely landed Airways Flight 1549 on the Hudson.
The events of January 15 in New York might well have resulted in casualties were it not also for Mr Skiles’ faithful execution of his emergency engine-failure and water-ditching checklists. Gary Klein, a cognitive psychologist, says such lists are vital to those who make critical decisions under pressure: “The Hudson River pilots didn’t have a half-hour to decide what to do with the engines. Instead they need a checklist that has been compiled by people who have seen these situations before and considered the ways to respond.”
Still curious? The Checklist Manifesto is a short read that could help you reduce stupid errors.