How I learnt the power of checklists

358

Most readers of this paper went on holiday this month. Like me they will probably have left some things behind. Perhaps they left something minor, such as toothpaste or deodorant; or something major, such as a camera or a swimsuit; or even something indispensable, such as a passport.

This kind of planning is difficult. But when I forgot my swimming goggles and bought a replacement from the shop of a cruise ship, I marvelled at the organisation which ensured that every one of tens of thousands of items needed on board had been loaded. You can buy tanning lotion on almost every beach but the delivery of forgotten sugar to a cruise liner needs a helicopter.

The cruise ship uses exhaustive checklists. You probably already have a mental checklist for travel. Some of your better organised friends have probably written theirs down. If you need help, checklists of travel needs are available in books and on the internet. Yet the problem of travelling lightly but not too lightly remains unsolved, and my wardrobe contains several ties I bought in foreign cities on my way to deliver a lecture or attend a business meeting.

So I turned to Atul Gawande’s The Checklist Manifesto. (One of the advances of the digital age is that you no longer have to remember to take the right books when you travel. So long as you remember the charger for your Amazon Kindle or whatever ereader you prefer, and the right electrical adaptor.) Mr Gawande, a surgeon with a philosophical bent and an effective writing style, is evangelical about the power of checklists. He presents impressive evidence on how the use of checklists before medical procedures significantly reduces the incidence of avoidable error – in both advanced US hospitals with higher experienced staff and superb facilities, and in primitive clinics in poor countries.

But, as Mr Gawande discovered, the construction of an effective checklist is not easy, which is why the checklist does not appear to resolve the travellers’ dilemma. If a new employee were instructed to write down all that a ship would need for a week at sea, many things would certainly be left out. The lists for the ship are the product of the accumulated knowledge of many people over long periods of time. The checklist is not a substitute for experience but a distillation of it.

Moreover, the loading of a ship is a relatively leisurely process. You can take time to get everything right. Some people take a day to pack for a trip but if everyone did that, much less work would be done. Checklists are most useful for people with limited time, such as the surgeon with an anaesthetised body on the table.

Similarly, the airline pilot going through his preflight routine has a cabin of impatient passengers behind. 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 websites or 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.

Now I know the principles, I will try to build my travel list. A year from now, I should remember my swimming goggles and will report on how well it works.

Print Friendly, PDF & Email