Checklists save lives, enhance teamwork, enrich leadership

In October 1935, at a military air base near Dayton, Ohio, a competition took place that changed the course of aviation history.

An experimental long-range bomber took to the air. It took off, turned out of the traffic pattern, rolled over and crashed. The pilot was the most experienced test pilot in the Army Air Corps.

 

THE ACCIDENT investigation showed that flying this new airplane using one pilot and no checklists could – and did – lead to disaster. Hence, it was in 1936 that the use of checklists in the cockpits of airplanes became the norm. The test airplane, built by Boeing, that crashed that day was to become the B-17, the most successful long-range bomber in the war in Europe.

This story of airplanes and checklists is outlined in a brilliant book: The Checklist Manifesto: How to Get Things Right, by Atul Gawande.

Taking the aviation lessons of the 1930s and applying them to the medical profession, Dr. Gawande has gained some important insights. He has demonstrated that operating rooms that routinely use standardized checklists in a sophisticated way have a much lower error rate and death rate than those operating rooms that don’t use checklists, use them only occasionally or use them haphazardly.

According to Dr. Gawande, a big breakthrough in the use of checklists in operating rooms came at Johns Hopkins University Hospital after using standardized checklists for a period of time. The leaders of this hospital, often ranked as the best hospital in America, made the decision to give nurses the power to remind doctors when they had missed a step in a checklist. To quote Dr. Gawande: “The new rule made it clear: If doctors didn’t follow every step, the nurses would have backup from the administration to intervene.”

 

ANOTHER AREA in which the systematic use of carefully crafted checklists can lead to better safety and more efficiency is in the construction of very large and very tall buildings. In this area, the checklists are focused largely on communication tasks. The 16 (or more) top leaders of the building trades are required, on a tightly scheduled basis, to meet and make decisions on when and how to go forward. The vital lesson here is that when key leaders are required to communicate, the result is better teamwork, fewer work stoppages and greater productivity.

The use of checklists to enhance safety in airplanes, hospitals and construction sites is only part of the story. Checklists, by enhancing communications,
teamwork and productivity, ultimately enhance leadership. Leaders of large organizations can better exercise a key element of leadership – trust – if they know that the use of well-designed checklists are an essential element of the work of every employee and associate.

 

WHEN JEFF FOLEY and I worked together this past year to produce the fourth edition of Rules and Tools for Leaders, we felt it essential that this practical guidebook should include handy, easy-to-use checklists. Hence, in this book there are checklists on introspection, hiring, firing, making decisions, handling crises, thanking associates, conducting meetings, managing electronic devices and dealing with the media. There is even a 25-step checklist on fund-raising.

So how can this discussion be of help to you? If you are about to raise money for a good cause, examine a fund-raising checklist. If you’re about to be interviewed for a new job and want to anticipate the questions you may be asked, study a hiring checklist. Dealing with a crisis in your job, your family or your church? Take a look at a crisis management checklist.

One caution: Checklists, if used too rigidly or not kept up to date, can lead to bureaucratic “checklist management.” Hence, everyone should monitor checklists and their uses to ensure they don’t become counterproductive.

 

PLEASE NOTE: Jeff Foley and I will be conducting a number of book signing sessions in the Augusta area between now and Christmas. Open to be public will be a session at the Augusta Museum of History from 4 to 5:30 p.m. Nov. 26. The books Rules and Tools for Leaders and Medal of Honor will be on sale at large discounts.

Incidentally, this is a grand time to visit the museum. It will be open every day of Thanksgiving week (except for Thanksgiving Day), and on display in the museum’s rotunda will be the always-popular holiday gingerbread village creations.

 

(The writer – a retired U.S. Air Force major general – is the secretary of the Congressional Medal of Honor Foundation. His email address is genpsmith@aol.com.)

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