How Checklists Can Save Lives -- and Your Business
If checklists with a simple mandate like "wash your hands" can keep scores of hospital patients from dying, imagine what they can do to improve your business outcomes.
Scott Jacobson, president of Sightline Business Advisors and the architect of solution-driven business processes, says, "Don’t roll your eyes. I have yet to find any business that doesn’t benefit by using checklists as a management tool."
The genius behind hospital checklists
A decade ago, Johns Hopkins critical care specialist Dr. Peter Pronovost adapted the lockstep process that aviators follow to land a plane into a five-step checklist for reducing infection when placing central venous catheters in intensive care patients.
Explaining his groundbreaking work in a 2010 New York Times article by Claudia Dreifus, Pronovost said, "It seemed to me that if you looked for the most important safety measures and found some way to make them routine, it could change the picture. The checklist we developed was simple."
In a New Yorker article titled "The Checklist," Dr. Atul Gawande reported that to doctors, "these steps are no-brainers." Yet over a month-long observation, "In more than a third of the patients, they skipped at least one." Once the checklist was established and enforced, however, "The ten-day line-infection rate went from 11 percent to zero," saving lives, saving money and earning Dr. Pronovost a 2008 MacArthur Fellowship, commonly known as a "genius" grant.
Transplanting checklists into the business arena
"Whenever I see simple things that everyone agrees should be done but never seem to get done, I see an opportunity for a checklist," says Jacobson. "For example, everyone generally agrees that getting testimonials is a good thing, but few actively ask for them. Making testimonials part of closing out a job guarantees the customer is asked."
- When an employee or small group has long performed an important role with little guidance, a checklist helps capture and preserve knowledge.
- When a project has to pass between departments, a checklist is the most basic form of agreement on what is important and how to communicate it.
- Checklists improve the outcome of infrequently conducted processes that otherwise may seem overwhelming or without a clear launch approach.
- Checklists establish regular patterns for communication, including meeting and sales-call preparation.
As an example, Jacobson cites a pricing-change checklist. "Pricing can be a very emotional process. A checklist forces consideration of all factors, including the subjective. For example: Determine average costs; estimate expected volume versus price; calculate price from costs and desired gross margin; determine breakeven point; rank price position (for instance, at least 30 percent over Competitor A and 10 percent under Competitor B); adjust for strategic objectives; compare prices and record reactions; set price."
Prescribing checklists to strengthen your business
Start by asking yourself these questions:
- Which processes contribute most significantly to your business success?
- Where are your most critical danger points?
- Where do mistakes most frequently occur?
Use your answers to devise checklists that eliminate errors, improve outcomes, protect against staff turnover disruption, and -- the bonus outcome -- create systems that add value to your business.
In his white paper "Use This Checklist or People Die!," Jacobson provides this checklist for creating a checklist:
- Target areas that are underperforming.
- Establish a benchmark for improvement.
- Document the sequence of tasks for each person involved.
- Prioritize each task and identify those that are essential.
- Identify every area where a decision is made or judgment is required.
- Implement a checklist and measure results.
- Create a checklist for future edits -- don't assume you will get it right the first time.
"Start with a known problem area for guaranteed buy-in. Then keep it simple with a short list," Jacobson says, warning, "Complexity kills checklists."
Finally, give every team member the right to intervene when a step is skipped. "Wash your hands" is, as the medical community knows, a "no-brainer," but doing it without fail is pure genius.