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Recently I was reading the book – “The Checklist Manifesto” by Atwul Gawande and it achieved two things that I love in a good business book. Firstly, it made me think “Ah! Yes of course”, giving obvious ideas that once they in your head are impossible to remove. The second thought process was “How can I use this?”

Gawande was commissioned by the World Health Organisation to develop a global program to reduce avoidable deaths and harm from surgery. Through the book he describes compelling real life situations across medicine, the airline business, building and other industries that looks at how checklists are used and how they can make a huge difference to success.  He covers how they developed a single checklist for all surgery (well actually it was three checklists – 7 items to check before anaesthesia, 7 between anaesthesia and making the first cut and 5 items once the surgery has been completed). To give an example of how the thorough these checklists were, one check is that they have the right patient and one is that they have the right procedure!

The book also describes the testing and the implementation activities. The test was carried out across eight hospitals worldwide. The results were amazing – major complications fell 36% and deaths fell by 47%. From a group of 4,000 people operated on they saved 27 from death.  Despite these impressive results, getting hospitals and health bodies to take on the change proved difficult. They asked the people working in the test program if they would want the checklists used if they were having an operation and 93% said yes.

Gawande stresses that if a pharmaceutical company came up with a drug that had that sort of success rate then they would make a fortune, but because it is something as simple as a team walking through a checklist there was great scepticism and pushback.

Now to the matter at hand, what would such a checklist look like for change initiatives and at what stages would we run the checklists?  Could such an approach improve the ability of us all to deliver change more successfully?

A few thoughts that might be helpful.

  • There is a difference between routine checklists and those for special situations (The section of the book covering the loss of an engine on the plane which crashed in the Hudson river is gripping).
  • Any checklist should be in as plain English as possible
  • Running through checklists as a team helps establish a team and gets them ready to work together
  • They must be tested in a live situation and constantly updated
  • Checklists only work if the people in the process are trained in their use and they actually use them – what I call the “gathering dust” test of process
  • The checklist gives all team members the ability to say “Have we done….” and breaks down the hierarchy


What would you check for and when?