Switch - Chip Heath [91]
The checklist contained straightforward advice: Doctors should wash their hands before inserting a line, a patient’s skin should be cleaned with antiseptic at the point of insertion, and so on. There was no new science in the checklist, nothing controversial. Only the results were surprising: When the checklist was put into practice by Michigan ICUs over a period of eighteen months, it nearly eliminated line infections, saving the hospitals an estimated $175 million because they no longer had to treat the associated complications. It also saved about fifteen hundred lives.
How can something so simple be so powerful? Checklists educate people about what’s best, showing them the ironclad right way to do something. (That means that checklists are effective at directing the Rider.) As Dr. Pronovost said, his five steps were black and white, backed by solid medical research. You could ignore the checklist, but you couldn’t dispute it.
Even when there is no ironclad right way to do things, checklists can help people avoid blind spots in a complex environment. Has your business ever made a big mistake because it failed to consider all the right information? A checklist might have helped. Cisco Systems, one of the largest internet hardware companies, uses a checklist to analyze potential acquisitions: Will the company’s key engineers be willing to relocate? Will we be able to sell additional services to its customer base? What’s the plan for continuing to support the company’s existing customers? As a smart business development person, you’d probably remember to investigate 80 percent of these critical issues before any deal is struck. But it would be inadvisable to recall the other 20 percent after the close of a $100 million acquisition. (Whoops! Those hotshot engineers refuse to leave the snow in Boulder.) Checklists provide insurance against overconfidence.
And overconfidence is worth insuring against because we all have a knack for it. In one classic study, people were asked to come up with solutions for their university’s chronic parking problem. Ideas ranged from raising parking fees to creating more “Compact Only” parking spaces. After the ideas were collected, a panel of experts assessed them—eliminating wacky or impractical options—and identified a set of “best solutions.”
The average individual brainstormer came up with 30 percent of the best solutions, which is pretty good for a solo effort. Here’s what’s not so good: The brainstormers confidently predicted that they’d identified 75 percent of the best ideas. (We all know people who believe that the world’s accumulated wisdom only adds an incremental 25 percent to their own contribution. You may have married one of them.)
A checklist could have helped these people. Imagine if you’d provided them with a list of “solution categories” to guide their thinking, reminding them to think about “solutions that raise the cost of parking” and “solutions that help more cars park in the same amount of space” and so on. That list would have served the same role as Cisco’s acquisition categories; it would have sparked their thinking and kept them from forgetting key areas of consideration.
People fear checklists because they see them as dehumanizing—maybe because they associate them with the exhaustive checklists that allow inexperienced teenagers to operate fast-food chains successfully. They think if something is simple enough to be put in a checklist, a monkey can do it. Well, if that’s true, grab a pilot’s checklist and try your luck with a 747.
Checklists simply make big screwups less likely. As Dr. Pronovost said, “We wanted people to standardize on the mission-critical elements—the areas where we have the strongest evidence. And these things that are mission-critical, we’ve got to do them every time.”
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