“We need a checklist,” my boss insisted. “So we don’t miss any steps.”
So I made a checklist of how to pay out physician incentives. Dozens of steps. I tried implementing it across the hundreds of instances over which incentives are paid. I still missed things.
“Why wasn’t that on the list?”
Checklists, surprisingly, are in vogue. I am nearly finished with Atul Gawande’s The Checklist Manifesto, which makes the case for checklists in healthcare. The book has been well-received in other industries, too.
But a careful reading of Gawande tempers the need for the Mother of All Checklists — for one reason he brings up, and for another I would like to present. I will also present a corollary.
A good checklist, Gawande argues, does not walk through every step and every scenario. Such a checklist would be so cumbersome as to be useful in the high-stakes operations of, for example, healthcare or aviation.
Rather, a good checklist accounts for critical tasks that, while seemingly simple, are often overlooked.
Think of a good checklist like a good model — paradoxically, a good one does not explain everything — there is always an unexplained variance.
But there is something deeper to this paradox checklist, I believe, that relates to this Asimov quote:
Any task that can be so precise and routine as to be “programmed” into a checklist should, well, be programmed!
Pilots, physicians, and other checklist users are ultimately professionals. This status implies work that is highly unstructured, with many uncertainties. Perhaps most tasks share some definites — but there will always be unknowns.
Admittedly, not all tasks are this unstructured. Some can be written into “recipes” — with outcomes that, with some sacrificing of requirements, can be easily scripted.
So, the corollary — if your task cannot be scripted into a long checklist, maybe it ought to be?
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