Comments on: Did this WSJ reviewer even read “The Checklist Manifesto?” http://www.leanblog.org/2010/02/did-this-wsj-reviewer-even-read-%e2%80%9cthe-checklist-manifesto%e2%80%9d/ Mark Graban's leanblog.org - Lean Healthcare, Lean Thinking, Lean Manufacturing, Toyota Production System Fri, 10 Feb 2012 10:01:31 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: A New App to Download, Events to Attend, and a Book to Read — Lean Blog http://www.leanblog.org/2010/02/did-this-wsj-reviewer-even-read-%e2%80%9cthe-checklist-manifesto%e2%80%9d/#comment-8381 A New App to Download, Events to Attend, and a Book to Read — Lean Blog Fri, 19 Feb 2010 11:35:22 +0000 http://www.leanblog.org/?p=4806#comment-8381 [...] the WSJ’s treatment of Dr. Atul Gawande’s latest, The Checklist Manifesto: How to Get Things Right, the Journal [...] [...] the WSJ’s treatment of Dr. Atul Gawande’s latest, The Checklist Manifesto: How to Get Things Right, the Journal [...]

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]]> By: Mark Graban http://www.leanblog.org/2010/02/did-this-wsj-reviewer-even-read-%e2%80%9cthe-checklist-manifesto%e2%80%9d/#comment-8201 Mark Graban Fri, 12 Feb 2010 02:21:03 +0000 http://www.leanblog.org/?p=4806#comment-8201 Thanks for the comment, T.F. and thanks for reading. I understand the concern that there can be dysfunctions in the use of checklists. A lot of those dysfunctions sound like management dysfunctions that could occur with lean or other approaches. I agree balance is necessary, so I'm sure we'd agree that doesn't mean that checklists are an easy cure-all, nor should they be thrown out with the dysfunction bathwater. Dr. Gawande writes quite convincingly that checklists cannot be mandated from the top down, they should be developed by those who use them. I hope you'd give his book a chance and then influence your organization to do this the right way. Thanks for the comment, T.F. and thanks for reading.

I understand the concern that there can be dysfunctions in the use of checklists. A lot of those dysfunctions sound like management dysfunctions that could occur with lean or other approaches. I agree balance is necessary, so I’m sure we’d agree that doesn’t mean that checklists are an easy cure-all, nor should they be thrown out with the dysfunction bathwater.

Dr. Gawande writes quite convincingly that checklists cannot be mandated from the top down, they should be developed by those who use them. I hope you’d give his book a chance and then influence your organization to do this the right way.

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]]> By: T. F. Gray http://www.leanblog.org/2010/02/did-this-wsj-reviewer-even-read-%e2%80%9cthe-checklist-manifesto%e2%80%9d/#comment-8197 T. F. Gray Thu, 11 Feb 2010 19:20:28 +0000 http://www.leanblog.org/?p=4806#comment-8197 While I believe there is great utility in checklists, I think Mr. Howard makes some valid points in his review (whether or not they reflect appropriately on Dr. Gawande's book, which I have not read). This is not an either/or issue; there needs to be a balance. As a physician, I have observed that the checklist mentality is often promulgated beyond seeming reasonable balance, pushed by CMS, JCAHO and hospitals administrations. The danger lies I think when employees are judged not on their work, but on how well they fill out or adhere to the checklists, which is much easier for management to quantify. See Abraham Verghese's writing on "the virtual patient". I think checklists function better as a tool used from the bottom up, rather than imposed from the top down. On a related topic, also see Jerome Groopman's essay in the NY Review of Books in February. While I believe there is great utility in checklists, I think Mr. Howard makes some valid points in his review (whether or not they reflect appropriately on Dr. Gawande’s book, which I have not read). This is not an either/or issue; there needs to be a balance. As a physician, I have observed that the checklist mentality is often promulgated beyond seeming reasonable balance, pushed by CMS, JCAHO and hospitals administrations. The danger lies I think when employees are judged not on their work, but on how well they fill out or adhere to the checklists, which is much easier for management to quantify. See Abraham Verghese’s writing on “the virtual patient”. I think checklists function better as a tool used from the bottom up, rather than imposed from the top down. On a related topic, also see Jerome Groopman’s essay in the NY Review of Books in February.

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]]> By: Lis http://www.leanblog.org/2010/02/did-this-wsj-reviewer-even-read-%e2%80%9cthe-checklist-manifesto%e2%80%9d/#comment-7610 Lis Sat, 06 Feb 2010 02:36:41 +0000 http://www.leanblog.org/?p=4806#comment-7610 Isn't there some kind of checklist for writing book reviews? Step 1: Read the book... Isn’t there some kind of checklist for writing book reviews?

Step 1: Read the book…

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]]> By: Andrew Bishop http://www.leanblog.org/2010/02/did-this-wsj-reviewer-even-read-%e2%80%9cthe-checklist-manifesto%e2%80%9d/#comment-7574 Andrew Bishop Fri, 05 Feb 2010 20:01:55 +0000 http://www.leanblog.org/?p=4806#comment-7574 Routine use of a checklist can allow us to eliminate (or reduce) attention spent on things we DON'T have to consider in the heat of an emergency so that artistry, intuition, talent, and heroism can come fully into play. A rigorous and standardized definition of "normal" allows us to focus on the abnormal condition with the attention it deserves. Routine use of a checklist can allow us to eliminate (or reduce) attention spent on things we DON’T have to consider in the heat of an emergency so that artistry, intuition, talent, and heroism can come fully into play.

A rigorous and standardized definition of “normal” allows us to focus on the abnormal condition with the attention it deserves.

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]]> By: Robert Drescher http://www.leanblog.org/2010/02/did-this-wsj-reviewer-even-read-%e2%80%9cthe-checklist-manifesto%e2%80%9d/#comment-7566 Robert Drescher Fri, 05 Feb 2010 17:58:57 +0000 http://www.leanblog.org/?p=4806#comment-7566 Checklists work for anyone that puts the effort into designing one for a purpose. Pilots use their checklists constantly to ensure that everything is done right, so they can minimize the possibility of a problem. Good food safety inspection requires checklists so that you do not accidentally miss something that kills a person. Good lawyers use them for routine tasks to ensure everything gets done on time. I know one that is almost religious about them, he tells me it allows him to focus more on his clients instead of the process. Most law practise is repetitive procedures that need to be followed, the checklist makes sure evrything is done in the right order at the right time. Even when I design a presentation I create a temp checklist to ensure I have all the parts in place. Good webdesigners use them to ensure they do not miss parts that could cause poor results in the search engines. Good doctors use them to prevent mistakes, and ensure that their patients get the best possible treatment. Because they do not have to concentrate on the routine stuff they can focus more energy, on looking for non-routine issues. Several I know couple it with their patient's visit treatment record, so at a glance they can see everything they may need. World class chefs insist on them, the little things can destory a class restaurant in a hurry. Additionally strict checklist use can prevent many false lawsuits. After all a checklist is a form of a plan for routine things, the lawyer/writer probably never plans out anything either. Although good lawyers do. The unfortunate thing is that people who do not care in the first place would design a checklist that way too. Having it in that situation would be useless. Anyway why would a lawyer be writing for the WSJ, doesn't he have real work to do. Checklists work for anyone that puts the effort into designing one for a purpose.

Pilots use their checklists constantly to ensure that everything is done right, so they can minimize the possibility of a problem.

Good food safety inspection requires checklists so that you do not accidentally miss something that kills a person.

Good lawyers use them for routine tasks to ensure everything gets done on time. I know one that is almost religious about them, he tells me it allows him to focus more on his clients instead of the process. Most law practise is repetitive procedures that need to be followed, the checklist makes sure evrything is done in the right order at the right time.

Even when I design a presentation I create a temp checklist to ensure I have all the parts in place.

Good webdesigners use them to ensure they do not miss parts that could cause poor results in the search engines.

Good doctors use them to prevent mistakes, and ensure that their patients get the best possible treatment. Because they do not have to concentrate on the routine stuff they can focus more energy, on looking for non-routine issues. Several I know couple it with their patient’s visit treatment record, so at a glance they can see everything they may need.

World class chefs insist on them, the little things can destory a class restaurant in a hurry. Additionally strict checklist use can prevent many false lawsuits.

After all a checklist is a form of a plan for routine things, the lawyer/writer probably never plans out anything either. Although good lawyers do.

The unfortunate thing is that people who do not care in the first place would design a checklist that way too. Having it in that situation would be useless.

Anyway why would a lawyer be writing for the WSJ, doesn’t he have real work to do.

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]]> By: Simon Ellberger http://www.leanblog.org/2010/02/did-this-wsj-reviewer-even-read-%e2%80%9cthe-checklist-manifesto%e2%80%9d/#comment-7562 Simon Ellberger Fri, 05 Feb 2010 17:22:17 +0000 http://www.leanblog.org/?p=4806#comment-7562 A potential problem to watch out for with checklists is when the checking process doesn't require you to actually "go look" at the items being checked. This can lead to a dangerous routinized non-conscious behavior if every time you go through the list, certain critical items are regularly checked off as being "okay." Because of your habitual familiarity with the list, the process, and the responses, you can end up following a "script" and go through the list by rote. You find yourself not paying attention to the very discrepancies you are supposed to be checking for when non-routine conditions occur. A real example: Right after taking off in Washington D.C. during below freezing temperatures on January 13, 1982, Air Florida Flight 90 crashed and fell into the Potomac River. The recovered cockpit recording of the flight includes a segment with the pilot and co-pilot going through a pre-flight checklist. One of the things they routinely checked was the "on/off" status of an anti-icing device that must be on during such freezing weather, so as to prevent the icing and consequent failure of certain critical engine gauges. The co-pilot can be heard reading from the checklist, “anti-ice” with the pilot responding, “off.” Given the weather conditions, this should have resulted in immediate corrective action, but it didn't; they just continued on down the checklist. Now you can attack the pilot and co-pilot for joint inattentive behavior, or, using a Lean approach, you can question the process instead to see how it might have caused the behavior. What was the standard? It was to read off the checklist in the cockpit. Why did neither the pilot nor the co-pilot react to the need to turn on the anti-icing device? The "anti-ice" check item and pilot's "off" response to it was a combination that had likely occurred countless times when going through the checklist previously, without any need for action, since Florida (it was an Air Florida flight) is routinely warm. This was probably routinized in the pilot and co-pilot's brain patterns as well. If either one had gone to the "Gemba” and looked out the airplane at the weather, instead of "reading reports" in their “office" (metaphorically speaking), they would have observed for themselves the obvious action to take. Instead, following the process, they just kept going down the checklist in an habituated tempo. Seventy-eight people died. A potential problem to watch out for with checklists is when the checking process doesn’t require you to actually “go look” at the items being checked. This can lead to a dangerous routinized non-conscious behavior if every time you go through the list, certain critical items are regularly checked off as being “okay.” Because of your habitual familiarity with the list, the process, and the responses, you can end up following a “script” and go through the list by rote. You find yourself not paying attention to the very discrepancies you are supposed to be checking for when non-routine conditions occur.

A real example: Right after taking off in Washington D.C. during below freezing temperatures on January 13, 1982, Air Florida Flight 90 crashed and fell into the Potomac River. The recovered cockpit recording of the flight includes a segment with the pilot and co-pilot going through a pre-flight checklist. One of the things they routinely checked was the “on/off” status of an anti-icing device that must be on during such freezing weather, so as to prevent the icing and consequent failure of certain critical engine gauges.

The co-pilot can be heard reading from the checklist, “anti-ice” with the pilot responding, “off.” Given the weather conditions, this should have resulted in immediate corrective action, but it didn’t; they just continued on down the checklist.

Now you can attack the pilot and co-pilot for joint inattentive behavior, or, using a Lean approach, you can question the process instead to see how it might have caused the behavior.

What was the standard? It was to read off the checklist in the cockpit. Why did neither the pilot nor the co-pilot react to the need to turn on the anti-icing device? The “anti-ice” check item and pilot’s “off” response to it was a combination that had likely occurred countless times when going through the checklist previously, without any need for action, since Florida (it was an Air Florida flight) is routinely warm. This was probably routinized in the pilot and co-pilot’s brain patterns as well. If either one had gone to the “Gemba” and looked out the airplane at the weather, instead of “reading reports” in their “office” (metaphorically speaking), they would have observed for themselves the obvious action to take. Instead, following the process, they just kept going down the checklist in an habituated tempo. Seventy-eight people died.

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]]> By: Mike Sporer http://www.leanblog.org/2010/02/did-this-wsj-reviewer-even-read-%e2%80%9cthe-checklist-manifesto%e2%80%9d/#comment-7225 Mike Sporer Tue, 02 Feb 2010 20:56:40 +0000 http://www.leanblog.org/?p=4806#comment-7225 "Set a Standard, Follow the Standard, Look for a Better Way". I also read the book, and it places checklists within this scenario. It emphasizes that a checklist is part of continuous improvement, not a mindless bureaucratic exercise. I was very impressed with the book as well! .-= Mike Sporer´s last blog ..<a href="http://freshperspectives.typepad.com/fresh_perspectives/2010/01/a-student-of-human-moves.html" rel="nofollow">A Student of Human Moves</a> =-. “Set a Standard, Follow the Standard, Look for a Better Way”. I also read the book, and it places checklists within this scenario. It emphasizes that a checklist is part of continuous improvement, not a mindless bureaucratic exercise. I was very impressed with the book as well!
.-= Mike Sporer´s last blog ..A Student of Human Moves =-.

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]]> By: Rui Coelho http://www.leanblog.org/2010/02/did-this-wsj-reviewer-even-read-%e2%80%9cthe-checklist-manifesto%e2%80%9d/#comment-7219 Rui Coelho Tue, 02 Feb 2010 15:59:32 +0000 http://www.leanblog.org/?p=4806#comment-7219 Mark, This reminds me of a time 20 years ago when "experienced engineers" said "they do not need a checklist" to qualify a product design. After time they realized the checklist eliminated the mind clutter of routine requirements and their minds were freed up to apply creativity to their designs. BTW applying this and many other Lean methods allowed the product development cycle to shorten from 3-5 years to 6-9 months. Mark,

This reminds me of a time 20 years ago when “experienced engineers” said “they do not need a checklist” to qualify a product design. After time they realized the checklist eliminated the mind clutter of routine requirements and their minds were freed up to apply creativity to their designs.

BTW applying this and many other Lean methods allowed the product development cycle to shorten from 3-5 years to 6-9 months.

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]]> By: Brandon Ruggles http://www.leanblog.org/2010/02/did-this-wsj-reviewer-even-read-%e2%80%9cthe-checklist-manifesto%e2%80%9d/#comment-7218 Brandon Ruggles Tue, 02 Feb 2010 15:19:49 +0000 http://www.leanblog.org/?p=4806#comment-7218 Great post. I am amazed at what I miss when reading based on my mental state at the time, and my overall mental model. When I re-read books I am always amazed at the great things that I missed the first time around. I had a class that talked a lot about mental models and systems thinking, and they mentioned a story about an article that was writen with the exact same number of arguments for and against a political issue. When the readers finished it, whether their own view was for or against the issue, they agreed 100% because their minds filtered out what they didn't want to hear. I think this is a very common occurance to be aware of when teaching anything. Great post. I am amazed at what I miss when reading based on my mental state at the time, and my overall mental model. When I re-read books I am always amazed at the great things that I missed the first time around.

I had a class that talked a lot about mental models and systems thinking, and they mentioned a story about an article that was writen with the exact same number of arguments for and against a political issue. When the readers finished it, whether their own view was for or against the issue, they agreed 100% because their minds filtered out what they didn’t want to hear. I think this is a very common occurance to be aware of when teaching anything.

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