If you want to improve quality, cut costs, and get better outcomes, then you should read the book I just read about how to improve patient outcomes, cut medical expenses, and prevent many deaths in the surgery suite and the ICU. The book which changed my outlook on improving business outcomes is The Checklist Manifesto by Atul Gawande. However, the book’s subtitle is; “How to Get Things Right.” Things, not patient care”. Everything in this book applies to whatever business you are in and whatever job you are responsible for completing.
Why People Fail
- “Necessary fallibility” – what we want to do is beyond anyone’s capacity. For example, your newest salesperson, a recent Ivy League MBA, tells you they will bring in more new orders than the five experienced salespeople combined without any discounts.
- “Ignorance” – we don’t know what we don’t know.
- “Ineptitude” – we know, but we still screw up. Despite training, education, and experience, we still do not always accomplish our goals. According to Gawande, the problem is “the volume and complexity of what we know have exceeded our ability to deliver its benefits correctly, safely, or reliably.”
- In a complex and stressful environment, we run into two issues:
- We forget to do something, get distracted, and then forget to do it. For me, this usually happens when I am doing something I do every day. My mind is on autopilot, and I skip a step or two.
- We don’t forget, but we are in such a rush we decide to skip a step or two because we convince ourselves that “it won’t matter.” For example, when I write a post, I always put it aside for a day and reread it to ensure it makes sense. But, if I am behind schedule and feel pressured to get the article sent to the publication, I get tempted to skip the last read, which usually results in an embarrassing return email.
- There are three types of problems.
- Simple – give someone a COVID vaccine shot. These tasks usually take a short time, and the people doing them have training and experience doing them well.
- Complicated – develop a COVID vaccine to cover all current variations. The people involved have successfully done significant projects, and each step is known. Short-term time pressure is usually not an issue. Frequently, the individual steps in the process are simple.
- Complex – eliminate cancer. These projects may never have been done before or have changed enough since the last time it was done that it feels like the first time. There is an elevated level of uncertainty at each step.
Real-life business failures
Most people in manufacturing and service operations deal with processes that have been proven to be doable. They experience simple problems (as defined above) caused by what Gawande calls ineptitude; they forget to do something they have been trained to do.
To prevent these problems, create and routinely use a checklist. But what type of checklist?
There are two types of checklists:
- A detailed checklist to guide someone through a process. Think of a cooking recipe or Waze instructions. If you skip a step, the cake winds up in the trash, or you get messages to get you back on the proper route. This type of checklist says “what to do,” not “how to do it.” For example, this article was written in late September 2022. This is at the start of a late hurricane season. Today CNN posted “A Checklist to Prepare for a Hurricane.”
- A brief checklist with only the significant few steps listed. Think about a pilot’s emergency checklists for life-threatening situations. The pilot knows how to do each step, but they forget it in battle.
I was skeptical when I read this far into the book.
At first, I told myself; it couldn’t be this easy because the world would be flooded with checklists if it were. But, I continued reading about checklists in operating rooms and ICUs. Then I read about airplane pilots’ checklists, and again I believed more about the value of a checklist. Then I did a Google search on checklists and received 1.4 trillion results. That was impressive! The results were terrific!
My next step was to create a checklist for posting a blog article on my website. In the past, I always skipped one of the steps. This was not a showstopper but a cause of frustration for me. Fortunately, I discovered I had missed a step (creating an internal link), which helped improve my page rating. I liked the idea of less frustration.
I thought back to when I was a Manufacturing Engineer preparing process sheets for the Production Group. The second or third day after we released a new product, the sheets seemed to go into hiding and would never be seen again. That would have been alright if we didn’t have quality issues, but we did have them. When I would discuss the quality problems with the line supervisors, their answer always seemed to be, “The beatings will continue until the quality improves.” I am now convinced that a checklist would have created better results.
Typical use cases where a checklist will lead to meaningful results
- You can use a short checklist as a reminder when you create and review your monthly report to ensure the data included is clear and concise. You are the company CEO and frequently hear the same complaint from Board members – “Your reports are too detailed and do not clearly articulate a problem, potential solutions, and recommended action. That would speed up our meetings instead of us having to pull all your thoughts while we sit around the table.”
- At your weekly executive committee meeting, your Vice President of Human Resources reports that they are hearing a lot of complaints from people who have to attend Zoom meetings but do not have any reason to be there. Another VP says that he has seen several employees either wearing a tee shirt or using a mug with this message “I survived another Zoom meeting that should have been an email.” The problem can be solved with a one-hour class about scheduling and running a meeting, including defining what you want the session to accomplish, the agenda, deciding who should attend, and sharing a scheduling checklist.
- You are the CFO and notice that outstanding receivables grow faster than billings. When you start digging into the cause, you discover that inaccurate invoices appear to be sent at a higher rate than in the past. It could be new people supplying the input data, demotivated invoice clerks, or too much stuff. Each possible step will benefit from a focused checklist to ensure the final invoice is correct and paid promptly.
I could go on with examples from every part of every company, but I think you get the point. In most cases, preventing most problems is as straightforward as creating and using a checklist. If it does not work, you should consider training as the next step.
A key point to remember:
Here is an interesting experiment you can do in a few minutes. Ask a handful of your rising stars how they constantly produce such valuable results. As you discuss their answers, ask them if they ever use a checklist and why? You may be surprised by the number of positive responses you receive.
The implementation of a checklist is just another change. It comes with the same resistance as automating a production process or introducing an eCommerce site for spare parts sales. If you want the cooperation of the teams that will use checklists, you must explain the problems, the solution, and the facts that support you. You might want to pilot their use in a limited cell or two as a first step. Be incredibly careful not to focus on any errors you observe. Instead, focus on improving the outcomes without highlighting the occasional failure.
About Middlesex Consulting
Middlesex Consulting helps our B2B product manufacturing clients grow their services revenue and profitability by applying the methodologies and techniques associated with Customer Value Creation and Customer Loyalty professions to assist its clients in designing and commercializing new services and the associated business transformations. Contact Sam here