THE POWER OF CHECKLIST T Ashok

linkedin.com/in/ashokstag

© 2017, STAG Software, www.stagsoftware.com

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The field of medicine 13000+ diseases, syndromes, injury types i.e 13000 ways a body can fail

6000 drugs, 4000 medicines & surgical procedures each with different requirements, risks and considerations.

Phew, a lot to get right.

The problem of extreme complexity

So what has been done to handle this ? 3

Split up knowledge into various specialisations.

So what has been done to handle this ? 4

Split up knowledge into various specialisations.

But it is not just breadth & quantity of knowledge that has made medicine complicated, it is also the execution of these.

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In an ICU,

an average patient required 178 individual interactions per day!

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So to save a desperately sick patient it is necessary to:

Get the knowledge right Do the 178 daily tasks right

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On Oct 30, 1985, a massive plane that carry 5x more bombs roared and lifted off from the airport in Dayton, Ohio and then crashed.

The reason cited was “Pilot error”. A newspaper reported “this was too much airplane for one man to fly”.

Boeing the maker of this plane nearly went bankrupt.

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So, how did they fix this issue?

By creating a pilot’s checklist, as flying a new plane was too complicated to be left to the memory of any one person, however expert.

The result : 1.8 million miles without one accident!

In a complex environment, experts are against two main difficulties

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1. Fallibility of human memory mundane/routine matters easily overlooked when you are strained to look at other pressing matters of hand

2. Skipping steps even when you remember them we know that certain steps in a complex process don’t matter

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1. Fallibility of human memory mundane/routine matters easily overlooked when you are strained to look at other pressing matters of hand

2. Skipping steps even when you remember them we know that certain steps in a complex process don’t matter

In a complex environment, experts are against two main difficulties

Checklists seem to provide against such failures and instil a kind of discipline of higher performance.

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TWO CASE STUDIES

Tackling central line infections in ICU using checklist (Peter Provonost in 2001) Prevented 43 infections & 8 deaths and saved USD 2 Million

In a bigger implementation “Keystone Initiative” (2006) involving more hospitals of 18 month duration, USD 17M saved, 1500+ lives saved

Stunning isn’t it?

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ALL BECAUSE OF A STUPID CHECKLIST!

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HIGHER BASELINE PERFORMANCE.

What a STUPID CHECKLIST CAN DO!

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So how can test practitioners become smarter to deliver more with less?

One way is to instil discipline and deliver baseline performance.

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I am sure we all use some checklist or other but still find results a little short.

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So how can I make an effective checklist and see higher performance ?

Especially in this rapid Agile Software world?

There are three kinds of problems in the world: (From “The Checklist Manifesto” by Atul Gawande)

SIMPLE Individualistic in nature, set of stuff to be done. e.g. Bake a cake.

COMPLICATED Multiple teams/people coordination/timing issues e.g. Launching a rocket.

COMPLEX Outcomes different despite same application e.g. Raising a child. “Expertise is valuable, but most certainly not sufficient”

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So how can checklists help in solving simple/complex problems?

Using simple activity task checklists to ensure simple steps are not missed or skipped

Using checklist with communication tasks to ensure that everyone talks though and resolves hard and unexpected problems.

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To solve complex problems push the power of decision making from a central authority to the periphery, allowing people to make decision and take responsibility.

The checklist needs to allow for judgement to be used in the tasks rather than enforce compliance, so that actions may be taken responsibly.

Set of checks to ensure stupid but critical stuff is not overlooked Set of checks to ensure coordination & Enable responsible actions to be taken without having to ask for authority.

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In COMPLEX situations, checklists not only help, they are *required* for success.

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Good checklists are : precise, easy to use in most difficult situations, do not spell out everything, just provide reminders of critical & important steps the ones that even the highly skilled professionals would miss.

From Boorman at Boeing

Bad checklists are : too long, hard to use; they are impractical they treat people as dumb detailing every step to do …they turn people’s brain off rather than turn them on.

So how should a good checklist look like? 22

Short : five to nine items only

Type : DO-CONFIRM checklist or READ-DO checklist.

DO-CONFIRM : do task from memory/experience, pause to confirm that every supposed to be done was done. READ-DO checklist : read task, tick them off and do them

Define clear pause points at which a checklist should be used

Fit the checklist into a page, free of clutter

Ticking boxes is not the ultimate goal

Checklist is not a formula, it enables one to be smart as possible

It improves outcomes with no increase in skill

Checklists aid efficient working

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NOTES

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As smart individuals, we don’t like checklists.

The fear is that checklists is about mindless adherence to protocol.

It somehow feels beneath us to use a checklist, an embarrassment.

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Hey, the checklist should get the dumb stuff out the way so as to let you focus on the hard stuff.

We are all plagued by failures - by missed subtleties, overlooked knowledge & outright errors.

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Just working harder won’t cut. Accept the fallibilities.

Recognise the simplicity and power of the checklist.

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I did a short 2-question survey on a simple problem of developer test quality.

Here are results of Developer Test Survey

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Well, a simple checklist can help greatly to aid the developer to test early.

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Try a checklist.

It works.

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The power of checklists https://www.linkedin.com/pulse/power-checklist-ashok-t/

Design checklists to “Do, Sync & Act” https://www.linkedin.com/pulse/design-checklists-do-sync-act-ashok-t/

Inspired by Atul Gawande’s book “The Checklist Manifesto” here are my two articles that formed the basis for this webinar.