October 29, 2010 Vol. 3, Issue 10
Checklists are an essential tool for managing complexity, according to surgeon and author Dr. Atul Gawande.
In 1935, the Boeing Corporation’s Model 299 looked like the frontrunner in a flight competition to serve as the Army Air Corp’s next long-range bomber. The “flying fortress” could carry five times as many bombs as required, and it could fly faster and further than any earlier bomber. In a flight at Wright Air Field that was supposed to seal the deal for Boeing, the plane taxied down the runway, lifted off, and suddenly stalled at 300 feet and crashed, killing two of the crewmembers.
The post-flight investigation determined that the crash was due to pilot error, and there was discussion about whether the aircraft was too complex for a single pilot to fly. Even so, the Army bought a few of the planes to serve as test aircraft, and a group of test pilots spent some time thinking about what to do to address the issue of pilot error.
The solution was a novel one at the time: a checklist. As Gawande writes in his book The Checklist Manifesto: How To Get Things Right, “Using a checklist for takeoff would no more have occurred to a pilot than to a driver backing a car out of a garage. But flying this new plane was too complicated to be left to the memory of any one person, however expert.” The checklist approach worked for the Model 299, and it went on to become a workhorse aircraft for the military.
Today, of course, the checklist is a standard risk-reduction tool. Gawande, a surgeon, has campaigned around the world for hospitals to use checklists to reduce infection rates, and the data he cites are impressive. He looks across medicine, aviation, construction, and other fields that use checklists, and he finds that checklists are useful for more than just routines—they are also problem-solving tools for non-routine complex problems. In the construction industry, he writes, “The philosophy is that you push the power of decision making out to the periphery and away from the center. You give people the room to adapt, based on their experience and expertise. All you ask is that they talk to one another and take responsibility. That is what works.”
