All Day Long

by Matthew Stollak on Tuesday, February 9, 2010

Every Thursday, I receive the latest issue of The New Yorker and I quickly turn to the table of contents to see this week’s set of contributing authors. I usually look for two names: Malcolm Gladwell and Atul Gawande. While Gladwell, I believe, needs no introduction, Gawande is an endocrinologist who writes frequently on the topic of health care. However, like Gladwell, he also often writes on decision-making.

So, it was with some excitement that I read his latest book, “The Checklist Manifesto,” Gawande tackles the problem of complex decision-making and problem solving and with it provides some suggestions that human resource managers should take to heart. Our world is becoming increasingly complex, and that has led to two significant problems. First, “the fallibility of human memory and attention, especially when it comes to mundane, routine matters are easily overlooked under the strain of more pressing events.” We tend to focus on a particular tree, and lose the forest. The second problem “is that people can lull themselves into skipping steps even when they remember them.” Even as non-programmed decision making becomes more familiar, people look for short cuts. The answer, Gawande argues, is the simple checklist.

Gawande recounts the story of Peter Pronovost, as critical care specialist at Johns Hopkins, who put together a simple 5-point checklist to address the problem of central line infections. This checklist consisted of

  • doctors washing their hands with soap
  • cleaning the patient's skin with chlorhexidrine antiseptic
  • putting sterile drapes over the entire patient
  • wearing a mask, hat, sterile gown, and gloves; and
  • putting a sterile dressing over the insertion site once the line is in.
Simple and obvious, right? Yet, when Provonost asked nurses to observe doctors in the ICU for a month and record how often they carried out each step, more than a third skipped at least one step. Pronovost got Johns Hopkins Hospital administration to authorize nurses to stop doctors if they skipped a step. They monitored the results for a year, and found that infection rates went from 11 percent to zero. They also calculated that the checklist had prevented forty-three infections, eight deaths and nearly two million in costs.

Gawande also shares the familiar story of Chelsey "Sully" Sullenburger, whose exploits in landing US Airways Flight 1549 in the Hudson River after the plane collided with a large flock of Canadian geese. While much has been made of Sully's experience, much of the success of the landing can be attributed to the array of checklists he and his co-pilot had at their disposal in case of such an emergency.

Why might there be reluctance to adopt checklists? Gawande argues that, first, checklists are boring. We get thrilled with the latest technological advance, but checklists lack flair. Further, they require discipline, something we often lack. It is something we have to work at. Third, is pride. As we become more specialized and gain more expertise, checklists often seem beneath us.

With that in mind, how can checklists be applied to the many tasks facing a human resource manager, such as:
  • detailing the steps to take with an applicant when they come in for an interview, ranging from greeting him/her to following up after the interview?
  • terminating an employee
  • a disciplinary or performance appraisal interview
  • an industrial accident
  • one employee attacking another
Do you have checklists of your own? Have they worked? Why or why not?