![]() When you’re making a checklist, you have a number of key decisions.Good checklists are, above all, practical. Instead, they provide reminders of only the most critical and important steps-the ones that even the highly skilled professionals using them could miss. They do not try to spell out everything-a checklist cannot fly a plane. They are efficient, to the point, and easy to use even in the most difficult situations. Good checklists, on the other hand, are precise.They turn people’s brains off rather than turn them on. They treat the people using the tools as dumb and try to spell out every single step. They are made by desk jockeys with no awareness of the situations in which they are to be deployed. They are too long they are hard to use they are impractical. Bad checklists are vague and imprecise.Checklists supply a set of checks to ensure the stupid but critical stuff is not overlooked, and they supply another set of checks to ensure people talk and coordinate and accept responsibility while nonetheless being left the power to manage the nuances and unpredictabilities the best they know how.Under conditions of true complexity - where the knowledge required exceeds that of any individual and unpredictability reigns - efforts to dictate every step from centre will fail.In these situations, you need both task and communication checklists.Complex problems can sometimes be broken down into a series of simple recipes, but there is no straightforward recipe.The successes have been sustained for several years now-all because of a stupid little checklist. In the Keystone Initiative’s first eighteen months, the hospitals saved an estimated $175 million in costs and more than fifteen hundred lives.Within the first three months of the project, the central line infection rate in Michigan’s ICUs decreased by 66 percent.In December 2006, the Keystone Initiative published its findings in a landmark article in the New England Journal of Medicine.They not only offer the possibility of verification but also instill a kind of discipline of higher performance. They remind us of the minimum necessary steps and make them explicit. Checklists seem to provide protection against such failures.In complex processes, after all, certain steps don’t always matter. A further difficulty, just as insidious, is that people can lull themselves into skipping steps even when they remember them.The first is the fallibility of human memory and attention, especially when it comes to mundane, routine matters that are easily overlooked under the strain of more pressing events. In a complex environment, experts are up against two main difficulties.They have two advantages over ordinary specialists: greater knowledge of the details that matter and a learned ability to handle the complexities of the particular job.We live in the era of the superspecialist-of clinicians who have taken the time to practice, practice, practice at one narrow thing until they can do it better than anyone else.Notes Chapter 1: The Problem of Extreme Complexity
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