By Christopher Aesoph, MA
On October 30, 1935, at Wright Air Field in Dayton, Ohio, the U.S. Army Air Corps held a competition to see which company had built the best new long-range bomber. In early competitions, Boeing’s Model 299 soundly beat the designs by Martin and Douglas.
That morning, Army brass and company executives watched the 299 taxi onto the runway. It had a hundred-and-three-foot wingspan, and four huge engines under the wings. The plane roared into the air and climbed to 300 feet. Then it stalled, turned sideways, and crashed in a fiery explosion. Two of the five crew members died. The crash investigation revealed that a highly competent pilot had forgotten to release a locking mechanism on the elevator and rudder controls. One newspaper called the 299 “too much airplane for one man to fly.” Due to this mishap, Boeing nearly went bankrupt. The Army declared Douglas the winner.
Still, the Army purchased a few Boeing 299s as test planes, and some people remained convinced that this plane was the best option. As a result of the crash, over the coming months Army pilots came up with an ingenious solution: they created a pilot’s checklist, with step-by-step checks for takeoff, flight, landing, and taxiing. Using the checklist, the pilots flew the 299 a total of 1.8 million miles without one accident. The Army ended up ordering nearly 13,000 of that aircraft, which it called the “B-17.” This plane played a critical role in the Second World War. More to the point, since then the checklist has entered many aspects of daily life, with remarkable results.
In 2001, a critical-care specialist at Johns Hopkins Hospital decided to try using a checklist in an intensive care unit. In an initial trial, the checklist had a dramatic impact. By comparing statistics from the unit with the stats from the period covered by the checklist, the numbers showed that over 15 months the checklist had prevented 43 infections, 8 deaths, and had saved two million dollars in costs. Further research revealed that by having doctors and nurses make their own checklists for what they thought should be done each day, the average length of stay in the intensive care unit was cut in half (from “The Checklist,” published in The New Yorker, December 10, 2007, pages 86-95.)
One of the most interesting aspects of the checklist is that too often, the most highly trained people resist using it.
Comments
There is a hospital in Toronto that specializes in gastro-intestinal surgery, including the operation in which the stomach is made smaller. The surgeons at this clinic do thousands of exactly the same sort of operations a year, especially the radical surgeries to "cure" morbid obesity. This hospital has a post-surgical death-and-complication rate that is far below the rate in other hospitals that do not specialize in gastro-intestinal surgeries.
Now, the reason for the lower death rate at the Toronto hospital is simple. The surgeons do the same operation in the same way over and over. A radical operation for obesity becomes a rote procedure that is gradually deeply ingrained in the doctors' and nurses' psyches. In other words, constant repetition = the effect of proceeding by a memorized checklist. And the effect on accidents and mistakes, the lowering of their incidence during surgery or post surgery, is astounding.
This reduction in deaths and infections is the driving force behind many trends in modern medicine: checklists, extreme specialization by doctors and nurses, team medicine, and much else.
But the resistance of intelligent people to working by a checklist can also be surprising, as Gawande and others have found. Doctors decline to think of themselves as soulless robots, and one can have some sympathy for this point of view, especially since all of us, as patients, have experienced the bad consequences of blocked communication between highly-specialized doctors.
I don't know what lessons, if any, one can draw for corporate and organizational communicators. Make as much of your job into a highly-efficient, almost automatic routine as you can, certainly, but what about the 20% of your job for which there are no rules, no checklist? It seems to me that in this critical one-fifth of one's professional day, one must resign oneself to a certain amount of floundering, embarrassing mistakes, misunderstandin gs, and conflict. In other words, don’t judge yourself so harshly when you've done your very best at something new and untried and seen it all turn to ashes before your eyes. And this will happen again and again in your career, especially if you deliberately force yourself out of your routine to venture into the unknown.
Isn't this the reason all those book-writing consultants are always urging us to dare and take risks over and over? Spurring us on to fail and fail yet once more? Lauding the CEOs who are more impressed with one woman's intelligent, courageous gamble that ends in fiasco than with another man's mildly risky success?
One hundred years ago, the great psychologist William James urged us in his masterpiece, The Principles of Psychology, to make as much of our behavior instinctive and automatic as we possibly could. This, James argued, is the true way to super-usefulness, superior efficiency, and to the clearing of our higher faculties for reflection and action on fruitful new ideas. We seem to have forgotten, or maybe never have learned, this great lesson.
Bill Sweetland
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