Cold-Cuppa Checklists

This is the way it happens. I’ll decide that I’m going to settle down and read one of the books in the teetering “to-be-read” pile. To lower the barrier a little, I go and make a nice hot mug of tea, then settle down in a (not too) comfortable chair. Some books grab me right away. Their writing style offers no resistance, the words flow smoothly and rhythmically, the grammar and punctuation does not force me to go back and re-read. The subject matter is made interesting, compelling, of relevance in some way to me. A little refreshment will keep me going, so I reach for that steaming cuppa and, darn: it’s stone cold.

So, I’ll go and make another, and the process will repeat itself.

Of course it is not always a cold cuppa. A few weeks ago, lying the beach in Santa Monica, I ended up getting sunburn due to my immersion in Malcolm Gladwell’s Outliers. With Stieg Larsson’s The Millennium Trilogy it was sitting in an empty train at Paddington Station long after all the other commuters had left.

Atul Gawande’s The Checklist Manifesto is a “cold cuppa” book for me. How could I possibly find a book about the creation of a pre-surgery checklist for the World Health Organisation such a good read? Because it is well-written and makes the subject compelling, interesting and directly relevant to me.

Gawande is a general and endocrine surgeon whom the WHO asked to help reduce the rate of complications due to surgery, worldwide. He describes the search for a meaningful way of influencing surgical outcomes and the eventual, after much refinement and testing, 19 point, single sheet, checklist that succeeded in reducing complications by 36% and deaths by 47%.

One of his sources of information about checklists is the aviation industry, and in contrast to the story of Korean Air flight 801 he tells the story of US Airways Flight 1549 that hit a flock of geese 90 seconds after take-off from La Guardia, losing power from both engines, but safely ditched in the Hudson 6 minutes later. All the way down the co-pilot was running through the checklist to try to restart the engines. He did this faster than anyone could reproduce in the simulator afterwards; the power of a good checklist!

An interesting early observation in the book, from the work of Brenda Zimmerman and Sholom Glouberman,  is the distinction between simple and complex problems. A simple problem is one that can be broken down into a number of steps, like a recipe. Follow the steps and the chances are that you will succeed. Complex problems are unique requiring a different approach each time and where the outcome is highly uncertain. A complex problem might contain a bunch of simple problems, but it is still complex. Checklists can help to stop us making the dumb mistakes we make when solving the same simple problem we’ve solved many times before (like baking a cake), but also in helping us to do the best we can in an entirely new situation (like ditching in the Hudson).

What I like about this distinction is that it turns a big negative of checklists for me into a positive. My problem is that checklists often seem to turn people’s brains off. They think “oh, I’m following a checklist” in much the way they think “oh, I’m following the GPS, I’m sure it is ok to turn my enormous truck down this small country lane…”.

Instead, I can now think of the “simple” elements of a “complex” problem. Those simple problems really benefit from a checklist. There is my “keys, phone, wallet” as I leave the house, or the “mug, kettle, tea bag” as I make another cuppa. That gives me the time and space to think about the complex stuff that needs “courage, wits and improvisation”.

Oh darn it, another cold-cuppa.