This is a review of a book with a bland title has a really interesting premise – know how and sophistication have increased remarkably in almost all realms of endeavour and as a result so has our struggle to deliver on them.
One of the examples that Gawande examines in detail is how large buildings now get constructed. Determining if a large building is to code is more knowledge than one person can have.
Response to complexity is to push decision-making to the centre but we should be pushing it to the periphery and giving each person room to adapt based on experience. For instance, in New Orleans, after the hurricane, the command and control method of getting through the crisis didn’t work well. Walmart took another tack and gave district managers the permission to make decisions above their level and make the best decision on the information available. In the end they could distribute diapers and ice and break into pharmacies to distribute emergency medication. As a result they got out food and water before the government.
The mechanism that worked was a mixture of freedom and expectations that work would be coordinated.
How does the checklist come in?
We need freedom and coordination but we also need a way to reign in the simple problems that besiege us. For lawyers (and bureaucrats) this might be deadlines. As Gawande says, checklists can defend even the most experienced against failure with a cognitive net.
The elements of the checklist in combination with the act of running through it orally as a team, are a way to increase communication. This creates good conditions to problem solve and avoid errors and lead to an increase in job satisfaction.
Here is the bottom line: we don’t like checklists – they are painstaking and seem beneath us and they demand a discipline. They also help us avoid errors.
I’ll be doing some more thinking about how I might work up checklists for my work environment going forward. I think one easy steal from this book is that I’ll move to ensuring that delegation of bigger items includes a sit down Q and A session with some standard elements to make sure that big assumptions are clarified from the start and that a dialogue gets started early.