Lessons in Structural Capital: The Checklist Manifesto

March 5, 2010 by  

There are two levels to the story of The Checklist Manifesto, a great new book by physician Atul Gawande.

The first level is about checklists: how to make them, how to use them and the extraordinary results that come from using them. The examples include hospitals that virtually eliminate hospital-acquired infections through the use of a simple checklist used in the operating room just prior to cutting the patient open. Other great examples are provided from the field of aviation. He explains that airline pilots not only have pre-flight checklists, they also have notebooks with sets of check lists to guide them through different kinds of crises. Construction provides another set of examples: how to assemble a complex skyscraper¬† by coordinating the work of dozens of subcontractors. There’s even an example about the rock bank Van Halen’s inclusion of a clause requiring a bowl of M&M’s with all the brown candies removed as a way of the band ensuring that the other requirements in their contracts related to the safety of the staging were also read and followed.

Checklists are a simple but powerful form of structural capital. Structural capital is one of the three basic categories of intangible capital along with human and relationship capital. It is the most powerful form of IC because it is essentially infinitely scalable. It is where the promise of the knowledge economy is most clear. But this is not that well understood. Structural capital is organizational knowledge that is captured and preserved for use by everyone in an organization.

That’s why the second level to this story is especially interesting. Because high-end knowledge workers do not necessarily see the need for checklists. They see themselves as experts and sometimes, artists, who shouldn’t be constrained by structure.

Gawande does a great job of explaining why checklists are helpful in complex situations even where there are experts at hand. Doctors and pilots are both highly trained and highly expert in their fields. Yet both benefit greatly from checklists. Why? Gawande explains:

They had made the reliable management of complexity a routine. That routine requires balancing a number of virtues: freedom and discipline, craft and protocol, specialized ability and group collaboration. And for a checklist to help achieve that balance, they have to take two almost opposing forms.  They 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. (page 79)

He also points out that checklists are especially applicable in learned occupations where there is an expectation of professionalism He asserts that most professions focus on ensuring selflessness, skill and trustworthiness. But those who use checklists add another dimension: discipline. He cites the strong checklist culture in aviation as an example of this. And he challenges all professionals to hold themselves to the standard of discipline as well:

We don’t study routine failures in teaching, in law, in government programs, in the financial industry, or elsewhere. We don’t look for the patterns of our recurrent mistakes or devise and refine potential solutions for them. But we could, and that is the ultimate point…When we look closely, we recognize the same balls being dropped over and over, even by those of great ability and determination. (pp 185-6)

So I recommend reading this book for both levels of lessons. First the reasons why even highly experienced professionals can benefit from checklists and second the lessons on how to build good checklists in your own organization.

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