Tag Archives: Atul Gawande

Best Laid Plans Don’t Get Done Unless They Get Made

“The volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably.” Atul Gawande wrote in The Checklist Manifesto.

What I see is that we have way too much knowledge coming at us at any given point in time and it can be overwhelming or just plain distracting. So we write down the important…what we need to remember in order to have something we can refer back to…so we aren’t missing anything.

I am willing to bet if you have ever done a household project and gone to Home Depot without a list you forgot something. Even if you had the list, if you weren’t specific, you still got the wrong item. Either way, you are back on the road wasting your valuable time redoing what you should have done right from the get go. Yes, I did this recently. The only difference is I did it three times in a row. Frustrating to say the least although, my wife seemed to find humor in it.

In the business world today, I have seen executives talk about their plans, but I would say only half actually wrote that plan down. If I had a nickel for every one of them who said, “It’s right here in my noggin,” I would be a rich man. So why write it down.  Writing objectives down solidifies what I want done, where I want to go, and how I am going to get there. I look back at some of the sales campaigns I ran, and when I don’t write down my plan, it fails.  Yes, it was in my noggin, but the complexity of the campaign did not allow me to cover all the bases or learn from my mistakes. Doctors have check lists so they don’t miss a step. Missing a step as a doctor has major implications. As managers, can we afford missteps? Bottom line is, the top performing managers believe they can’t.

Having a plan on paper allows you to learn from past mistakes. As a football coach in my earlier years, I would have the first 12 plays already on paper before we started the game. From those 12 plays I would learn what worked best and move forward with those best plays and retool the others to make them better. Don Mann wrote “Inside Seal Team Six” and how they planned for the capture or death of the USA number one bad guy, Osama bin Laden. They had a plan but were prepared for all kinds of contingencies.  “Plan your dive and dive your plan.”

What it really boils down to is what do you really want to happen? If it’s that important to you or your organization, then write it down and make it happen.

Richard Goering, Guest Blogger, 3C Network

Richard is a top performing sales and operational leader in the building industry backed by 18 years of experience. He currently is the Executive Vice President of  3C Network. His previous position was as the General Manager, for BlueLinx Corporation (a leading national wholesale distributor) presiding over the entire northwest & mountain regions of the US including Hawaii and Alaska.  Richard’s career path has encompassed various positions held across the nation and abroad. He has a B.S. in Sport Management and a minor in Public Relations from Georgia Southern University. Richard currently lives in Denver, Colorado with his wife, Shiloh and children.

The Power of Tools around Performance Directives: Do the right thing right.

“If something so simple can transform intensive care, what else can it do?”

I recently read a book called The Checklist Manifesto. For years, I have been looking for a study that validated the importance of creating and completing effective checklistsAtul Gawande did the work for me.  A New York Times article summarized it beautifully:

“The study… results were startling. Without adding a single piece of equipment or spending an extra dollar, all eight hospitals saw the rate of major postsurgical complications drop by 36 percent in the six months after the checklist was introduced; deaths fell by 47 percent. In every site, introduction of the checklist had been accompanied by a substantial reduction in complications,” he writes. “In seven out of eight, it was a double-digit percentage drop. This thing was real.”

One might think with these results, hospitals and doctors would adopt the use of checklists immediately.  The cost is minimal and if using a checklist saved just one life, wouldn’t it be worth it?  Obviously not, because after this study was released in the New England Journal of Medicine, almost no hospitals are using a checklist.

While Doctors seem to be believe that using checklists are beneath their education and experience, airline pilots would not fly a plane without them.  Why is that?  The answer is obvious; airline pilots are in the plane, they are committed.

Airlines are not the only industry using checklists.  Actually most companies that serve consumers including restaurants, convenience stores, hotels, retailers, and others extensively use checklists pinned to their walls, floating on clip boards, et cetera.  What is disturbing is that a lot of companies are starting to wonder if using a checklist is effective and maybe they should eliminate its use.  You have to wonder why companies are making these decisions, especially in light of reputable in-depth studies such as done by Atul Gawande. This study should convince everyone that checklists are a critical element to a company’s success and efforts should be made to improve these checklists, not eliminate them.

One issue is that most companies don’t know how to build an “effective” checklist, and once the checklist has been created they are rarely updated or managed to.  We have seen instances where a company has checklists that are more than five years old.  They are obviously outdated, containing items that are no longer valid.  Companies then wonder why their managers are not completing them or don’t find them useful.   Companies also tend to make checklists disparate from other key communication, planning and evaluation tools.  The most effective systems consolidate all of these tools into one place so it effectively becomes the creedfor the organization.

The other issue is checklists are not cool—not a good reason to not put in place tried-and-true tools that are known to improve performance.  I’m betting you have some sort of checklist that you are running off right now.

The fact is that most good managers use checklists and similar tools to help them run their operations.  Not only does it ensure that everything is getting done, but it helps their management team coordinate efforts and effectively communicate with each other.  Creating systems of accountability has always been a time tested approach to strong management.

Last, changes are being made at such an accelerated rate, checklists are more important than ever to successfully run an operation.  Keep them current, make sure they cause specific action and consolidate them so they are easy to find and review. You’ll find you are getting things done at record pace and on strategy.

Greg Thiesen, Chief Executive Officer, Red Book Solutions