Bombers, biopsies and brown M&Ms – it’s all part of the Checklist Manifesto | npENGAGE

Bombers, biopsies and brown M&Ms – it’s all part of the Checklist Manifesto

By on Mar 11, 2010


Bombers, biopsies and brown M&Ms – what do they all have in common?  They each tell an interesting story about checklists, a simple notion whose time has come, according to Atul Gawande in his recent book The Checklist Manifesto.

Gawande is a surgeon who, as leader of a World Health Organization taskforce, developed a general checklist for surgery that has prevented thousands of deaths and reduced complications by more than a third.  Using examples from aviation, construction, and finance, he shows that checklists, when developed thoughtfully and used with discipline, can avoid errors and free us to perform with greater confidence in almost any field. In effect, checklists can be a critical bulwark against information overload and complexity that challenge all of us.

The book is a quick read, with several engaging stories.  For example, one of the icons of the Allied victory in World War II was the B-35 bomber.  It was a big leap in aviation technology at the time, with 4 engines, long range, and large payload capacity – the war probably couldn’t have been won without it.  However, I didn’t know that this airplane was almost rejected by the US military when it was first tested in the 1930s, when it failed catastrophically during its first public test.  The military cancelled their order and Boeing nearly went bankrupt. However, a group of pilots and engineers worked to develop a set of checklists that helped prevent pilot errors. It was primarily the adoption of checklists, not major technological changes that made the difference.

These checklists are a critical part of aviation today. Anyone who has flown a commercial flight has probably heard the cabin crew running through cryptic elements of a larger pre-takeoff checklist with the pilots.  Remember the “miracle on the Hudson” last January?  Gawande reviews the important role pilot checklists made in saving all the passengers and crew.

OK, biopsies is an alliterative stretch here, but Gawande discusses his development of a surgical checklist, based largely on the successes of Dr. Peter Pronovost in reducing hospital infections. Pronovost reveals some interesting points about institutional and individual resistance to change in his recent NYT interview.

The “brown M&M” story is a classic rock and roll urban legend – one which turns out to be true.  Van Halen’s contract with venues and promoters included a clause that there would be “no brown M&Ms in the backstage area”.  This is typically explained as adolescent ego-tripping, but it turns out it was part of a checklist.

As the band explained it, their touring show required a lot of technical support – heavy equipment, lots of electricity, sturdy stages, etc.  They had been burned a few times where concert venues promised to have everything needed for Van Halen to put on their show, but when the band arrived, there were serious issues – a door on the loading dock not being large enough, for example.  To solve this, they put a clause in the fine print requiring the brown M&Ms. They didn’t really care about the candy, but it was a proof point that the venue was serious about meeting their conditions.

Most of us already use checklists in some form. As a personal example, I have adopted two checklists that have made my life much easier.  I adapted a version of David Allen’s Travel Checklist for work trips, and then created a separate list for things I take to the gym.  Each is just a list of things I should think about bringing – the actual contents will vary from trip to trip.  The list helps me pack more quickly, avoids (or mostly avoids) forgetting important items, and helps keep me calm and focused.

The point of Gawande’s book (and this post), is to think more creatively about the challenges of complexity in our life and work, and how we can in effect “avoid the avoidable errors.”  Checklists are one important tool we can all use to standardize and “error-proof” our work and life. How are you managing complexity?  Are you using checklists?


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