by Marshall Goldsmith
My friend Dr. Bob Spiegel, the chief medical officer at Schering-Plough (SGP), sent me an amazing article from The New Yorker titled “The Checklist” (Atul Gawande, Dec. 10, 2007), which describes the groundbreaking work done in medical critical-care research by Dr. Peter Pronovost.
In 2001, Dr. Pronovost developed a checklist to tackle one problem: line infection, a common complication that may occur when a catheter is inserted into the body. His checklist to avoid line infection is incredibly simple. “Doctors are supposed to (1) wash their hands with soap, (2) clean the patient’s skin with chlorhexidine antiseptic, (3) put sterile drapes over the entire patient, (4) wear a sterile mask, hat, gown, and gloves, and (5) put a sterile dressing over the catheter site once the line is in.”
These were not new steps. They had been known and taught for years. However, when nurses observed doctors in real intensive-care practice for one month, at least one of these steps was skipped in more than a third of patients.
For the next year, one hospital decided to enforce the checklist. Nurses were authorized to “stop doctors if they saw them skipping a step in the checklist; nurses were also asked to ask doctors each day whether any lines ought to be removed, so as not to leave them in longer than necessary.”
The results from this simple checklist follow-up procedure were phenomenal: infection rates plummeted, lives were spared, and millions of dollars of unnecessary costs were saved.
Checklist Across Industries
Over the last few years, Dr. Pronovost has gone on to replicate this study several times, with consistently beneficial results. In spite of the dramatic positive outcomes produced by his checklist, only a small percentage of hospitals have chosen to implement this procedure.
Three explanations were presented in The New Yorker piece: (1) the egos of some physicians, who felt insulted that professionals with their level of wisdom and experience should have to stoop to the level of being monitored by nurses and governed by a checklist, (2) a feeling of already being too “busy” and an aversion to more “tasks” in a world that is already consumed with too much bureaucracy, and (3) a medical research establishment that is almost entirely focused on more “exciting” issues such as disease biology and finding therapies for treatment, while often ignoring more “mundane” research that measures if therapies are effectively delivered to patients.
I believe that Dr. Pronovost’s “checklist” discipline can be used in myriad ways outside of the medical arena. For example, in my work with executives, I see even the most successful leaders make very common mistakes when facilitating team meetings. Perhaps a checklist could help leaders avoid some of these routine errors. During the team meeting leaders could have a checklist with items including: (1) clear goals for the meeting, (2) encouraging input from participants, (3) listening without interrupting, (4) recognizing others for their contributions, and (5) avoiding destructive comments about co-workers in other parts of the organization.
While a simple checklist would not solve all the problems that occur in team meetings, it would probably help leaders to become more effective facilitators and help teams become more effective in solving problems.
Outlining What You Know You Should Do
As an executive coach, I find that my clients almost always know what they should do. They, like all human beings, just don’t always do it. In the same way the nurses in Dr. Pronovost’s research remind doctors to do what they already know they are supposed to, I remind executives. Just as in Dr. Pronovost’s research, it works!
For example, almost every leader preaches – and believes in – the value of synergy and cross-organizational teamwork. Many of these same leaders slip on occasion and blast their cross-organizational colleagues in team meetings. This destructive communication is generally contagious, leads to direct reports joining in the bash-fest, and ultimately undermines cross-organizational teamwork. If these same leaders had a checklist that included No. 5 above, this behavior might not be eliminated but it would greatly decrease.
How can what we have learned from the good doctor help you?
Here are my suggestions:
– Before your next meeting with another person at work, make a checklist that covers how you want to behave in the interaction.
– Write your checklist down on a piece of paper that you can observe during the meeting.
– Evaluate yourself after the meeting on how your actual behavior aligned with the desired behavior on your checklist.
– In the same way that the doctors were reminded about what to do by nurses, find someone you trust to keep reminding you what to do.
– Make the checklist review part of your regular routine.
– Do your own “personal research” and watch how your behavior begins to change.
I am going to start doing this myself!
In reflecting on the past month, I can think of examples where my behavior was closely aligned with the behavior that should have been on my checklist – and unfortunately, I can come up with cases otherwise. And I bet the same is true for you.
Right now you may be thinking, “I am too smart to need a simple checklist to be effective in my role,” or “I am too busy to need another task,” or “This is too mundane, I would rather focus on something more exciting, like how to transform my organization.”
Remember, these are the same excuses that medical professionals used to avoid following Dr. Pronovost’s checklist.
Unfortunately all of these excuses have to deal with the preferences of the doctors – not the needs of the patients.
In the same way, if we can get over our own egos, admit that we need checklists to do what we know we should, and focus on the needs of others, we can all “reduce infection” in our own ways, better serve our key stakeholders, and make our organizations more effective.