The Value of Checklists
The checklist has been used in aviation for years. It grew out of necessity with the development of an experimental aircraft, Boeing's test plane Model 299, the predecessor to the B-17, considered to be the plane that helped America win World War II.
Boeing's Model 299, tested in 1935, was the most complex aircraft of the time; the best test pilots could not take-off, fly, land and taxi the plane without serious incident. The answer to such a challenge was the development of a checklist covering each of the areas the pilot and crew had to master in order to safely fly the plane.
The aviation checklist concept was so successful that it became standard procedure for all flights - military, commercial and private. You would not think of boarding a plane if it were announced that the flight crew was too busy to check the flight safety checklist.
Another industry that has found value in checklists is the medical industry. Hospital intensive care units (ICU) are great places for critical care but a large number of patients get infectious diseases while in an ICU. The medical staff is confronted with the sheer complexity of the treatment being rendered patients. A study found medical teams attending to 1,224 different injury-related diagnoses in 32,261 unique combinations. How can a checklist work in this situation?
In 2001, Dr. Peter Pronovost of John Hopkins Hospital was determined to find an answer. In a critical study the doctor along with a team of nurses observed the rendering of medical treatment. In the flurry of delivering medical care they noticed inconsistencies with the delivery of injections including shots and intravenous therapy. They found lapses in standard protocol, simple steps that all medical personnel know but were not consistently delivering.
From these observations he developed a five step checklist for injections. Part of the success of this project was having nurses and doctors work together as teams to assure all five steps were followed. These were not rocket science procedures but the complete follow through of standard good medical procedures - wearing of masks and gloves, properly using sterile drapes, making sure the patient's skin is antiseptic, and more - five steps followed, checked and consistently delivered.
The results of implementing the checklist procedure were stunning. After a year, infections dropped dramatically. Dr. Pronovost convinced a second hospital to let him institute this checklist. Again infections associated with injections were reduced 66 percent. Dr. Pronovost and his team immediately sought out other areas to institute medical procedure checklists: delivering timely medications to patients in pain, and making sure patients on mechanical ventilation received the full intended benefit. These simple checklists reduced patient issues by up to 70 percent.
Such ICU checklists have resulted in written protocol of the right steps to be followed by the medical team, patient stays reduced in half, reduced hospital costs, and improved patient recovery. This process is so effective that like aviation this is now standard protocol in hospitals, clinics and doctor offices all in just a few years.
How can the success of checklists in aviation and medicine relate to your business? Can you achieve stunning improvements in your business operations by implementing the use of checklists?
Developing Business Checklists
Your first decision is where to begin. Start by identifying the critical areas where systems are most important. Areas to address might include employee retention, customer satisfaction, cash flow, sales, or management development.
Begin with the area that is most critical. Dr. Pronovost, the crucial care specialist, did not attempt to address everything. He purposely tackled just one problem. He chose the one that nearly killed a patient, infections from injections.
Review your top areas and select one for your focus. Which "one" of those identified will make the biggest difference when solved. This becomes your number one priority.
Solve it! Develop a checklist, looking for ways to make progress an inch at a time. If you choose employee retention, for example, your checklist might include items on orientation, training, reviews, integration, team involvement, and career path development.
One company determined that if they could keep a new employee for nine months, they kept the employee over 15 years. They developed a checklist to set a schedule of events to fully integrate the employee to get immersed in the culture. They were successful at making sure every crucial component of their employee retention plan was executed.
If customer satisfaction is your number one, develop a checklist that includes training your employees to consistently deliver the best service, never leaving a customer without thanking them for the opportunity of working with them. A checklist of crucial components ensures your customers receive star treatment by every one of your employees, with every interaction.
Once you have been successful in one area, go to a second and then a third. Achieve consistency and excellence in all critical areas of your business.
I do some flying, but have never been a patient in an ICU. I am more confident knowing that the flight and medical crew are doing their best to assure my safety. In your business, adopting checklists can result in satisfied customers, more productive employees and increased profits!
Joseph P. Leverich, CPA, is managing partner and President of The Leverich Group, a Salt Lake City-based CPA and management consulting firm specializing in solutions and services to businesses and individuals. Contact Joe by e-mail at [email protected] or by phone at (801) 364-4949.