6 ms·

The Checklist (2007)

78 points by bearwithclaws 15y ago

wr1472 15y ago
Atul Gawande wrote the Checklist Manifesto (http://gawande.com/the-checklist-manifesto http://gawande.com/the-checklist-manifesto) which goes into a lot more detail about all this. I would thoroughly recommend reading it if you want to improve how you get stuff done.
- RyanMcGreal 15y ago
  It's a fantastic book that literally changed my life. I've incorporated checklists deeply into my workflows, to the extent that when I start a new project, the first thing I do is generate a checklist to work against. The number of casual errors, oversights and other preventable errors I make has dropped precipitously. Call it Checklist-Driven-Development (CDD).
- prakashk 15y ago
  +1 for the Checklist Manifesto. Gawande is an excellent writer. I liked his other books, particularly Complications (http://gawande.com/complications http://gawande.com/complications).
- adolph 15y ago
  The checklist for checklists seems like gold for making certain a group of people are on the same page when making checklist items. http://www.projectcheck.org/checklist-for-checklists.html http://www.projectcheck.org/checklist-for-checklists.html
  - r00fus 15y ago
    From that same site [1], you can see a collection of checklists [1], one of which is the actual checklist that Pronovost created at Johns Hopkins Hospital. [1] http://www.projectcheck.org/checklists.html http://www.projectcheck.org/checklists.html
- danso 15y ago
  I second-thirded-n'ed this recommendation...the closing chapter in which Gawande describes how a checklist prevented a patient from dying on him in surgery is just gripping. There's also excellent sections on construction...such as how project managers make and disseminate decisions at a breakneck pace in skyscraper construction.
yummyfajitas 15y ago
Checklists (or scripts) also work well in education: http://www.jefflindsay.com/EducData.shtml http://www.jefflindsay.com/EducData.shtml http://www.mathematicallycorrect.com/honestft.htm http://www.mathematicallycorrect.com/honestft.htm http://www.projectpro.com/ICR/Research/DI/Summary.htm http://www.projectpro.com/ICR/Research/DI/Summary.htm
- kgroll 15y ago
  And, as patio11 suggests, in deploying code. From his Mixergy interview (4/30/10) [1]: ``I have a physical checklist for when I’m doing a deployment. It’s, off the top of my head maybe six commands long; one, two, three, four, five, six. I check them off; dink, dink, dink, dink, dink. And then after I do that, I have the other checklist to verify that it actually took, you know the things that I did that had the expected effect. I missed doing that once because I was exhausted at the day job and, sure enough, that was my biggest down time in four years. So I’m trying to be better at it in the future.'' [1] http://mixergy.com/patrick-mckenzie-interview/ http://mixergy.com/patrick-mckenzie-interview/
  - yummyfajitas 15y ago
    True, though I generally treat such checklists as a code smell. Ideally all the items should live in your makefile. [edit: added emphasis to the word "ideally".]
    - hello_moto 15y ago
      Sometime some type of technology does not not lend itself to 100% automation. So there will be certain steps that would require a bit of human intervention. Of course, we all wish that all software is written according to the UNIX philosophy.
- jmcqk6 15y ago
  Project Follow Through contained several major problems, but it doesn't take a researcher to recognize the biggest problems of Direct Instruction. Scripted curriculum might sound good to some people, but it has two major flaws: first, it destroys any possibility of differentiated instruction. Secondly (and related), it insures mediocre performance by students. Scripted curriculum tells teachers exactly what to do during every moment of the day, from hand gestures to exact words. In most places that implement this, any deviance from the script is grounds for reprimand. How many HN users would like to learn in this environment? How many of you think you could learn like this? I'm willing to wager that many of you would answer 'no' to both of these questions.
nhebb 15y ago
I have a number of checklists I use, from deployment to form design, but the practice that has had the biggest impact for me is creating on-the-fly checklists while I'm coding. I often set out to do one thing and realize there are four or five other things that need to be implemented or changed. I used to try to keep track of everything in my head, but when your mental todo list starts looking like a complicated digraph, that just isn't effective. Now I don't code without a scratch pad by my side.
hello_moto 15y ago
HN-ers, listen to this business proposition (this is not a sarcasm, but this is an idea, a perspective if you will). Find one of the productivity books, preferably ones that are quite popular. Implement a software, web-app, mobile-app, desktop-app, plugins, whatever, based on such books.You'll get instant userbase that love your software. Rinse-and-repeat. There are a few productivity tools based on GTD out there. Looking at the checklist-for-checklists link that adolph mentioned in this thread reminds me of Trello. Seems like a simple money making scheme don't you think?
- adolph 15y ago
  Thanks for the reference to Trello. That looks interesting and I'm trying it out now. I think that one of the challenges in the business proposition you make is the translation from paper to screen, somewhere between Gawande and Tufte.
- zefhous 15y ago
  It's a good idea, but not so simple to actually get traction... A couple years ago I was hired to build a checklist web app based on Atul Gawande's book, The Checklist Manifesto. Being the very idea that you're referring to here it's a very relevant example. The guy who hired me has invested a lot of time and some money into trying to get traction but nothing has come of it. Granted he's probably not done everything perfectly, but he's put a lot of time into seeding the site with public checklists for different subjects and trying to get people using it. As far as I know nobody uses the site. It's not that great but it provides some basic value and is definitely a minimum viable product including revisions, public and private checklists, ability to share and collaborate with others, pdfs, etc. For those curious the site is here: http://expertchecklists.com/ http://expertchecklists.com/
AdamFernandez 15y ago
I think all of these checklist ideas are great, but does anyone have any suggestions regarding how to make the decision makers in the medical community pay attention? It sounds like there are possible opportunities here.
peteretep 15y ago
I used to travel a lot for work. My "Master Packing List", has meant I no longer find myself meeting clients without, say, a belt, or socks, or laptop charger, etc.
tom_b 15y ago
Challenge HN: Share your checklist for training yourself to be a better hacker. Or to have more successful projects.
GFischer 15y ago
I guess that a hospital is like the military in that there has to be clearly delineated chain of command, but some points raised in the article could be solved by empowering doctors and especially nurses: "chlorhexidine soap, shown to reduce line infections, was available in fewer than a third of the I.C.U.s. This was a problem only an executive could solve" If nurses and doctors were empowered, that problem probably wouldn't have arisen. I agree that other solutions are more in executives' territory: "they persuaded Arrow International, one of the largest manufacturers of central lines, to produce a new central-line kit that had both the drape and chlorhexidine in it."
- ArbitraryLimits 15y ago
  I don't know about that. The main point I got from the article is that when doctors are more empowered they disdain the checklist and mess up more.
  - GFischer 15y ago
    I'm not taking away from the checklists, which sound like a great improvement :) . It was an observation about the executives.
kylemaxwell 15y ago
I've seen this many times and it never gets old.

78 points by bearwithclaws 15y ago

Atul Gawande wrote the Checklist Manifesto (http://gawande.com/the-checklist-manifesto http://gawande.com/the-checklist-manifesto) which goes into a lot more detail about all this. I would thoroughly recommend reading it if you want to improve how you get stuff done.

RyanMcGreal 15y ago
It's a fantastic book that literally changed my life. I've incorporated checklists deeply into my workflows, to the extent that when I start a new project, the first thing I do is generate a checklist to work against. The number of casual errors, oversights and other preventable errors I make has dropped precipitously. Call it Checklist-Driven-Development (CDD).
prakashk 15y ago
+1 for the Checklist Manifesto. Gawande is an excellent writer. I liked his other books, particularly Complications (http://gawande.com/complications http://gawande.com/complications).
adolph 15y ago
The checklist for checklists seems like gold for making certain a group of people are on the same page when making checklist items. http://www.projectcheck.org/checklist-for-checklists.html http://www.projectcheck.org/checklist-for-checklists.html
- r00fus 15y ago
  From that same site [1], you can see a collection of checklists [1], one of which is the actual checklist that Pronovost created at Johns Hopkins Hospital. [1] http://www.projectcheck.org/checklists.html http://www.projectcheck.org/checklists.html
danso 15y ago
I second-thirded-n'ed this recommendation...the closing chapter in which Gawande describes how a checklist prevented a patient from dying on him in surgery is just gripping. There's also excellent sections on construction...such as how project managers make and disseminate decisions at a breakneck pace in skyscraper construction.

yummyfajitas 15y ago

Checklists (or scripts) also work well in education: http://www.jefflindsay.com/EducData.shtml http://www.jefflindsay.com/EducData.shtml http://www.mathematicallycorrect.com/honestft.htm http://www.mathematicallycorrect.com/honestft.htm http://www.projectpro.com/ICR/Research/DI/Summary.htm http://www.projectpro.com/ICR/Research/DI/Summary.htm

kgroll 15y ago
And, as patio11 suggests, in deploying code. From his Mixergy interview (4/30/10) [1]: ``I have a physical checklist for when I’m doing a deployment. It’s, off the top of my head maybe six commands long; one, two, three, four, five, six. I check them off; dink, dink, dink, dink, dink. And then after I do that, I have the other checklist to verify that it actually took, you know the things that I did that had the expected effect. I missed doing that once because I was exhausted at the day job and, sure enough, that was my biggest down time in four years. So I’m trying to be better at it in the future.'' [1] http://mixergy.com/patrick-mckenzie-interview/ http://mixergy.com/patrick-mckenzie-interview/
- yummyfajitas 15y ago
  True, though I generally treat such checklists as a code smell. Ideally all the items should live in your makefile. [edit: added emphasis to the word "ideally".]
  - hello_moto 15y ago
    Sometime some type of technology does not not lend itself to 100% automation. So there will be certain steps that would require a bit of human intervention. Of course, we all wish that all software is written according to the UNIX philosophy.
jmcqk6 15y ago
Project Follow Through contained several major problems, but it doesn't take a researcher to recognize the biggest problems of Direct Instruction. Scripted curriculum might sound good to some people, but it has two major flaws: first, it destroys any possibility of differentiated instruction. Secondly (and related), it insures mediocre performance by students. Scripted curriculum tells teachers exactly what to do during every moment of the day, from hand gestures to exact words. In most places that implement this, any deviance from the script is grounds for reprimand. How many HN users would like to learn in this environment? How many of you think you could learn like this? I'm willing to wager that many of you would answer 'no' to both of these questions.

nhebb 15y ago

I have a number of checklists I use, from deployment to form design, but the practice that has had the biggest impact for me is creating on-the-fly checklists while I'm coding. I often set out to do one thing and realize there are four or five other things that need to be implemented or changed. I used to try to keep track of everything in my head, but when your mental todo list starts looking like a complicated digraph, that just isn't effective. Now I don't code without a scratch pad by my side.

hello_moto 15y ago

HN-ers, listen to this business proposition (this is not a sarcasm, but this is an idea, a perspective if you will). Find one of the productivity books, preferably ones that are quite popular. Implement a software, web-app, mobile-app, desktop-app, plugins, whatever, based on such books.You'll get instant userbase that love your software. Rinse-and-repeat. There are a few productivity tools based on GTD out there. Looking at the checklist-for-checklists link that adolph mentioned in this thread reminds me of Trello. Seems like a simple money making scheme don't you think?

adolph 15y ago
Thanks for the reference to Trello. That looks interesting and I'm trying it out now. I think that one of the challenges in the business proposition you make is the translation from paper to screen, somewhere between Gawande and Tufte.
zefhous 15y ago
It's a good idea, but not so simple to actually get traction... A couple years ago I was hired to build a checklist web app based on Atul Gawande's book, The Checklist Manifesto. Being the very idea that you're referring to here it's a very relevant example. The guy who hired me has invested a lot of time and some money into trying to get traction but nothing has come of it. Granted he's probably not done everything perfectly, but he's put a lot of time into seeding the site with public checklists for different subjects and trying to get people using it. As far as I know nobody uses the site. It's not that great but it provides some basic value and is definitely a minimum viable product including revisions, public and private checklists, ability to share and collaborate with others, pdfs, etc. For those curious the site is here: http://expertchecklists.com/ http://expertchecklists.com/

AdamFernandez 15y ago

I think all of these checklist ideas are great, but does anyone have any suggestions regarding how to make the decision makers in the medical community pay attention? It sounds like there are possible opportunities here.

peteretep 15y ago

I used to travel a lot for work. My "Master Packing List", has meant I no longer find myself meeting clients without, say, a belt, or socks, or laptop charger, etc.

tom_b 15y ago

Challenge HN: Share your checklist for training yourself to be a better hacker. Or to have more successful projects.

GFischer 15y ago

I guess that a hospital is like the military in that there has to be clearly delineated chain of command, but some points raised in the article could be solved by empowering doctors and especially nurses: "chlorhexidine soap, shown to reduce line infections, was available in fewer than a third of the I.C.U.s. This was a problem only an executive could solve" If nurses and doctors were empowered, that problem probably wouldn't have arisen. I agree that other solutions are more in executives' territory: "they persuaded Arrow International, one of the largest manufacturers of central lines, to produce a new central-line kit that had both the drape and chlorhexidine in it."

ArbitraryLimits 15y ago
I don't know about that. The main point I got from the article is that when doctors are more empowered they disdain the checklist and mess up more.
- GFischer 15y ago
  I'm not taking away from the checklists, which sound like a great improvement :) . It was an observation about the executives.

kylemaxwell 15y ago

I've seen this many times and it never gets old.