To ensure that extremely com­plex tasks–tasks too com­plex even for “super-specialists”–are per­formed effec­tively, accu­rately and with min­i­mal mis­takes, check­lists are an invalu­able tool, sug­gested Atul Gawande in a 2007 arti­cle in The New Yorker (and every­where else since, it seems).

Gawande illus­trates (in an inor­di­nate amount of detail) how seem­ingly unnec­es­sary check­lists can make huge dif­fer­ences to our effec­tive­ness in com­plet­ing the most com­plex (and sim­ple) of tasks by look­ing at how Peter Pronovost dra­mat­i­cally reduced infec­tion rates (from 11% to 0% in some cases*) in hos­pi­tals through­out America.

So how do you actu­ally man­age [immense] com­plex­ity? The solu­tion that the med­ical pro­fes­sion has favored is specialization. […]

We now live in the era of the super-specialist—of clin­i­cians who have taken the time to prac­tice at one nar­row thing until they can do it bet­ter than any­one who hasn’t. Super-specialists have two advan­tages over ordi­nary spe­cial­ists: greater knowl­edge of the details that mat­ter and an abil­ity to han­dle the com­plex­i­ties of the job. [But] what do you do when exper­tise is not enough? […]

It’s far from obvi­ous that some­thing as sim­ple as a check­list could be of much help in med­ical care. […] Map­ping out the proper steps for each [patient] is not pos­si­ble, and physi­cians have been skep­ti­cal that a piece of paper with a bunch of lit­tle boxes would improve mat­ters much.

In 2001, though, a critical-care spe­cial­ist at Johns Hop­kins Hos­pi­tal named Peter Pronovost decided to give it a try. […]

The check­lists pro­vided two main ben­e­fits, Pronovost observed. First, they helped with mem­ory recall, espe­cially with mun­dane mat­ters that are eas­ily over­looked in patients under­go­ing more dras­tic events. […] A sec­ond effect was to make explicit the min­i­mum, expected steps in com­plex processes.

Gawande notes how Pronovost enabled the wide­spread use of check­lists by per­suad­ing hos­pi­tal man­age­ment to actively encour­age and take the side of those lower down in the pro­fes­sional hier­ar­chy (i.e. nurses) to chal­lenge those above them (i.e. con­sul­tants) with­out recriminations.

via @zambonini

*The check­list used was extremely sim­ple and con­tained only five steps. It was so sim­ple that it was resisted by almost every employee. With the check­list actu­ally being con­sulted read­ily, it turned out that at least one step was either missed or not imple­mented cor­rectly in many cases.