Those checklists

Checklist Manifesto
Checklist Manifesto

I had the luxury of working on a terrific team at a financial services startup from the early 00s to the early 10s. Though we jelled as a self-organizing agile team with expert domain knowledge, we occasionally made some really dumb mistakes when deploying to production. The operations VP, Anne, wagged her finger at us and said we should be using checklists. We took this advice and were happy with the results. I don’t remember anymore if it was Anne who recommended it, but I finally read Atul Gawande’s The Checklist Manifesto, which totally sold me on the value of checklists. Even when you think you couldn’t possibly forget some obvious items on your checklist – you can! Just use the checklist!

Personal experience

I recently had an unhappy accident where I slipped on hidden ice in the donkey pen and broke my leg. This necessitated surgery. I was fascinated at how pervasive checklists really are at hospitals. Medical errors the third-leading cause of death in the U.S. I was quite happy to be asked repeatedly for my name and date of birth (DOB), have my hospital ID scanned, repeat why I was there, what was my injury, what was I having surgery for, which leg was it. I was glad to see the kind and comforting hospital staff record every bit of information and sanitize their hands over and over.

Even the anesthesiologist quizzed me as to my specific injury and surgery. He then gave me options for anesthesia. I could have spinal and be awake or semi-awake, and recover faster from the anesthesia. Or have general anesthesia. I asked about a nerve block because someone else had mentioned it. This brought a visit from the pain management team. As I made decisions, they were noted down on the consent form and we all signed. Which leg are we operating on? What surgery is being done? Repeating the plan for anesthesia and pain management over and over. Initialing changes as they were thought up. It was a whole team approach – the surgeon, the main anesthesiologist, the pain management team all consulted each other as well as me, the “customer”. Final decisions were up to me. What is your full name and DOB?

Having a spinal anesthesia meant I was awake in the operating room when the team went over its final checklist. What are we doing? Which leg is it? The surgeon signed my big toe and my thigh on my right leg with a Sharpie. Yes, it can seem a little silly, but think of the impact of doing the wrong leg or the wrong person!

There was a list of things to check to make sure the anesthesia was wearing off, a list to make sure the nerve block was done in the correct location (though I have to say, I never felt it had an effect, I had plenty of pain!), a list to hand me over to recovery. Taking my vitals every few hours. What’s your full name, what’s your DOB, what did you have done? They obviously kept careful track of my pain meds and gave me the options available to me at any time I asked for more.

Boring is better than disaster

I imagine going over the same checklists hundreds of times a day must be boring for the hospital staff, though they can record the answers digitally these days. If it prevents even one death, it’s worth doing, and I suspect it prevents a lot of mistakes. Let’s embrace a bit of tediousness and mitigate the risk when it’s essential to do so. Having all that covered will free parts of our brain up for creative problem-solving and decision-making. We’ll have clear communication to deliver valuable changes to our customers. We’re able to automate so many of our checks, but we may need to check in on a human level too.

Continuous delivery is meant to be boring! The only excitement we want is customers enjoying new features when we turn them on in production. In a way, our pipeline is a checklist. We check off each stage. We do it over and over. We keep improving it. We make sure we’re working with the right people and the right things. We prevent silly mistakes. Sometimes you can’t cut corners. It may be boring and tedious, but it is easy and the payoff is big.

2 comments on “Those checklists

  1. Checklists can be really helpful but it’s fascinating how many people resist using them. I keep trying to suggest the developers add some as well, but that rarely happens. i think it often takes that specific personality who values list making to create these types of processes. 😀 Hope you are feeling better Lisa.

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