When US Airways Flight 1549 lost both engines after striking a flock of Canadian geese, crash landed in New York's Hudson River and all 155 passengers and crew survived, America hailed Captain Chesley B. Sullenberger III as a hero. Humble Captain Sully – as he came to be known – insisted that the successful crash landing, the Miracle on the Hudson, was a team effort by the entire crew.
As Harvard surgeon, journalist, and bestselling author Atul Gawande points out in his book The Checklist Manifesto, the captain's modest claims may be grounded in truth. But in addition to the heroic efforts of the cabin and passenger crews, another unlikely hero seems to have emerged. The checklist.
In his latest work, Gawande – who made tsunami-size waves last year with his New Yorker Magazine article on healthcare spending in McAllen, Texas (an amazing expose that I strongly suggest you read) – shows how adding a simple checklist to a standard process can save you from calamity by helping you make sound judgments and reduce the likelihood of errors. I admit that I am no list maker, never have been. But the results cited by Gawande are so powerful and unexpected that I am rethinking my approach!
Just like his piece about McAllen, Texas, Gawande's checklist idea raises eyebrows, and not just mine. As seasoned professionals with deep experience and understanding of our specialty, we can lay legitimate claim to our multitasking and performance-under-stress skill sets.
But Gawande's research proves that a simple checklist can benefit the most seasoned professionals. He recounts how a checklist has saved lives, even within his own operating room. In fact, in eight test hospitals around the world, a ninety-second checklist before surgery reduced deaths and complications by more than one-third!
Interestingly, the research shows that much of the success isn't so much the checklists themselves, but rather the teamwork that the checklists help to instill in the individuals working together on a particular task. Before I bring this teamwork idea to the supply chain, let me continue to illustrate this point with the checklists used on Sullenberger's flight.
Sullenberger and First Officer Jeffrey Skiles had never flown together before the January 15, 2009 trip. Upon starting the engines at the gate, the two ran methodically through their checklists, which included introducing themselves to each other and to the rest of the cabin crew. Then, also as dictated by the checklist, they discussed the plan for the flight, any concerns, and how to handle potential trouble.
In taking these list-mandated steps, Gawande writes, Sulley and Skiles transformed themselves from strangers into an effective team. When trouble struck 90 seconds after takeoff, each team member knew his role.
We know something about roles in the medical setting, don't we? Thousands of professionals go to work each day to concentrate on making the appropriate diagnoses, ordering the right products, prescribing and administering the right medications, and performing successful procedures. We focus so intently on our particular specialty that it can be easy to lose sight of the intricate interdependence of our roles in achieving the end game: the delivery of quality patient care.
The value analysis process provides a good case study in microcosm for this interdependence. The committed collaboration of supply chain professionals, clinicians, physicians, and financial analysts toward a common goal can produce dramatic breakthroughs in standardization and cost reduction. Many of us have seen this. We've also seen similar VA efforts end in failure.
So how does a checklist, which many of us consider as a way to get the "dumb stuff out of the way," help individuals expand their preoccupation with core competency and enable them to function as a cohesive unit? In many team situations, Gawande suggests that the first element be that of introductions: name, title, role. That's what the crew of Flight 1549 did.
Introductions are not perfunctory. Psychological studies have uncovered something profoundly simple: when individual members of a group don't know one another's names, they don't work together nearly as well as when they take the time for introductions. When you know someone else's name, you automatically establish a human connection, and the quality of your communication with that person increases significantly.
In a team setting, this goes a long way in coming together to carry out a common mission. Gawande has noted in his own practice that, when given a chance to introduce themselves and voice any concerns at the beginning of a case, the participants in a surgical procedure are more likely to note problems and offer solutions, and in real time. Much as a co-pilot is responsible – per the checklist – for verbally confirming changes in course, speed, and altitude made by the pilot, a checklist puts pointing out surgical errors squarely in the line of duty.
Consider the benefits of the checklist to value analysis teams: it establishes the category of product being evaluated – commodity or PPI – and what the requisite data is for each. It ensures that the whole team clearly understands the decision criteria. It establishes a time line. It identifies follow-up activities to measure time to conversion. And so on.
"Man is fallible," Gawande writes, "but maybe men are less so." Good stuff.
It was good stuff for Flight 1549, too. First Officer Skiles tried to restart both engines, as airline protocol (yes another checklist) dictated. But if Sully and Skiles didn't perform the pre-flight checklist in which they introduced themselves and became a team, then perhaps both men would have reacted by attempting to re-start the engines at the same time. No one would have been solely focused on gliding the plane safely into the Hudson.
Give a checklist a try, and please let me know how it works!
