Project management (Part 14): The power of checklists

In the business bestseller The Checklist Manifesto, Atul Gawande makes a powerful case for the value of this simple project management tool. 

As the book jacket notes, “The volume and complexity of knowledge today has exceeded our ability as individuals to properly deliver it to people – consistently, correctly, and safely.”  Checklists can solve this problem by addressing two problems that every busy expert faces: “The first is the fallibility of human memory and attention, especially when it comes to mundane routine matters that are easily overlooked under the strain of more pressing events….[The second] is that people can lull themselves into skipping steps, even when they remember them” (p. 36).

The book gives examples of the power of checklists ranging from flying the B-17 bomber (p. 34) to building skyscrapers (p. 54).  Since Gawande is an endocrine surgeon at the Brigham & Women’s Hospital in Boston and an associate professor at Harvard Medical School, many of his examples relate to hospitals.  The most compelling story in the book describes a medical procedure commonly performed in intensive care units: inserting a central line (a catheter placed in a large vein to deliver medications and more). 

Until recently, infections from central lines were a major source of illness and death in ICUs.  But in 2001, a Johns Hopkins intensive care physician named Peter Pronovost created a checklist of five simple steps to reduce infection, starting with doctors washing their hands with soap and cleaning the patient’s skin with the antiseptic chlorhexidine.  Almost everyone agreed that all five of these steps were important.  In fact, “some physicians were offended by the suggestion that they needed checklists” (p. 40).  But Pronovost believed that high infection rates were related to the fact that in the real world of medical trauma, one or more steps were often skipped in the heat of the moment, or simply because hospitals ran out of the needed supplies.

He spent several years refining and promoting his five item checklist.  When it finally became a standard operating procedure, the results were dramatic.  One study was performed in Michigan hospitals and published in the December 2006 issue of the New England Journal of Medicine.  In the first eighteen months of this Michigan initiative, Pronovost’s checklist saved 1,500 lives and $100 million, simply by forcing doctors to comply with five items that summarized “ridiculously primitive insights” (p. 39).

A number of legal experts have written about ways to apply lessons from The Checklist Manifesto to the practice of law, including here, here, and here. 

From my perspective, the most valuable use of legal checklists is to summarize basic knowledge in a simple form which is easy for busy lawyers to access and use.  Whether they list well-defined step-by-step procedures or fuzzy brainstorming ideas, checklists provide lawyers with “just in time” information at the exact moment they need that knowledge at their fingertips.

When we develop customized versions of our Legal Project Management Quick Reference Guide for clients, we include proprietary documents that are already being used in each firm.  Some of the most valuable tools we’ve found are checklists that lawyers have developed for everything from due diligence to closing a deal. 

Most of the time, developing a legal checklist is the easy part.  The hard part is getting lawyers to use it.

Comments

[Paul C. Easton]

You are absolutely correct in extolling the value of checklists. Those lawyers who feel that it demeans their work or insults their intelligence need to read Mr. Gawande's excellent book.