Good Books: The Checklist Manifesto

-by Jack M. Jose

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It always seemed to happen this way: The parents left the room at the end of the meeting, and walked down the hallway. We resumed our team meeting, addressing the next issue on the agenda. Someone would exclaim, “Rats! Forgot to ask them about the permission slip for the field trip!” And he or she would rush to the door, but the parents were gone.

Or maybe we had forgotten to explain a key upcoming homework assignment, or mention an important project deadline.

This was a chronic experience for each of the teacher teams I was on at Hughes Center. And it turns out that forgetting things is a problem for people in other professions too. I learned a simple and effective solution to this vexing problem in a book about making detailed lists, and following them in order: The Checklist Manifesto.

 

Atul Gawande, a renowned surgeon and author, starts The Checklist Manifesto by differentiating between errors made in the face of great complexity (because we do not know enough), and errors made by ineptitude (because we fail to access or use what we do know). Speaking from his profession as a surgeon, great complexity is a reality of his daily work. We encounter similar complexity as educators – what is the necessary preparation to help a student understand or create an appropriate metaphor, or to know when to solve a problem using the quadratic formula? These are complex, but knowable. As professionals in a particular discipline, we should be expected to have a grasp of the solutions to these intellectual progressions. This is where our expertise is absolutely necessary and irreducible. Checklists cannot necessarily help with this.  Errors of ineptitude or oversight, however, are the kinds of errors that checklists are designed to eliminate. Procedures need to happen in a certain order, and doing them that way creates better outcomes.

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picked up a newer version of The Checklist Manifesto at a book store last year, and saw that it had a new introduction. Though I had read the book years before, I was immediately drawn into the narrative, demonstrating how a checklist was instrumental in helping to safely (and famously) crash land a plane into the Potomac River. More on that later, as I talk more about the book that helped me see the world of my work completely differently. Principals and teachers inhabit a world of tremendous complexity. There are layers of expectations placed on their students, dozens of types of assessments, and countless instructional tools and techniques at their disposal to help their students master the skills necessary for promotion. Within this complexity, there are some processes that repeat somewhat endlessly into the future, processes contained within a single class period, a day, a week, a quarter, a semester and even a year. There are right ways to do many of these regular processes. Checklists are, in this complex environment, a remarkably simple way to make sure we are doing the important things right.

 

Checklists to help with routine events

In 2012, as part of training for principals in Cincinnati Public Schools, a member of the Board of Cincinnati Children’s Hospital spoke about the mistakes made by doctors at the hospital. They had a patient mortality rate of 4.6% in 2001, which had been a very slight improvement on the year before.  This placed them above the middle of the pack for similar hospitals, and had been a point of some pride for earlier leadership. However, they had become dissatisfied with being in the middle of the pack relative to the percentage of children dying in their care. Each number was a tragedy, and there was no excuse for not taking effective measures to prevent them. The Board at Children’s was especially concerned to note that many of these deaths were, in their estimation, preventable. Doctors administering incorrect medicines or doses, doctors and nurses making mistakes that resulted in infections, such as pneumonia acquired while on a ventilator. They instituted a series of reforms which included checklists. At the end of 2011, their mortality rate had been cut dramatically[1].

Gwande provides as an example a different institution, Johns Hopkins hospital, where checklists were instituted for a specific common ventilator procedure. In addition to a clear set of steps posted where all could see them, nurses were given the unusual authority to stop the procedure if a step was missed. Prior to the implementation of the checklist, secondary infections had been the leading cause of complications and deaths at one of the world’s most prestigious medical facilities. This simple addition nearly eliminated those infections.

Checklists are, in this complex environment, a remarkably simple way to make sure we are doing the important things right.

So checklists can help eliminate mistakes as we repeatedly complete important procedures. An example of an academic use for routines is the weekly checklist in the structured classroom. In a typical classroom, a child might receive one or two assignments each day, with varying due dates. Assignments may even be dispensed one at a time. However, a checklist is an important tool in helping a child develop skills related to managing time and work. The Montessori weekly checklist enumerates planned lessons and activities, such as regular reading time for students to encounter challenging and engaging material, teacher-led mini-lessons to provide new content, and shelfwork to help each student develop existing skills. The checklist format aids the student in utilizing her time wisely to complete the necessary work. Powerfully, the checklist in this case serves the “patient” and the “doctor” equally, as utilizing the format from week to week ensures that the necessary modes of instruction are regularly used, instead of a teacher falling back on a favorite or comfortable routine or lesson format.

 

 

Checklists to help with infrequent events

The popular rock band Van Halen’s live performances included massive amplifiers, fireworks, lights, and electric and audio cables spread across entire stadiums. Their shows were memorable, but their demands as a band were legendary and one was individually ridiculous: they demanded M&Ms at every show, with all the brown ones picked out. Their manager explained to Dr. Gawande that it was not because they were pampered celebrities with an aversion to brown candies. Instead, their demanding checklist was created to make sure that the performers and fans were safe on stage every night. There was a lot that could go wrong, especially as the lead singer was hoisted in a harness for a spectacular entry, and fans stood near scaffolding holding massive audio equipment – and did I mention fireworks, water, and electricity? The tour double-checked everything the day they arrived; if there were brown M&Ms in the bowl, they would know that the venue did not pay attention to the details. It was not a frivolous demand; it was a fail-safe to ensure that no one’s safety was at risk.

So checklists can help make sure that an infrequent or even one-time event, such as a Van Halen show in your local arena, happens flawlessly.

I explained earlier that Gawande said checklists could help with errors of ineptitude or oversight, where someone makes a mistake in carrying out a familiar procedure. This is the team meeting problem. We would enter a conversation with a specific objective, and the intention to cover one or two items in particular, such as poor grades, or a particular disciplinary incident. The conversation would address the big issue, and the parent might bring up new and important information. We would wander off-task, fully engaged in the new direction of the conversation. These can be contentious meetings, full of hurt feelings and embarrassment for students and adults alike. It is understandable that everyone involved might forget other, less significant topics momentarily. Perhaps we missed a signature on a permission slip for an upcoming trip, or we failed to make sure the family could access the online gradebook.

Inspired by this book, and motivated by our repeated experience, we created a team meeting checklist. We made a simple list on the bottom of the page, charting the things we might need to cover in a conference. We used our old meeting form with this small addition and we found that we forgot less, and accomplished more, than we had before just by assigning one person to run through the checklist at the end of the meeting, to ensure we hit each topic.

This checklisted sequence of questions works to prevent anger and withdrawal just like a correct sequence of events in a hospital helps to prevent infection.

Okay, so maybe conferences are not life-and-death situations on the surface. And they definitely are not rock-n-roll concerts. However, they can be important moments in a child’s education, and key pivot points in the relationship between a family and the school. Getting things right in the conference – covering the important issues fully, addressing critical needs, and valuing the family’s time – is an important part of building trust and making sure that the student’s needs are met. There are a finite number of things that can potentially be covered in a conference, which have a seemingly infinite number of permutations. A checklist like the one here is an investment in the golden triangle – the relationship between the student, teacher, and parent.

 

Checklists to help in moments of conflict or crisis

Pilot Chesley “Sully” Sullenberger will be the first to tell you that he finds it odd to be famous as a pilot because he crashed a plane. As his passenger jet lifted off from LaGuardia airport in 2009, it struck a flock of geese, causing damage to both jet engines. There could have been dozens of causes. The airline industry, which has an understandable focus on safety, has used checklists for years, and they had one for just this situation. Sully and his copilot were able to speed twice through this troubleshooting checklist before deciding they needed to look for the safest possible place to land a plane in Manhattan. He chose the Hudson River, and there were – famously – no deaths. He attributes his clear thinking to his familiarity with the checklist. The process for eliminating all possible causes reduced his panic and allowed him the time to find the best place to crash land.

Checklists can not only be used to make sure that the necessary steps all happen in a moment of high tension or anxiety, they can also work to make sure that steps happen in the correct order. At Gamble Montessori high school, we realized that when students returned from suspension, that they felt dislocated from the school – out of touch with what they had missed in class, and still feeling as if their teachers distrusted or disliked them because of the incident. So we instituted a return conference checklist, which we explain in more detail in our post Welcome Back. We had learned from experience that these steps had to happen in a certain order. Too often, these conferences after an incident immediately start with a description from someone at the school of what happened. The student often would react one of two ways: they would either dispute the details of what was being said, or they would sit in silence and mentally remove themselves from the conference. We know that a student in this mindset will not be a partner in problem-solving for the future. So we turned the old, ineffective conference model on its head. Our checklist starts with a non-negotiable step where every adult at the table offers a strength that they see in the child. Only later in the conference is there a brief description of the incident followed not with accusations and a re-hashing of the event, but with everyone involved being asked to partner in helping the student be successful moving forward.

This checklisted sequence of questions works to prevent anger and withdrawal just like a correct sequence of events in a hospital helps to prevent infection. The student, having been welcomed back with a shared awareness and acknowledgement of his strengths, gets to become a partner in problem-solving how to help himself be successful moving forward. The intentional sequence of events works to help students return to school ready to learn.

Ordered checklists, simple lists of routines and important processes, are tremendously useful in many professional situations, including education. Whether in routine events, infrequent occurrences, or moments of conflict, having a list of the correct sequence of steps to try can help make sure we reach the best possible outcome for all involved.

Perhaps there are processes for which you already use effective checklists, or there are processes at your school that need to be “checklisted.”

We would love to hear your ideas in the comments below.

[1] “Newsroom.” Cincinnati Children’s Earns National Award for Patient Safety. Jim Feuer, n.d. Web. 30 July 2016.