How Can Checklists Be Important to Lean Thinking?

Recently, I read the latest book from Atul Gawande, The Checklist Manifesto, and it brings to life a great Lean technique, the humble checklist. Malcolm Gladwell in Amazon provides a brief summary and review:

Over the past decade, through his writing in The New Yorker magazine and his books Complications and Better, Atul Gawande has made a name for himself as a writer of exquisitely crafted meditations on the problems and challenges of modern medicine. His latest book, The Checklist Manifesto, begins on familiar ground, with his experiences as a surgeon. But before long it becomes clear that he is really interested in a problem that afflicts virtually every aspect of the modern world--and that is how professionals deal with the increasing complexity of their responsibilities. It has been years since I read a book so powerful and so thought-provoking.

Gawande begins by making a distinction between errors of ignorance (mistakes we make because we don't know enough), and errors of ineptitude (mistakes we made because we don’t make proper use of what we know). Failure in the modern world, he writes, is really about the second of these errors, and he walks us through a series of examples from medicine showing how the routine tasks of surgeons have now become so incredibly complicated that mistakes of one kind or another are virtually inevitable: it's just too easy for an otherwise competent doctor to miss a step, or forget to ask a key question or, in the stress and pressure of the moment, to fail to plan properly for every eventuality. Gawande then visits with pilots and the people who build skyscrapers and comes back with a solution. Experts need checklists--literally--written guides that walk them through the key steps in any complex procedure. In the last section of the book, Gawande shows how his research team has taken this idea, developed a safe surgery checklist, and applied it around the world, with staggering success.

The danger, in a review as short as this, is that it makes Gawande’s book seem narrow in focus or prosaic in its conclusions. It is neither. Gawande is a gorgeous writer and storyteller, and the aims of this book are ambitious. Gawande thinks that the modern world requires us to revisit what we mean by expertise: that experts need help, and that progress depends on experts having the humility to concede that they need help.

The reason checklists are so Lean-like is that they are built on the core concept of standardization of work. One of Gawande's major themes is that as the world becomes more and more complex, the typical response of most professions is to promote more specialization. This can, in many cases, be a dead-end as the narrow specialist can miss the obvious if it is out of his or her small area of expertise. Furthermore, the view of the total system and it's response, which is often not the sum of the parts, can be overlooked by the specialist. 

Checklists, properly conceived and designed, do not, as this ridiculous review in the Wall Street Journal posits, encourage rote, unimaginative thinking (see this for a detailed take-down of the WSJ review). On the contrary, they free up the expert professional to focus on solving the problem at hand and not waste time and mental energy rediscovering and remembering what has been done many times before. I will discuss what makes a good checklist in a future entry.