|Why Won't We Use Checklists?|
|Written by John Crossan|
Over the years, as have many others, I’ve spent a lot of time in discussion, debate (argument?) in plants, over the use of checklists for equipment changeovers, startups and other processes. I have explained, reasoned, rationalized, cajoled, appealed, beseeched, entreated, implored, pleaded, urged, (ratiocinated?) and I’ll swear, even cried real tears, in efforts to get people to use checklists.
So for me it was great to find discussions, , referencing a study published in the New England Journal of Medicine that found (amazingly?) that hospitals using checklists in their operating room procedures suffer a much lower death rate than those that don’t.http://www.who.int/patientsafety/safesurgery/en/
I was glad to see the study, but still my very first reaction on reading it, was really outrage, along the lines of “Why was a study like this even necessary? Operating Rooms don’t routinely use checklists? What the (expletives deleted)?"
But experience has absolutely convinced me, that there is something in the human psyche that fights back desperately against using checklists.
“We need to get things done quickly. Checklists will slow us down. We know what we’re doing; we’ve done it a zillion times before.”
Best intentions in the world. Just not a correct statement.
Generally we found on packaging lines, that any missed item on a changeover checklist cost us at least 10 minutes of lost time on startup. In several cases it resulted in some really significant equipment damage, and who knows how many other times, there were damage near misses, or safety near misses. Settings that weren’t changed, bolts that weren’t tightened, clamps left loose,All completely unintentional, done by people who had done it many, times before.
Human memory just isn’t reliable enough, especially if interrupted to briefly do something else, or perhaps someone has a question, or needs a hand momentarily. Once the mind has changed focus, all bets are off on memory.(I'm still incredulous. How can hospital operating rooms not use checklists?)
A weakening memory in our culture seems to be treated as a real indicator of diminished capability, a sign of oncoming senility. the dreaded "senior moments"(An older friend I play golf with on occasion, describes dryly that in his experience, the older people get, the more of them it takes to have a conversation. With a big enough group, someone will remember what fills the blank the current speaker is struggling with.)
But human memory isn’t a reliable mechanism at any age. We all forget our keys, or where we left them, or "What did we come into this room to get?". I’ve seen even the smartest, most capable people I’ve worked with forget things when distracted.
I can understand why surgeons, renowned for the magnitude of their egos, would resist anything that seems to suggest a compensation for a failing capability. But why then have airline pilots (with at least, comparable egos?) accepted checklists for many years. (Well yes, the regulations say they have to, but if you talk to them, they say they just wouldn’t even think of operating without them).
My associate Mike Thomas, (http://msi-lean.com/) who was a navy pilot, and then a trainer of navy pilots and airline pilots for years, explains it as just a part of flying. From their very first exposure to airplanes, pilots work from checklists, and a key part of the trainer’s job is training in how to use checklists, just as much as training in the actual functions of the airplane.
Similarly in plants, we found when individuals are trained to perform tasks using checklists, they tend to continue using them. The difficulty comes when someone has been routinely performing a task before the checklist is developed. Even if they help develop the checklist, it’s still difficult for them to begin using it.
And of course we always got the argument, that for pilots it’s a life and death situation. (Surgeons too?) And the same rigorous practices are just not necessary (and not affordable) in industry. But yet, always, when we started using checklists, things got better and faster.Well the simple answer then, of course, is we just make it a requirement for people to use checklists, and if they don’t, then there are consequences. (Whatever it takes, Seems to work for Jack Bauer.)
I have looked in many files and seen many pristine checklists, and PM workorders, without any fingerprints, or smudges, or stains, and wondered how people could manage to keep them that clean out on the floor.
North Americans historically, are not good at mindless obedience, but we are quite excellent at mindful disobedience, particularly when someone tries to force us to do something we don’t have much value for.
That’s the way people in this country are typically wired. (And I’m sure it’s becoming the case in most countries these days). We always push the limits, and we don’t take much for granted.
So what actually works?
This means constant work for team leaders, supervisors, managers, but it’s an essential part of their job. And most importantly, they themselves, really have to believe that using checklists is the most effective, efficient approach.
(But it's really neat when more and more people become advocates).
Later I found this recent article that really develops the medical issue and gives some great history of the use of checklists.