A couple years back Atul Gawande published his popular Checklist Manifesto, recounting the use of checklists in the operating room and arguing that this marvelous tool can be used to reduce injuries and quality errors. On the wave of checklist mania also rides a group of pilots who call themselves Check Six who make a strong case for the precision of checklists allowing for quite amazing feats of gravity done safely.
I personally am a cheerleader for the checklist. My behavioral science colleagues and I have been studying checklists for decades now, publishing research investigating their efficacy in quality improvement, sales, sanitation, and, of course, safety. It is no accident that we made the checklist the primary tool of behavior-based safety. From a behavioral science perspective, the checklist is the Altoid Mint of behavior change techniques… it’s curiously strong … when done right.
Checklists offer a nice mix of antecedents that clarify the behaviors needed — prompting the user in the moment. Progressing through and finishing the checklist can provide some mildly reinforcing feedback of a job well done. Checklists can also be designed to be associated with other consequences to heighten their impact. Pilots, for example, cannot gain clearance to take off until the checklist is completed. In other cases checklists are required to be turned in so supervisors can verify their use.
No ticket to success
However, creating a checklist isn’t a ticket to success; in fact, the opposite can happen.
You see, while checklists can be used effectively to manage behavior, we must fully recognize that using checklists is a behavior itself. In order for checklists to manage behavior, the behavior of using checklists must be managed.
I was in oil fields working to identify and manage critical behaviors that lead to losses such as injury, process safety incidents, or service delivery interruptions. Through a records review, we found that a particular piece of equipment was contributing to most losses and most of the incidents could have been avoided through common preventative maintenance. But the lack of preventative maintenance was causing the issues.
Operators were supposed to conduct the preventative maintenance in a 60-minute interval when the machine was idle between cycles of operation. Managers had been assuming this PM was being done because all operators were required to progress through a PM checklist and turn the checklist in to their support engineers when completed. Piles of these completed checklists could be found on every site.
Piles of photocopies
I asked to look at them and was handed a stack that was just turned in. As I paged through them it occurred to me that they were all the same… exactly the same. They had been photocopied! The person who turned them in had been so brash as to mark out the photocopied date and write in a new one!
A critical piece of equipment requiring critical behaviors to properly maintain was causing significant loss because the checklists were being pencil whipped and the “completed checklists” were then filed away (probably in a round metal container) never to be viewed.
This checklist was over 100 items! It was not physically possible to do all 100 items in the hour or less; the checklist did not consider the context of the work. I also wondered who would want a paper checklist in and out of a pocket when doing greasy maintenance.
Let’s have a lesson in the behavioral principle of Response Cost. The more effort something takes to do, the more punishing it is and the less likely it is to get done. It’s a basic principle that governs nearly everything you do.
Completing a 100-item checklist required too much response cost for the operator. Reviewing these 100-item checklists required too much response cost for the supervisor.
Consider behaviors as currency, effort to be invested. Behavior is going to go where it can have the greatest impact for the time provided. And “impact” is interpreted on a personal level. A 100-point checklist represents a big cost of behavioral currency with little return on investment.
Is it worth the investment?
Using checklists in surgery or piloting an aircraft probably is worth the investment. Doing preventive maintenance, or not, does not have immediate or obviously catastrophic consequences.
Increasing the use of checklists takes consequence management. Increase the reinforcement for doing the checklist through positive reinforcement such as praise or other good things.
Managers are more likely to use negative reinforcement with threats if the checklists are not completed. But managers typically don’t because that would require someone enforcing those consequences that, think about it, is a big response cost too.
Reducing the "cost" of checklists
In the oil fields, we gathered a group of operators, support folks, and supervisors responsible for the equipment and took them through a method of identifying and prioritizing the most critical behaviors that would lead to the most reduction in loss. A 100+ item checklist was reduced to three. The rest of the items were transferred to other points in the operation or in the maintenance yard where the behavioral effort matched more reasonably.
As of this writing, loss attributed to one behavior dropped more than 60% and the use of these “checks” (not called a checklist any longer) increased 75% - 300% depending on the site.
Once the operator demonstrates mastery, completing the behavior nearly 100% of the time, it is time to remove that behavior from the Check and replace it with another critical behavior. Knocking an item off a checklist is reinforcing. Managers can praise these events because this mastery is linked to operational success. No response cost there, only something worth investing in.
Your checklists manifested? Build them smart and use your people. Target behaviors and make them critical. Keep them short but effective, nimble and curiously strong.