Steve Krizman's blog

My organization has a Leadership Forum every quarter for 300 to 400 managers and supervisors. I’ve helped plan and put on more than 30 of them now. For almost every one, there was drama with the slides. This dates back to when slides really were slides — the kind that went up on overheads.

Let’s leave for another post the issue of Death By PowerPoint. Today, let’s talk about mastering the dumb stuff.

For our most recent Forum, we produced four video vignettes, prepped 13 presenters, including the CEO, the Medical Director and the Labor chief, coached 25 facilitators and lined up technology to videoconference the program to 37 locations. The slides were finalized less than 30 minutes before show time.

Next time, we use a checklist. Not just any checklist. A checklist like pilots and surgeons use.

Atul Gawande, the Boston rock star surgeon, says checklists ensure you don’t miss the dumb stuff — like making sure the cargo door is closed or the patient has had antibiotics within 60 minutes of incision. They help rule out the common mistakes so that we reserve our gray matter and adrenalin for the work we are meant to do.

Fact is, we had a checklist for Leadership Forum. One person tracked it and helplessly watched as more and more people got into the act, last-minute changes were made and the unexpected happened.

Our new checklist will be in front of all planners. It won’t be detailed like a recipe, but instead list those things that commonly foul us up: Has the topic been vetted by the right people? Have key presenters confirmed their availability? Have reminders gone out? Have the darn slides been submitted for review at least a week in advance?

There will be pause points: All planners stop, review the checklist and agree that it’s safe to continue on to the next phase.

These are the best practices described by Gawande in his book The Checklist Manifesto. Military pilots began to develop checklists after test pilots “augered in” with a bit too much regularity. Gawande led a World Health Organization project to try checklists in operating rooms large and small, rich and poor. Every single hospital saw dramatic reductions in infections and other post-op complications.

Mistakes may be rare in the OR, but the number of individual actions is so large that even a 1 percent error rate translates to a high probability that a patient will experience one.

“Checklists seem to provide protection against such failures. They remind us of the minimum necessary steps and make them explicit. They not only offer the possibility of verification but also instill a kind of discipline of higher performance.”

A skyscraper is built by hundreds of engineers, craftsmen, accountants and laborers. They use a checklist, one that has periodic pauses at which the different disciplines get together to talk about variances and the adjustments to be made.

Gawande described the “submittal schedule” he saw posted in a construction trailer:

“It was also a checklist, but it didn’t specify construction tasks; it specified communication tasks. For the way the project managers dealt with the unexpected and the uncertain was by making sure the experts spoke to one another—on X date regarding Y process. The experts could make their individual judgments, but they had to do so as part of a team that took one another’s concerns into account, discussed unplanned developments, and agreed on the way forward. While no one could anticipate all the problems, they could foresee where and when they might occur. The checklist therefore detailed who had to talk to whom, by which date, and about what aspect of construction—who had to share (or “submit”) particular kinds of information before the next steps could proceed.

The submittal schedule specified, for instance, that by the end of the month the contractors, installers, and elevator engineers had to review the condition of the elevator cars traveling up to the tenth floor. The elevator cars were factory constructed and tested. They were installed by experts. But it was not assumed that they would work perfectly. Quite the opposite. The assumption was that anything could go wrong, anything could get missed. What? Who knows? That’s the nature of complexity. But it was also assumed that, if you got the right people together and had them take a moment to talk things over as a team rather than as individuals, serious problems could be identified and averted.

So the submittal schedule made them talk. The contractors had to talk with the installers and elevator engineers by the thirty-first. They had to talk about fire protection with the fireproofers by the twenty-fifth.”

Gawande learned that checklists need to be tested in the real world. So that’s what we’ll do with our Leadership Forum checklist. I suspect it will evolve and improve as we go. And while we won’t prevent infections or building collapses, we’ll get the dang slides done on time!