Book Review The Checklist Manifesto: How to Get Things Right

What makes a good checklist versus a bad checklist?  What are the limits in the power of a checklist?  Sure, checklists work for the weekly run to the grocery store or packing before we go on vacation but can they work to reduce errors in surgery?

The answers to these questions and more can be found in the fascinating book, The Checklist Manifesto by acclaimed writer and surgeon Atul Gawande.  This book is filled with a series of stories from hospital settings to piloting airplanes that makes a compelling argument that using well developed checklists can produce a significant impact on performance success and eliminate errors.  Facing ever-growing complexity in our lives and workplaces along with pressures to get things right the first time, checklists may prove to be a simple yet valuable tool in our error-proofing approach.

The final results of a World Health Organization initiative which is the core study described in this book “showed that the rate of major complications for surgical patients in all eight hospitals fell by 36 percent after the introduction of the checklist.  Deaths fell 47 percent. Overall, in this group of nearly 4,000 patients, 435 would have been expected to develop serious complications based on our earlier observation data. But instead just 277 did.  Using the checklist had spared more than 150 people from harm-and 27 of them from death.”   These results are exciting and hopeful in the quest for improved patient outcomes but it should be clearly understood that the use of checklists is not described as the complete solution to the problem.  It is just a simple one that appears to make a significant impact.

 The Checklist Manifesto is extremely well written that draws the reader along the journey of the author in exploring the power of checklists.  I found the stories interesting and hopeful that the simple checklist might work surprisingly well which the evidence seems to support in this book.

 This book is not a “How-to-do-it” type book however it provides some helpful suggestions in creating useful checklists.  For example, good checklist are designed to only provide critical reminders, practical, precise, easy to use and short and most of all, ones that are used consistently.  In addition, it will take some experimentation and collaboration with the users to develop a good checklist so expect to try out several variations until you create a checklist that works well.

 For more details on building a better checklist, read the chapter The Checklist Factory in which Atul learns about how to create a great checklist from his field trip to Boeing’s “Checklist Factory” under the guidance of uberchecklist master, Daniel Boorman.  I found it fascinating and it opened my eyes to just how difficult it is to create a really good checklist.

 The most significant and insightful observation in this book is the use of checklist as a team activity to enhance communication as a team, to simply talk to each other and coordinate our activities at critical points in the process. Dr. Atul Gawande writes:

 “But like builders, we tried to encompass the simple to the complex, with several narrowly specified checks to ensure stupid stuff isn’t missed (antibiotics, allergies the wrong patient) and a few communication checks to ensure people work as a team to recognize the many other potential traps and subtleties.”

And finally, as we know from our lean and six sigma work, it is not easy to influence culture change, promote new behaviors and sustain improvements, just as the author found in trying to influence surgeons to use checklists. Dr. Atul Gawande writes:

"...using the checklist involved a major cultural change, as well - a shift in authority, responsibility and expectations about care"

As organizations, are we ready and able for a shift in authority, responsibility and expectations for success?  Do we still cling to the illusion of superior lone superstar status or are we ready to humbly work as a member of a well coordinated and trained team?

I enthusiastically recommend this book to all!  This book is easy to read, short and a fascinating story of battling complexity with a simple checklist. The Checklist Manifesto is a must read for anybody working on continuous improvement and reducing errors in any process.

Going from "Oh-oh" to "Ta-da" Faster

As young children, we learn from our experiences through relentless trial and error. It does not take us long to figure out if we touch something hot, for instance fire or a hot skillet, it burns us and we quickly jerk our hand back. This is an example of a fast feedback loop thanks in large part to our central nervous system.

Fast feedback loops are critical to be effective at problem solving. With fast feedback loops we can better link cause and effect. Fast feedback loops within a structured experimental or problem solving process helps us arrive at a solution quicker as we cycle through multiple experiments. Think repetitive, quick PDCA cycles.

One of the obstacles we face in business is slow or disconnected feedback loops. An action takes place and we don’t see the results for a lengthy period of time or sometimes not at all. For example, how long does it take for a quality defect to occur and when it gets detected? We can better solve the problem if it is detected by the operator at the source versus months later by the customer.

Another slow feedback loop typically occurs with many of our metrics and KPIs. How long does it take from the point of process performance till the time it shows up on the chart of graph?

In kaizen, faster feedback loops helps to see quicker if our countermeasure we put into place actually made a positive impact or not. If our countermeasure does not work, we can adjust and try something else quicker.

A great example of the impact in using faster feedback loops can be seen in the Marshmallow challenge. Tom Wujec provides some interesting results when conducting this seeming simple construction challenge. In addition to faster feedback loops, the marshmallow challenge has great insight to team collaboration.

Tom stated “So there are a number of people who have a lot more “oh-oh” moments than others and among the worst are recent graduates of business school. […] An of course, there are teams that have a lot more “ta-da” structures and among the best are recent graduates of kindergarten. […] And that’s pretty amazing. […] not only do they produce the tallest structures, but they’re the most interesting structures of them all.”

When we kaizen, are we more like recent graduates of business school with one PDCA cycle or are we more like recent kindergarten graduates with multiple PDCA cycles?

Where are the opportunities in your business to put in faster feedback loops to quickly move from “oh-oh” to “ta-da”?

Lean Snake Oil Cures what Ails Ya

Step right up Ladies and Gentleman! Do you suffer from bulging inventories? Are you feeling tired and wore down chasing problems everyday at work? Are parts of your organization afflicted by dislocation? Perhaps you suffer from irregularity of flow or constipation and blockage? Do rashes of quality problems create irritability and discomfort? Having trouble applying kanban or finding the time for kaizen? Do you find incorporating lean thinking into your culture just too difficult and painful?

My friends fear not! Your days of suffering are over. Just one bottle of this new and improved formula of lean elixir has been scientifically proven under the most rigorous of conditions to cure what ails ya!

Yes, you heard me correct, my dear friends. This wonderful tonic of the east has the magical like powers to create a self-healing, self-improving, self-regulating system to free you from the hard work, constant coaching and relentless pursuit of perfection. No need to lead by example or get your hands dirty understanding your processes or teach others within your organization. You no longer need to help improve, just let you employees do it on their own under this system of self fixing.

Taking regularly and by explicitly following the directions on the bottle, you will be transformed like never before. And for a few extra dollars, you can speed up the lean process like never before by adding heavy doses of metrics and measurements followed by holding them accountable. Now all you need to do is go back to your office, sit back, relax and let the miracle medicine work its wonder.

Who will be the first to free themselves from the burdens of continuous improvement? Step right up!

Doesn’t this spiel sound just like what you imagine a snake oil salesmen from yesteryear would bark to the crowd gathered around his traveling wagon of wonder cures and concoctions?

Today, there is plenty of snake oil to go around. There seems to be a lot of touting of different models to achieve higher levels of leanness. Some place emphasis on certain lean tools, others promote a specific path or model as the missing link to achieve lean greatness. Really, can a lean system be self healing and self improving? Seriously?

In all my years of experience in learning the lean way and applying lean thinking in various companies and industries, I found that there is no silver bullet and no one best way, despite the boisterous marketing hype. I also learned that lean systems do not run by themselves.

Using kaizen and developing lean thinking into your culture takes time, energy and effort. More time than you think, tons of energy and a tremendous amounts of effort. Even after all your blood, sweat and tears, there are still no guarantees.

The lean approach is not easy and requires practice, perseverance and patience. It takes serious commitment by management that most are not willing to make.

We need everyone involved in kaizen, everyday, everywhere. This certainly includes our management. Everyone needs to make time for kaizen. Management need to be in gemba more often, not less. Bottom line, you can’t delegate kaizen.

So next time you hear about some secret to becoming lean remember that hard work and personal commitment is no secret. In the wise words of our elders before us, “if it sounds too good to be true, it is too good to be true”.

Suffering from Sick Sigma?

My good friend, Jonathan Sands, a Director of Operational Excellence for a large firm, recently told me about his experience with a company six sigma effort years ago. At first go around, he and other leaders undertook their black belt training with a huge burst of energy. Everyone was passionate about their six sigma projects and making huge improvements to their operational performance. The six sigma excitement was as hot as the burning fever with the winter flu.

As the six sigma virus started running its course, management interested grew less interested in dealing with real, significant problems and focused on just adding to the roster the number of people with colored belts. Training was done for training sake.

Anytime a complex problem with no solution known (which you would think is the perfect type for a six sigma black belt to attack) was made visible, it was pushed back and ignored. No real reason why, it just happened.

In just a short time, the six sigma update meetings were held less frequent and attendance started dropping.

Six Sigma projects were just done to get certified. And it seemed that the projects were less and less focused on the customer.

It did not take long for the six sigma fever to break and things started getting back to normal (a return to the status quo).

The six sigma program, left to wither and die, became known around this company as their sick sigma program.

This is not to be critical of the six sigma approach. I know many attempts using lean have met the same fate. Each program starts out with such promise for a bright future only to be found DOA in the morgue a few years later.

And they were so young, such a needless tragedy.

New Webinar "A Day in the Life of a Lean Supervisor"

I invite you to please join me in a free webinar next week “A Day in the Life of a Lean Supervisor” hosted by Gemba Academy on April 4, 2012 at 1:00 pm – 2:00pm (USA-Central Time).

Click here to register.

In this webinar, I will help define standards of daily lean supervision and how to maintain these within your company's lean operating system. Also, I will discuss how supervisors can improve their own performance and promote lean just by focusing on the key needs shared by all employees. I will tell a few stories as examples, talk about a few simple tools and answer as many of your questions as possible.

Listening, Doing, Thinking

The more I listen, the more I know.
The more I do, the more I learn.
The more I think, the more I understand.

Bruce Lee as a Lean Sensei

Growing up I watched plenty of movies, with action movies being my favorite, especially good guy versus bad guy with the good guys always winning in the end with amazing skill, character, courage and perhaps a bit of luck or divine intervention depending on your beliefs. A favorite action hero of mine was Bruce Lee.

I watched in awe, the speed, grace and ability of Bruce Lee’s skill as a martial artist. Learning more about his life, as short as it was, I discovered that Bruce Lee was more than just a gifted martial artist and he actually studied drama and philosophy at the University of Washington.

Here are a few of my favorite Bruce Lee quotes that I find helpful as a source of inspiration:

“The less effort, the faster and more powerful you will be.”

“It's not the daily increase but daily decrease. Hack away at the unessential.”

“If you always put limit on everything you do, physical or anything else. It will spread into your work and into your life. There are no limits. There are only plateaus, and you must not stay there, you must go beyond them.”Obey the principles without being bound by them.

“Fear not the man who has practiced 10,000 kicks once, but I fear the man who has practiced one kick 10,000 times.”

“Knowing is not enough we must apply. Willing is not enough we must do”

“Those who are unaware they are walking in darkness will never seek the light.”

“A wise man can learn more from a foolish question than a fool can learn from a wise answer.”“To know oneself is to study oneself in action with another person.”

“A goal is not always meant to be reached. It often serves simply as something to aim at.”

“To grow, to discover, we need involvement which is something I experience everyday, sometimes good, sometimes frustrating.”

Influenced by Taoism and Buddhism along with his martial arts training, Bruce Lee developed his own set of beliefs and philosophy that challenged the status quo of traditional martial arts and formed his own style. Not only did he have a truly positive attitude and a dedicated spirit for self-improvement, Bruce Lee had some profound insights that we might apply to our lean journey as well as our life journey.