Do Linchpins have Checklists?

Atul Gawande has convinced me that checklists are way more powerful than I’d ever realized.  I picked up The Checklist Manifesto because I love Gawande’s writing and I’m fascinated by ways to improve the practice of medicine.  While I wanted to learn more about improving surgical outcomes, I never expected that in so doing I’d learn why buildings don’t fall down, why planes are a safer way to travel than cars, and how some of the most successful VC firms beat their competitors: you guessed it, they all use of checklists.

Guwande leads with a deep look at the building trade, which used to rely on master builders who ran the show, until that stopped working.   What it takes to put up a building got too complex for any one person to handle in an improvisational way, and so the “master builder” model gave way to intensive use of checklists: checklists that describe who does what, the steps to follow, and, most importantly, how the groups interact with each other.  The parallel is to modern surgery which, until recently, has been dominated by the surgeon as “master builder;” Guwande’s compelling argument is that modern medicine, with all of its sub- sub- specialties and technology, has become so complex that this “master builder” mindset is hopelessly outdated.

As I’ve been digesting this, I’ve been trying to reconcile it with the idea – which I believe on a deep level – that to thrive in the modern economy and to be a happy and fulfilled person, what the world is asking of all of us is that we be linchpins, that we create our art and do the work that no one else can do.  And then the question arises: where are checklists in this picture?

And then it hit me that the point of intersection between checklists and linchpins grows out of the recognition that the most successful checklists define both the steps to take in a given situation AND the norms and expectations for how people are going to interact.  For example, something as simple as members of a surgical team introducing themselves to one another by name before the start of surgery, Gawande found, has a significant positive impact on surgical outcomes: people on the surgical team (nurses especially) are more likely to speak up when a step is skipped or a mistake is made if everyone knows each others’ names.

Last week at NextGen:Charity Seth Godin said that only the perfect problems are left today – because all the imperfect ones have already been solved.  What a great rallying cry!  As our teams get more virtual and more loosely connected, as roles begin to blend and the edges around our roles and responsibilities get softer, the answer Guwande points us towards is not to create a process for everything, to think that there’s a series of all-encompassing steps that will foresee each new situation and how we interact with it.   Instead, the onus is on us to increase our comfort with that place of uncertainty by defining two things: the steps we’re going to take in situations in which the steps can be defined; and how we’re going to interact with each other all of the time.

So it’s not about constantly improvising outside of all norms and best practices; nor about thinking that everything will go right if we can just systematize the process.  It’s about our orientation towards the world, and the knowledge that we can optimize how we solve the imperfect problems and, in so doing, free up the space in our minds and our lives so we can practice our art – and tackle the remaining, perfect problems.

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