The Economics of Checklists

I just took a relative to a local hospital’s emergency room. Like Atul Gawande described in his book, The Checklist Manifesto, a nurse first noted “four physiological data points–body temperature, pulse, blood pressure, respiratory rate.” Had we been in that hospital 50 years ago, the procedure might have been very different. It took until the 1960s for the four vital signs to be included in patient charts.
His point? Checklists help you get it right. And, let’s add that getting it right is all about productivity.
Even for a rock band…
In its contract with local promoters for a small city tour, one rock group, Van Halen, required a dish of M&Ms with the brown ones removed in their dressing room. Ignore the request and the concert would be cancelled. Their reason was their checklist. Crucial for safety, the band figured that if the M&Ms were not done properly, insufficient attention would also have been paid to their checklist of safety requirements.
And for an airline pilot…
The year was 1935. In Dayton Ohio, airplane manufacturers were competing for a government contract. Boeing seemed to have it in the bag with its faster, longer distance plane that could carry more bombs than the government asked for. Because its plane crashed on take-off during a key demonstration, other firms got the order.
There was nothing wrong with Boeing’s plane. Having 4 engines, retractable landing gear, wing flaps, constant speed propellers that needed pitch oversight, a rudder control and so much more, it was state-of-the-art…and complicated. With more to remember during take off, the pilot forgot to release the new locking mechanism that manipulated the rudder.
Recognizing the quality of the Boeing aircraft, someone in the army realized the pilot needed a checklist. Subsequently, during 1.8 million miles in the air, the Boeing plane had no accidents and it was crucial in the air war against Germany during WW II.
Explaining checklists, Gawande says they increase the chance for success with simple, complicated and complex problems. Baking a cake is simple, getting that rocket to the moon is complicated, and raising a child is complex. The difference between complex and the first two is the outcome. Just learn your checklist for a simple or a complicated task and you can do it again and again. Not necessarily true, though, for raising a child. With all three types of tasks, however, success is more likely with checklists.
Our bottom line: The simple checklist is all about productivity because it helps us increase the output from the same land, labor and capital.