• Jim Payne

Checklist Concepts

How is it that hospital errors kill some 250,000 people a year while the airlines rarely kill anybody? It could be because pilots are taught to use checklists to manage their processes.


The following are some of the key concepts from the book The Checklist Manifesto by Dr. Atul Gawande.


There are two types of checklists:

  • Do-Confirm is used to confirm that all the critical steps have been taken care of by reading the checklist after the steps have been done. In the business of providing accounting services, the accountant might enter all of the client’s transactions and do the various reconciliations before turning to the checklist to verify that all the necessary steps have been completed.

  • Read-Do checklist is used by reading each step and then doing the action. In the accounting example, a reviewer might start at the top of the Reviewer Checklist and verify that each of the bank accounts has been reconciled.


What to put and how many items should be on a checklist?

  • Checklist items must be designed to help an expert remember how to manage a complex system.

  • Precision is the goal. Wording needs to be simple and direct. Vagueness will not work.

  • It needs to be short, between 5 and 9 items. Long lists will encourage shortcutting and steps will get missed. Limiting yourself to this small number forces you to prioritize to include only the critically important.

  • You need to test the checklists in the real world and expect that the first draft will have problems.

  • Additionally, over time your checklists will become outdated.


Read the book and you will become convinced that checklists are the answer to producing processes that work.

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