How to make a good checklist

TJL #130

Context

  • The book is a fun read but… doesn’t really tell you how to make a checklist

  • That information is buried in the book, but I have dug it up for you

  • Found in The Checklist Manifesto

Story

When you’re making a checklist, Boorman explained, you have a number of key decisions. You must define a clear pause point at which the checklist is supposed to be used (unless the moment is obvious, like when a warning light goes on or an engine fails). You must decide whether you want a DO-CONFIRM checklist or a READ-DO checklist. With a DO-CONFIRM checklist, he said, team members perform their jobs from memory and experience, often separately. But then they stop. They pause to run the checklist and confirm that everything that was supposed to be done was done. With a READ-DO checklist, on the other hand, people carry out the tasks as they check them off—it’s more like a recipe. So for any new checklist created from scratch, you have to pick the type that makes the most sense for the situation.

  • Define a clear pause point at which the checkpoint is supposed to be used (unless it is super obvious)

  • Decide whether you want a DO-CONFIRM checklist of a READ-DO checklist

But after about sixty to ninety seconds at a given pause point, the checklist often becomes a distraction from other things. People start “shortcutting.” Steps get missed. So you want to keep the list short by focusing on what he called “the killer items”—the steps that are most dangerous to skip and sometimes overlooked nonetheless. (Data establishing which steps are most critical and how frequently people miss them are highly coveted in aviation, though not always available.)

  • Keep the checklist <90 seconds

  • Focus on “killer items”

The wording should be simple and exact, Boorman went on, and use the familiar language of the profession. Even the look of the checklist matters. Ideally, it should fit on one page. It should be free of clutter and unnecessary colors. It should use both uppercase and lowercase text for ease of reading. (He went so far as to recommend using a sans serif type like Helvetica.)

  • Use simple and exact wording

  • Use a legible font (helvetica)

To some extent, we had covered this territory in drafting our surgery checklist. No question, it needed some trimming, and many items on the list could be sharper and less confusing. I figured we could fix it easily. But Boorman was adamant about one further point: no matter how careful we might be, no matter how much thought we might put in, a checklist has to be tested in the real world, which is inevitably more complicated than expected. First drafts always fall apart, he said, and one needs to study how, make changes, and keep testing until the checklist works consistently.

  • Test it in the real world and tweak it

The checklist cannot be lengthy. A rule of thumb some use is to keep it to between five and nine items, which is the limit of working memory. Boorman didn’t think one had to be religious on this point.

  • Keep it short between 5-9 points, but this depends on the task

What we can learn from this story

How to make a good checklist:

  • Define a clear pause point at which the checkpoint is supposed to be used

  • Decide whether you want a DO-CONFIRM checklist of a READ-DO checklist

  • Keep checklist <90 seconds to use

  • Keep checklist <5-9 points (not a hard rule, depends on complexity of task)

  • Focus on “killer items” (based on data)

  • Use simple and exact wording and a legible font

  • Test it in the real world and tweak it