In the early 2000s, an anesthesiologist named Peter Pronovost began studying a persistent problem in hospitals: central line infections.
A central line (or central venous catheter) is a type of IV, but instead of going into a vein in your arm, it goes into a major vein in the neck or chest. Central lines make it easier to give medication and to take blood, and they can stay in longer than normal IVs. For patients who are going to be in the hospital for a while, they’re common. And usually they’re inserted without incident.
But sometimes, an infection sets in.
A central line infection is bad news. It’s a bloodstream infection, and patients who need a central line tend to be pretty sick in the first place. Between 12-25% of patients with a central line infection die.
Pronovost had an idea for combatting this deadly hospital killer. It was a sophisticated, abstract idea, and I only barely understand it myself, but I’ll do my best to explain it to you:
Before inserting a central line, doctors and nurses should wash their hands, clean the patient, and use sterile equipment.
In other words, Pronovost suspected that just doing the things they already knew they were supposed to do could enable medical staff to drastically cut the rate of central line infections. He devised a simple, 5-point checklist for preparing to insert a central line:
- Wash your hands with soap.
- Clean the patient’s skin with an antiseptic.
- Put sterile drapes over the entire patient.
- Wear a sterile mask, hat, gown and gloves.
- Put a sterile dressing over the insertion site.
The checklist was first introduced at Johns Hopkins Hospital, one of the leading hospitals in the United States. Their central line infection rate dropped from 11% to 0%. Encouraged by these results, Pronovost then ran a study with 108 ICUs in the state of Michigan, and over 18 months, ICUs using the checklist saw their central line infection rate decrease by an average of 66%, saving 1500 lives and $100 million.
All hail the latest medical miracle! The cutting edge of 21st century medical technology! The . . . checklist?
As author and surgeon Atul Gawande notes in his fascinating book The Checklist Manifesto: How to Get Things Right, we don’t like checklists very much. We fear they’ll make us rigid and unthinking, stripping us of our humanity and turning us into automatons. But, as industry after industry has learned, that’s not what checklists do.
Let’s talk about some of the benefits of checklists and how we can use them effectively in our own lives (even if we never put in a central line).
Checklists reduce error
We make silly mistakes all the time. Doctors and nurses forget to wash their hands, I forget my wallet, and you forget your brown bag lunch on the kitchen table. The human mind is unreliable, and checklists help improve reliability by removing some of the cognitive burden. It’s easier to follow a checklist than to rely on your memory, and in stressful or high-stakes situations, checklists can help us avoid forehead-smacking mistakes. We’ve all had a minor mistake cost us big time, and a good checklist prevents this.
Checklists simplify a complex world
As Gawande points out, most areas of work have become exponentially more intricate and specialized in the last few decades. This was Peter Pronovost’s essential insight—that critical care (caring for a hospital’s sickest patients) has become so complex that no one person can dependably understand what should be done next with a given patient in a given situation. Of course doctors should don a mask before inserting a central line. They know this. But in the whirlwind of the modern ICU, it’s easy to forget even basic steps. In a complex world, checklists provide clarity.
Aviation has understood this for 50 years, and pilots rely on a series of checklists to fly increasingly complicated aircraft. Have you seen the cockpit of a 747? It contains nearly 1000 instruments. I don’t want my pilot trying to remember what to do if something goes wrong—give her a checklist.
Checklists lower the barrier to action
This is my favorite benefit of checklists. Checklists make unpleasant, multi-step tasks easier by breaking them down.
I’ve recently adopted a productivity practice borrowed from Cal Newport called a “work shutdown routine” designed to help me leave work at work at the end of the day. Essentially, I just review all of the projects I’m currently working on and confirm, one by one, that each one is under control and that I have a plan in place that I trust. It takes about 30 minutes, and it’s the last thing I do at work each weekday. Now, put yourself in my shoes. It’s 5:00 PM. Do you really want to spend 30 minutes reviewing every single project you’re working on? You do not. You want to go home.
But a checklist makes things simpler. I don’t really want to spend 30 minutes completing my work shutdown routine, but I am willing to grab my checklist and complete the first step, and before I know it, I’m halfway done. Checklists break down frequent tasks into smaller chunks.
Here are a few examples of checklists you might find helpful.
- Travel packing checklist. A list of everything you want to have with you when traveling. Never forget your phone charger again!
- Leaving-for-work checklist. Wallet, keys, phone? Lunch? Workout bag? Tape up a short checklist by the front door and scan it on your way out the door in the morning.
- Big purchase checklist. Before making a big purchase, it's a good idea to ask yourself a few questions about the situation---"Have I researched alternatives? Could I do without this?"---and a checklist is a great way to force yourself to coolly and rationally evaluate a big purchase.
Checklists are neither new nor exciting, but they can have a significant impact on performance and outcomes in a given area. Consider tightening up any checklists you currently use and adding a few more to your life.