Struggling for Competence


Checklists are loved by pencil pushing bureaucrats who must detail every minute step of some mundane task. They stifle creativity and are an affront to professional judgement. Real professionals rely on their skill and daring to get the job done.

In his book The Checklist Manifesto, Atul Gawande works hard to dispel this attitude and make the case increased use of checklists in a professional setting. I think he has a pretty good argument and even if you are sceptical, the book's a good read.

The main thing to realise is the checklist is not a procedure; it does not define exactly how to do the job or detail every step required. Rather it is a summary, designed to catch common mistakes, which even experienced practitioners make. And a technique to foster teamwork and cooperation - to make sure people are talking to each other.

You can see both these aspects in the Safe Surgery Checklist Gawande developed. Many of the items are designed to trap routine mistakes, for example mislabelled specimen bottles. But some are about teamwork - just prior to skin incision the team introduce themselves by name and reviews anticipated critical events in the surgery.

Developing a good checklist is difficult. There is an overriding need to keep the checklist short, or it will not be used. But this means leaving out information. Deciding what to put in and what to leave out is tricky, and can only really be judged by testing and refining the checklist.

In summary a good checklist should: