One Checklist Done Quotes

We are all plagued by failures - by missed subtleties, overlooked knowledge, and outright errors. For the most part, we have imagined that little can be done beyond working harder and harder to catch the problems clean up after them. We are not in the habit of thinking the way the army pilots did as they looked upon their shiny new Model 299 bomber — a machine so complex no one was sure human beings could try it.

I’m Jay Powers, the circulating nurse”; “I’m Zhi Xiong, the anesthesiologist”—that sort of thing. It felt kind of hokey to me, and I wondered how much difference this step could really make. But it turned out to have been carefully devised. There have been psychology studies in various fields backing up what should have been self-evident—people who don’t know one another’s names don’t work together nearly as well as those who do. And Brian Sexton, the Johns Hopkins psychologist, had done studies showing the same in operating rooms. In one, he and his research team buttonholed surgical staff members outside their operating rooms and asked them two questions: how would they rate the level of communications during the operation they had just finished and what were the names of the other staff members on the team? The researchers learned that about half the time the staff did not know one another’s names. When they did, however, the communications ratings jumped significantly. The investigators at Johns Hopkins and elsewhere had also observed that when nurses were given a chance to say their names and mention concerns at the beginning of a case, they were more likely to note problems and offer solutions. The researchers called it an “activation phenomenon.” Giving people a chance to say something at the start seemed to activate their sense of participation and responsibility and their willingness to speak up. These were limited studies and hardly definitive. But the initial results were enticing. Nothing had ever been shown to improve the ability of surgeons to broadly reduce harm to patients aside from experience and specialized training. Yet here, in three separate cities, teams had tried out these unusual checklists, and each had found a positive effect. At Johns Hopkins, researchers specifically measured their checklist’s effect on teamwork. Eleven surgeons had agreed to try it in their cases—seven general surgeons, two plastic surgeons, and two neurosurgeons. After three months, the number of team members in their operations reporting that they “functioned as a well-coordinated team” leapt from 68 percent to 92 percent. At the Kaiser hospitals in Southern California, researchers had tested their checklist for six months in thirty-five hundred operations. During that time, they found that their staff’s average rating of the teamwork climate improved from “good” to “outstanding.” Employee satisfaction rose 19 percent. The rate of OR nurse turnover—the proportion leaving their jobs each year—dropped from 23 percent to 7 percent. And the checklist appeared to have caught numerous near errors. In

But there are some to-do list essentials that we should all know if we want to help our brains navigate the day, based on the science of working memory, motivation, and goal pursuit. I don’t always see people applying these brain-friendly essentials, so here’s a checklist for you to consider: Write it down as soon as it comes to mind. Never waste your brain’s precious working memory by trying to hold your tasks or ideas in your head. Use your intelligence for getting things done, rather than trying to remember what you need to do. That means having a process for capturing to-dos as soon as they occur to you, even if you then end up transferring them to a master list. Only keep today’s tasks in view. You might have a grand list of tasks you’d like to complete in the coming weeks or months. But once you’ve decided what you really need and want to get done today, work off that list, and hide the rest. As long as your longer-term items are visible, they’ll use up a little of your brain’s processing capacity—and may even depress you a little if your long list is very long. Make it satisfying to check off. If you’re online, give yourself a box to check, and a ping or a swoosh to hear. If you’re working on paper, give yourself the satisfaction of a big bold line through everything you’ve done. The more rewarding it feels to track your progress, the more your brain will tend to spur you toward getting things done. Be realistic about what you can do in a day. Progress feels good to your brain’s reward system; failure doesn’t. Do you have five things you’d like to tackle today, but know you probably only have time for three? It’s better to feel great about nailing three tasks. If you succeed and find you’ve got more time, you’ll be flushed with motivation to seek out one or two more tasks. Include mind-body maintenance. Put exercise, rest, and other physical health goals on your list alongside your other tasks. If you take a moment to put “take a walk” on the list, you’re way more likely to build it into your day rather than let it be crowded out by other demands—just as defining goals for anything makes it more likely you’ll get it done.

Use the following checklist to determine when a procedure is needed: � Will anyone ever look at the procedure again? � Will it be used for training? � Do you often have new people who need to be trained? � Is the process so critical to the business that it must be done perfectly? � Would it reduce waste of time or resources to have the process documented? � Would it help save time for your experts by reducing the number of questions that people ask them? � Is it required by any standard or certification? � Does the process involve more than one organization, or is it used by people in different geographic regions? � Do you need to improve or optimize the process

From a nitty-gritty, practical standpoint, here is the drill that can get you there:   Loose Papers Pull out all miscellaneous scraps of paper, business cards, receipts, and so on that have crept into the crevices of your desk, clothing, and accessories. Put it all into your in-basket for processing.   Process Your Notes Review any journal entries, meeting notes, or miscellaneous notes scribbled on notebook paper. List action items, projects, waiting-fors, calendar events, and someday/ maybes, as appropriate. File any reference notes and materials. Stage your “Read/Review” material. Be ruthless with yourself, processing all notes and thoughts relative to interactions, projects, new initiatives, and input that have come your way since your last download, and purging those not needed.   Previous Calendar Data Review past calendar dates in detail for remaining action items, reference information, and so on, and transfer that data into the active system. Be able to archive your last week’s calendar with nothing left uncaptured.   Upcoming Calendar Look at future calendar events (long- and short-term). Capture actions about arrangements and preparations for any upcoming events.   Empty Your Head Put in writing (in appropriate categories) any new projects, action items, waiting-fors, someday/maybes, and so forth that you haven’t yet captured.   Review “Projects” (and Larger Outcome) Lists Evaluate the status of projects, goals, and outcomes one by one, ensuring that at least one current kick-start action for each is in your system.   Review “Next Actions” Lists Mark off completed actions. Review for reminders of further action steps to capture.   Review “Waiting For” List Record appropriate actions for any needed follow-up. Check off received items.   Review Any Relevant Checklists Is there anything you haven’t done that you need to do?   Review “Someday/Maybe” List Check for any projects that may have become active and transfer them to “Projects.” Delete items no longer of interest.   Review “Pending” and Support Files Browse through all work-in-progress support material to trigger new actions, completions, and waiting-fors.   Be Creative and Courageous Are there any new, wonderful, hare-brained, creative, thought-provoking, risk-taking ideas you can add to your system?

Managing the Neutral Zone: A Checklist Yes No   ___ ___ Have I done my best to normalize the neutral zone by explaining it as an uncomfortable time that (with careful attention) can be turned to everyone’s advantage? ___ ___ Have I redefined the neutral zone by choosing a new and more affirmative metaphor with which to describe it? ___ ___ Have I reinforced that metaphor with training programs, policy changes, and financial rewards for people to keep doing their jobs during the neutral zone? ___ ___ Am I protecting people adequately from inessential further changes? ___ ___ If I can’t protect them, am I clustering those changes meaningfully? ___ ___ Have I created the temporary policies and procedures that we need to get us through the neutral zone? ___ ___ Have I created the temporary roles, reporting relationships, and organizational groupings that we need to get us through the neutral zone? ___ ___ Have I set short-range goals and checkpoints? ___ ___ Have I set realistic output objectives? ___ ___ Have I found the special training programs we need to deal successfully with the neutral zone? ___ ___ Have I found ways to keep people feeling that they still belong to the organization and are valued by our part of it? And have I taken care that perks and other forms of “privilege” are not undermining the solidarity of the group? ___ ___ Have I set up one or more Transition Monitoring Teams to keep realistic feedback flowing upward during the time in the neutral zone? ___ ___ Are my people willing to experiment and take risks in intelligently conceived ventures—or are we punishing all failures? ___ ___ Have I stepped back and taken stock of how things are being done in my part of the organization? (This is worth doing both for its own sake and as a visible model for others’ similar efforts.) ___ ___ Have I provided others with opportunities to do the same thing? Have I provided them with the resources—facilitators, survey instruments, and so on—that will help them do that? ___ ___ Have I seen to it that people build their skills in creative thinking and innovation? ___ ___ Have I encouraged experimentation and seen to it that people are not punished for failing in intelligent efforts that do not pan out? ___ ___ Have I worked to transform the losses of our organization into opportunities to try doing things a new way? ___ ___ Have I set an example by brainstorming many answers to old problems—the ones that people say we just have to live with? Am I encouraging others to do the same? ___ ___ Am I regularly checking to see that I am not pushing for certainty and closure when it would be more conducive to creativity to live a little longer with uncertainty and questions? ___ ___ Am I using my time in the neutral zone as an opportunity to replace bucket brigades with integrated systems throughout the organization?

Identifying Cultural Norms The following domains are areas in which cultural norms may vary significantly from company to company. Transitioning leaders should use this checklist to help them figure out how things really work in the organizations they’re joining. Influence. How do people get support for critical initiatives? Is it more important to have the support of a patron within the senior team, or affirmation from your peers and direct reports that your idea is a good one? Meetings. Are meetings filled with dialogue on hard issues, or are they simply forums for publicly ratifying agreements that have been reached in private? Execution. When it comes time to get things done, which matters more—a deep understanding of processes or knowing the right people? Conflict. Can people talk openly about difficult issues without fear of retribution? Or do they avoid conflict—or, even worse, push it to lower levels, where it can wreak havoc? Recognition. Does the company promote stars, rewarding those who visibly and vocally drive business initiatives? Or does it encourage team players, rewarding those who lead authoritatively but quietly and collaboratively? Ends versus means. Are there any restrictions on how you achieve results? Does the organization have a well-defined, well-communicated set of values that is reinforced through positive and negative incentives?