The ‘Checklist Manifesto’ - Saving Lives with Standard Work…?

A recent bestseller expounds the benefits of a simple tool that is being used to save lives in hospitals around the world. How can we apply the same tool to improve quality outcomes in other processes?

Atul Gawande’s book ‘The Checklist Manifesto – How to Get Things Right’ takes possibly the simplest, most effective single idea for improving quality (in any process), and looks at how it can be (and is being!) applied to the medical profession in order to improve outcomes for patients. The idea is borne out of two simple facts: first, every day, all across the world, people undergoing medical treatment die or suffer complications that are entirely avoidable. Second; the solution to that problem is not increased training, or greater discipline, or legal consequences for medical professionals. The solution, is finding a way to help highly skilled people manage all the complexities of their everyday lives in a consistent, repeatable manner.

How can this be achieved? Gawande borrowed an idea from the aviation industry - the checklist; a simple instruction that indicates the steps to be taken and the sequence in which they should be taken. This simple idea transformed aviation industry safety by avoiding the simple human errors that can occur when even highly skilled and experienced individuals struggle to cope with the increasingly complexity of their work. He applied the idea to surgeons – surely one of the most skilled professions, and not subject to the same kind of human error that afflicts us all? Surely an idea as simple as a ‘pre-surgery’ checklist, that addresses the sources of the most common complications and surgery-related deaths (which are widely known and understood already) would not significantly affect outcomes?

Despite much scepticism, the results were extremely positive - in a global trial, surgeons using the checklists had 36% fewer complications and 47% fewer deaths than surgeons of comparable skill and experience who were not using the checklist.

How can we apply these lessons to the pharmaceutical industry? It is now widely understood that reducing the variation of an input to a process will generally reduce the variability of the output, and improve quality. We see this every day in the life sciences industry, with techniques such as ‘Statistical Process Control’ and ‘Quality by Design’ increasingly utilised, and design to do just that. However the potential quality impacts of Standardisation and Standard Work are often misunderstood. Many organizations fail to take those lessons and apply them to one of the most important (but potentially the most variable) inputs – people. This is particularly true of laboratory environments, where analysts will often complete the same task in many different ways – and the lab may suffer variability in results and poor quality, the root cause of which is never fully understood.

Through the application of BSM’s Real Lean principles, we can enable the kind of structured, levelled workload that facilitates the introduction of accurate Standard Work. By using experienced analysts to determine the important steps and design an optimum sequence to complete a task we create Standard Work that not only uses the analyst’s time well, but represents the best method to complete that task. The result is higher quality, improved investigations and root cause analysis (because one of the major variable inputs has been standardised), and a productivity benefit above that realised through the application of Levelling and Flow.