2. About the Presenter
VP of Product at Contactually
since April 2014
Leads x-fn team and develops the
product vision, strategy, and roadmap
Jordan Berman
3. Atul Gawande, MD, MPH, is a surgeon,
writer, and public health researcher.
“[Gawande] is really interested in a
problem that afflicts virtually every aspect
of the modern world–and that is how
professionals deal with the increasing
complexity of their responsibilities.”
— Malcolm Gladwell
About the Author & Book
4. Problems to-be-solved
☑ How do we improve quality of our output throughout the product
development process, from conception through deployment?
☑ How do we create repeatable processes that are lightweight and help us
scale our team?
☑ How do we get increase collaboration and coordination across roles on
the team?
circa July 2015
6. Johns Hopkins’ Infection Checklist
☑ Wash hands with soap
☑ Clean the patient's skin w. chlorhexidine antiseptic
☑ Put sterile drapes over the entire patient
☑ Wear a mask, hat, sterile gown, and gloves before operating
☑ Put a sterile dressing over the insertion site once the line was in
7. RESULTS
Year 1: Hopkins' rate of infections went from 11% to
zero.
Year 2: prevented 43 infections, 8 fatalities, and
saved over $2m
8. WHO Safe Surgery Checklist
Surgery has four big killers: infection, bleeding, unsafe anesthesia, and “the
unexpected.”
Gawande concluded a standardized checklist could address the first three,
and the fourth could only be surfaced by provoking a discussion about team
member concerns.
The first draft of the WHO Safe Surgery Checklist was piloted at eight
hospitals of widely varying geography, wealth, and resources. A three month
baseline review was conducted and complication rates varied from 6-21% of
surgeries.
9.
10. RESULTS
No new equipment or techniques were introduced
during the experiment - surgical teams just added
the checklist to their processes.
By the end of the pilot program, major complications
fell by 36% across the eight hospitals and deaths
fell by 47%. In the sample of 4000 patients, 150
fewer experienced complications and 27 fewer died
than without the checklist use.
11. Apple New Product Process
“[I]n the world according to Steve Jobs, the ANPP would rapidly evolve into a
well-defined process for bringing new products to market by laying out in
extreme detail every stage of product development.
“Embodied in a program that runs on the company’s internal network, the
ANPP resembled a giant checklist. It detailed exactly what everyone was to
do at every stage for every product …”
— Leander Kahney, “Jony Ive: The Genius Behind Apple's Greatest Products”
14. ☑ Increase “Eptitude”
Human endeavors fail for three reasons:
1. we attempt things beyond our ability;
2. we are ignorant of what we need to know to succeed;
3. we ineptly apply available knowledge.
The explosion of knowledge in the last century has cut down on failure due to
ignorance and shifted to failure from ineptitude. Our chief concern is now
“eptitude—making sure we apply the knowledge we have consistently and
correctly.”
15. ☑ Diminish Complexity
“The volume and complexity of what we know has exceeded our individual
ability to deliver tis benefits correctly, safely, or reliably. Knowledge has both
saved us and burdened us.”
16. ☑ Impose Discipline
“In complex environments, experts are up against two main difficulties. The
first is the fallibility of human memory and attention, especially when it comes
to mundane, routine matters that are easily overlooked under the strain of
more pressing events. . . . People can lull themselves into skipping steps. . . .
Checklists instill a kind of discipline of higher performance.”
“Just ticking boxes is not the ultimate goal here. Embracing a culture of
teamwork and discipline is.”
17. ☑ Focus Attention
Checklists “provide a cognitive net. They catch mental flaws . . . of memory
and attention and thoroughness.”
18. ☑ Aid Judgment
Checklists are not designed to make us automatons and remove the need for
craft or judgment. They produce judgment, aided and enhanced by
procedure.
19. ☑ Gain Efficiency
Investors who added checklists to their process saw their returns improve
and got efficiency gains: “The process was more thorough but faster.” They
could evaluate more deals than before.
20. ☑ Encourage Conversation
Checklists are reviewed jointly by multiple members of the team at key
“pause points” where multiple members of the team need to work together
but may otherwise “hand off” work from one person to the other.
22. Gawande looked to other disciplines, namely construction project
management, aviation, and supply chain/logistics, to develop general
principles for a good checklist. What he found in common:
☑ Forcing functions exist to provoke conversation between multidisciplinary teams, referred to as
"pause points."
☑ These conversations, focused on what could go wrong, produce an "activation phenomenon."
☑ Interventions must be simple, measurable, and produce widely transmissible benefits (high ROI)
☑ Each item on the checklist must be precise, easy to complete, and essential to success.
☑ Measures must be taken to make the checklist use habitual.
☑ Behaviors that are already routine should be omitted.
☑ When possible checklists should be limited to 5-9 items (the limit of working memory)
28. ☑ Get team buy-in; persuade with data; treat it as an experiment
☑ Create & roll out one checklist at-a-time
☑ Focus on area of highest repeatability (code reviews?) - ingrains habits
☑ Review bug reports, error logs, and other sources of data for patterns
☑ Ask the team!
☑ Iterate, iterate, iterate
