More than a to-do list – build teamwork, improve execution with a project checklist
Two unique sources demonstrated a strong link between the use of a project checklist and effective team building in January 2009: the US Airways incident in New York and the publication of a study on medical checklists. The January 2009 special article of the New England Journal of Medicine highlights the surprising results of a medical study that involved the use of checklists. The medical researchers proposed that since about half of all surgical complications are preventable and there is strong evidence linking effective team building to better outcomes, a project checklist can help decrease medical errors and improve patient safety.
The researchers did not anticipate as dramatic an impact as their research demonstrated. Over the course of the study, death rates dropped from 1.5% to 0.8% and serious complications dropped from 11% to 7%, an improvement of 47% and 37%, respectively. The project checklist is only now being recognized as a powerful tool in healthcare, while it has long been used in the military, particularly military aviation, where tools and techniques developed in this low tolerance environment to the error they have highlighted the value of the project. checklist on performance improvement as well as effective team building initiatives.
‘Plan-Brief-Execute-Debrief’ encourages effective team building
Brigadier General Charles “Chaz” Campbell, now retired, spent a considerable part of his career in the United States Air Force in the cockpit of a front-line fighter jet. During his career, he logged more than 3,700 hours on high-performance fighter jets. And on all those flights, Chaz flew without an essential piece of equipment for any pilot just twice: his flight checklist. “Those two times I forgot my checklists,” says Chaz, “I was a nervous wreck even though I knew each step represented on the checklist by heart. Despite that knowledge, the distraction resulted in a significant reduction in performance.” . Chaz continued, stating that “the medical community is one of the few professions that has recently adopted standard procedures. They have now condensed those procedures into checklists, just like military aviation. Most organizations do not invest the time to develop standards and project checklist initiatives and suffer from the resulting lack of execution discipline. “
In addition to demonstrating the value of a project checklist, the study also reinforced the links between project checklists, such as briefings and debriefing, that play a role in effective team-building strategies. “To implement the checklist,” the study reports, “all sites had to introduce a formal pause in care during surgery for pre-operative team presentations, briefings, and post-operative briefings: effective training practices. Equipment that has previously been shown to be associated with improved safety processes and attitudes and with the rate of complications and death reduced by up to 80%. ” Proper informational and briefings to foster effective and collaborative team building, as evidenced by the Plan-Brief-Execute-Debrief cycle, are critical processes in successful military aviation missions, as is the project checklist.
“The act of opening a project checklist,” says Chaz, “speaks to the individual and the team, sending the message that there is a deliberate intention to be disciplined. This intention is often a self-encouraging step that results. in better performance. This occurs in addition to eliminating the obvious errors of omission for which the project checklist is designed. “
The role of a checklist and effective team building in the medical industry
The Joint Commission and other patient safety groups have been incorporating tools that military pilots use not only to reduce errors, but also to improve the performance of the operating room and emergency team during surgery. The U.S. Air Force learned first-hand in the 1950s and 1960s that as pilots transitioned to much faster aircraft from propeller-powered aircraft without proper planning, reporting, and debriefing procedures, more pilots died in training than in combat. Even in the super high reliability of modern aviation, we can see, for example, the US Airways accident on the Hudson River and the importance of checklists and good standard operating procedures. Captain Sullenburger would probably say that in his pre-flight training and briefings, emergencies, like the one he encountered, had been pre-planned, reported and executed in his simulator training and visualized in his head many times before. Think about the impact these simple principles would have on business, or as we are seeing now, in saving lives in our hospitals.
Checklists have long been a tool in the bag of professional tricks of military and commercial pilots to foster both effective team building and personal confidence. “When you get into the cockpit of an F-16, there is only one seat,” says Chaz, “and when you realize that it is all up to you to make the right decisions, that there is no one else to lean on when something works. Too bad, a checklist provides a powerful sense of security and allows you to focus on the mission. ” The project checklist is becoming widely recognized as a powerful tool in many different professions. Some of the main benefits are obvious. A checklist helps ensure that all critical steps in a process are performed. But, as Chaz knows, checklists have much greater and little understood value.
Mutual support: the value of process planning
That value is related to both individuals, as in Chaz’s reassuring psychological need for his checklist and effective team building. When teams make a serious commitment to referencing a project’s checklist, proper execution discipline emerges. To encourage effective team building initiatives, teams are often assigned goals that contain both routine and groundbreaking operations. Routine operations, which can often be numerous and critical to success, can be taken for granted as “driven” by “them,” and finger pointing occurs when the team fails to achieve its goal. Part of the study of the surgical project checklist included a concept that Chaz calls Mutual Support. Chaz explains, “Mutual support is simply taking care of each other and requiring teammates to speak up when something is overlooked or someone makes a mistake. Checking each other’s actions and holding each other accountable during any effective team activity is a an important part of proper use of a project checklist. So when you are a pilot supporting a team of other pilots on a mission, they take care of each other and maybe even use your checklist to help someone else. “
“In a crisis,” he says, “innovation genius is not always helpful. What is absolutely critical to success is doing the things we know from collective wisdom and experience to be right. Developing a good project checklist. and using it correctly is a great way to make sure we always do the right things. “