The Checklist Manifesto – A Surgeon’s Attempt to Keep You Alive as a Recruiter



Did you know that over 80,000 people die each year in hospitals due to infections?  Depending on how you define an accident, as many as 225,000 people die each year “accidently” in the United States while being treated by a physician.  (The Journal Of The American Medical Association)  


Check List Compare these numbers to other forms of death, and it becomes apparent that one of the most dangerous things a person can do in the United States is step into a hospital!  However, one of the safest things a person can do is take a trip on a commercial airplane.  On average, only 200 people die each year while undergoing air transport.


A few years ago, an inquisitive surgeon named Atul Gawande noticed this differential and wondered if there was something a surgeon could learn from the airline industry to help save lives.  His discovery was so simple that it almost seems ridiculous:  a checklist saves lives no matter what industry you use it in.


A recent article in the Seattle Times tells the story:

“Commercial pilots have been using checklists for decades.  Gawande traces this back to a fly-off at Wright Field, Ohio, in 1935, when the Army Air Force was choosing its new bomber.  Boeing’s entry, the B-17, would later be built by the thousands, but on that first flight it took off, stalled, crashed and burned.  The new airplane was complicated, and the pilot, who was highly experienced, had forgotten a routine step.

For pilots, checklists are part of the culture.  For surgical teams they have not been.  That began to change when a colleague of Gawande’s tried using a checklist to reduce infections when using a central venous catheter, a tube to deliver drugs to the bloodstream.


The original checklist:  wash hands; clean patient’s skin with antiseptic; use sterile drapes; wear sterile mask, hat, gown and gloves; use a sterile dressing after inserting the line.  These are all things every surgical team knows.  After putting them in a checklist, the number of central-line infections in that hospital fell dramatically.


Then came the big study, the use of a surgical checklist in eight hospitals around the world.  One was in rural Tanzania, in Africa.  One was in the Kingdom of Jordan.  One was the University of Washington Medical Center in Seattle.  They were hugely different hospitals with much different rates of infection.  Use of the checklist lowered infection rates significantly in all of them.”

This is a very counter-intuitive finding.  You’d think that with all the training, equipment, procedures, and smart people involved in the process of conducting a surgery, the simple things would be covered.  But, the opposite is true.  It seems that failures in the mundane arenas of life have a way of derailing some of the most important things we try to accomplish.  Something as simple as a checklist can have a profound effect on the end result.


If you think about it, this finding can be directly applied to recruiting.  Many of us have been working in and around the recruiting process for many years.  While that experience is valuable and necessary to perform at a high level, it can also be the very thing that trips us up.  When we start to see circumstances that repeat themselves, it is human nature to get bored and start to skip steps.  Before long results start to diminish and the cause is not obvious.  We tend to want to concentrate on what we perceive to be the most significant issues (the condition of the market, the quality of the candidates, our company’s offerings compared to competitors, etc.) and assume we have the basics down.  Dr. Gawande would say that’s a mistake.


Have you ever considered building a checklist for your recruiting process?  The new year is a great time to take inventory of the processes you’re using to accomplish the most important functions in your business.  At first, this will feel ridiculous, but as with surgery or commercial air transport, it can have a profound impact on your end result.


Take the time to build a list of 12 to 15 steps that you know work (i.e. best practices) in your recruiting process.  Arrange them in a checklist format and follow the checklist for each candidate.  Then, measure results on a month-by-month basis.  If your results improve, then I guess it’s not just those airline “dummies” who need a checklist to be successful.


One of the questions Dr. Gawande often gets regarding his research is:  If providing a checklist can improve results and (in his profession) save lives, then why has this not been done in the past, and why do surgeons still resist the concept?  The answer is almost as simple as the concept of using a checklist–surgeons don’t want to use checklists because they are arrogant.  Hopefully, this issue will not be the thing that trips you up…
  





Editor’s Note:  This article was written by Ben Hess.  Ben is the Founding Partner and Managing Director of Tidemark, Inc. and a regular contributor to WorkPuzzle.  Comments or questions are welcome.  If you’re an email subscriber, reply to this WorkPuzzle email.  If you read the blog directly from the web, you can click the “comments” link below.