Preparing Your Professional Checklist

Just like a doctor who laid out simple ways to avoid line infection, business leaders could gain from a similar humbling self-discipline

by Marshall Goldsmith

My friend Dr. Bob Spiegel, the chief medical officer at Schering-Plough (SGP), just sent me an amazing article from The New Yorker titled "The Checklist" (Atul Gawande, Dec. 10, 2007), which describes the groundbreaking work done in medical critical-care research by Dr. Peter Pronovost.

In 2001, Dr. Pronovost developed a checklist to tackle one problem: line infection, a common complication that may occur when a catheter is inserted into the body. His checklist to avoid line infection is incredibly simple. "Doctors are supposed to (1) wash their hands with soap, (2) clean the patient's skin with chlorhexidine antiseptic, (3) put sterile drapes over the entire patient, (4) wear a sterile mask, hat, gown, and gloves, and (5) put a sterile dressing over the catheter site once the line is in."

These were not new steps. They had been known and taught for years. However, when nurses observed doctors in real intensive-care practice for one month, at least one of these steps was skipped in more than a third of patients.

For the next year, one hospital decided to enforce the checklist. Nurses were authorized to "stop doctors if they saw them skipping a step in the checklist; nurses were also asked to ask doctors each day whether any lines ought to be removed, so as not to leave them in longer than necessary."

The results from this simple checklist follow-up procedure were phenomenal: infection rates plummeted, lives were spared, and millions of dollars of unnecessary costs were saved.

Checklist Across Industries

Over the last few years, Dr. Pronovost has gone on to replicate this study several times, with consistently beneficial results. In spite of the dramatic positive outcomes produced by his checklist, only a small percentage of hospitals have chosen to implement this procedure.

Three explanations were presented in The New Yorker piece: (1) the egos of some physicians, who felt insulted that professionals with their level of wisdom and experience should have to stoop to the level of being monitored by nurses and governed by a checklist, (2) a feeling of already being too "busy" and an aversion to more "tasks" in a world that is already consumed with too much bureaucracy, and (3) a medical research establishment that is almost entirely focused on more "exciting" issues such as disease biology and finding therapies for treatment, while often ignoring more "mundane" research that measures if therapies are effectively delivered to patients.

I believe that Dr. Pronovost's "checklist" discipline can be used in myriad ways outside of the medical arena. For example, in my work with executives, I see even the most successful leaders make very common mistakes when facilitating team meetings. Perhaps a checklist could help leaders avoid some of these routine errors. During the team meeting leaders could have a checklist with items including: (1) clear goals for the meeting, (2) encouraging input from participants, (3) listening without interrupting, (4) recognizing others for their contributions, and (5) avoiding destructive comments about co-workers in other parts of the organization.

While a simple checklist would not solve all the problems that occur in team meetings, it would probably help leaders to become more effective facilitators and help teams become more effective in solving problems.

Outlining What You Know You Should Do

As an executive coach, I find that my clients almost always know what they should do. They, like all human beings, just don't always do it. In the same way the nurses in Dr. Pronovost's research remind doctors to do what they already know they are supposed to, I remind executives. Just as in Dr. Pronovost's research, it works!

For example, almost every leader preaches—and believes in—the value of synergy and cross-organizational teamwork. Many of these same leaders slip on occasion and blast their cross-organizational colleagues in team meetings.