Between October 2007 and September 2008, eight hospitals participated in the WHO's Safe Surgery Saves Lives program. These hospitals were from eight cities, including Toronto, New Delhi, Amman, Auckland, Manila, Ifakara, London, and Seattle. And they represented a variety of economic circumstances and a diverse population of patients around the world.
Before the program, researchers collected data on clinical processes and outcomes from over 3,733 consecutively enrolled patients. They then introduced a 19-item surgical safety checklist to all eight participating hospitals for implementation. Their hypothesis was that the checklist would help improve team communication and consistency of care and thus, reduce complications and deaths associated with surgery.
The researchers subsequently collected data on 3,955 consecutively enrolled patients after introducing the Surgical Safety Checklist. What they found was astonishing.
The rate of death was 1.5% before the checklist was introduced and declined to 0.8% afterward. That was a 46.7% drop by implementing the 19-item checklist. And they see a significant reduction in inpatient complications, too—from 11% at baseline to 7% after the introduction of the checklist. That was a 27.3% drop by implementing it.
Making fewer decisions
In my article on decision minimalism, I share how Steve Jobs, one of the co-founders and the former CEO of Apple, wore the same outfit at almost every keynote event. To the point that the black turtleneck, blue jeans, and sneaker become the essential brand elements when people think and talk about Steve Jobs. So do Barack Obama wearing the same gray or blue suits and Mark Zuckerberg wearing the same gray t-shirt.
"You'll see I wear only gray or blue suits," Obama said. "I'm trying to pare down decisions. I don't want to make decisions about what I'm eating or wearing. Because I have too many other decisions to make."
The same goes for Zuckerberg. When asked why he wore the same t-shirt every day, he said, "I really want to clear my life to make it so that I have to make as few decisions as possible about anything except how to best serve this community."
Maybe wearing the same outfit every day isn't for you. And that's fine. There are many ways to pare down the number of decisions you make, and one of the most effective ways is by making checklists. A checklist frees up mental space and allows us to focus on higher-level, non-repetitive things. At the same time, having a checklist helps us get the important things done the right way—every single time.
How to get started with checklists
You don't need to be a surgeon or high-profile CEO to make use of checklists. I used to work as a kitchen helper and a bartender a decade ago, and checklists are everywhere. They are not nice-to-haves. They are must-haves—especially when working in a fast-paced, high-stakes team environment. In fact, the habit of making and using checklists is what turns people into high performers and successful teams.
So how do you start? By observing and tracking what you do daily and weekly. Grab a piece of paper and start making notes on the things you do in a day.
- Your morning routine. What do you do when you wake up? And what's next?
- Your before-bed ritual. What are the things you do to wind down?
- The way you work. What are the things you do to get yourself into deep work?
These are the things you do on a daily basis. And they become checklists when you start writing them down.
You can—or I would say you should—also implement checklists in your work and business. For every hour I spent making these podcast episodes and writing these newsletters, I spent an equal amount of time recording the processes of how I do things, from coming up with content ideas to promoting published work—and turned them into checklists.
While it takes a lot of time, it's temporary. Once you set up your checklists, maintaining and optimizing them takes minimal effort. But you get to use them to speed up your work by not spending the time and energy recalling how to do something repeatedly.
- Want to spend 47% less time on emails? Create an inbox zero checklist.
- Want to get 47% more productive with your meetings? Create a meeting checklist.
- Want to improve your product launch performance by 47%? Create a product launch checklist.
The first step to getting better
It's challenging to assess how we do when we bury ourselves deep in the weeds. And that's how a checklist becomes useful. It helps us separate our thinking and our doing. And it creates the space between our roles as a manager and a maker.
If you ever ask yourself: "How do I improve what I do?" whether it's in your professional work or personal life. Or "How do my team improve what we do?" in your business. You know it's hard to answer that questions without having what you do and how you do them laid out in front of you. And making a checklist is the answer and the first step to getting good and better.