> A number of studies found that they only help for a few months, while they're new.
Interesting, that kind of surprises me. Without going to research it right now, I wonder how/if the efficacy is affected by things like going through them in tandem with a partner, or doing them out loud or with exaggerated physical acknowledgements (like the Japanese train drivers who point out signs/notices along their route as a way to maintain focus on those notices).
A speculative hypothesis related to this (based on my own experience as someone who has read the Checklist Manifesto and is a big advocate for checklists):
Over time people internalize the checklists because they unwittingly conclude the reason for the checklist is to learn a new procedure rather than foolproof their procedures and avoid errors. As a result, they start to skip the checklist or get sloppy with it.
There are a couple other points related to this that I believe Gawande does address in his book:
1. Doctors (more generally experts or egoists) will be resistant to checklists because they find them unnecessary (given their experience or expertise).
2. Checklists need to managed with regular review and updates.
You can boil Gawande's book down to: "Start using checklists because they're really effective." But his book goes deeper than that and addresses some of the underlying human factors involved in getting an organization to use checklists effectively.
> Doctors (more generally experts or egoists) will be resistant to checklists because they find them unnecessary (given their experience or expertise).
At the end of Chapter 7 of Gawande's book (The Checklist Manifesto) is this revealing tale:
<quote>
Nonetheless, some skepticism persisted. After all, 20 percent did not find it easy to use, thought it took too long, and felt it had not improved the safety of care.
Then we asked the staff one more question. “If you were having an operation,” we asked, “would you want the checklist to be used?”
So basically people stop doing checklists and then claim they don’t work. Checklists are great, but they have to be used. Instead of treating them as a learning process, I treat them as something I explicitly do not have to learn. It frees my mind for other things.
I don't know that this is the case. I was just speculating in response to the claim upstream that Gawande "chose to overlook the studies about how transient the benefit of checklists is." I too would like to see the citations. If there was a study showing this regression, I would be interested to see if it controlled for this sort of factor.
But I agree with you wholeheartedly. I don't want my mind cluttered with stuff that can be handled by simple script.
"Dropping protections because the failure rate dropped" is a common failure mode, as seen in: Checklists, vaccines, financial regulations, and I'm sure many more arenas.
That was the explicit justification for the Supreme Court finding that the Voting Rights Act wasn't necessary, from memory - states weren't doing the things it banned, so it wasn't necessary to ban them any more.
Makes me feel like there's a similarity between implementation of checklist methodology and implementation of agile methodology. Depends so much on culture and processes and people.
While we're guessing, I would figure it just becomes drilled into people as automatic & a given, the same way you buckle your seatbelt without thinking about it.
Interesting, that kind of surprises me. Without going to research it right now, I wonder how/if the efficacy is affected by things like going through them in tandem with a partner, or doing them out loud or with exaggerated physical acknowledgements (like the Japanese train drivers who point out signs/notices along their route as a way to maintain focus on those notices).