As we progress toward higher skill work, we assume we can handle the simple aspects of getting work done with our minds. However, the reality is that we can’t – and we shouldn’t.

Why Skilled Workers Should Use Checklists

This particularly true of experts or high-performing professionals, but one such professional realized the folly of this mindset and has gone in the other direction. Atul Gawande, current Assistant Administrator for Global Health at USAID, renowned surgeon, best-selling author, and former professor at Harvard Medical School, has become a global champion of using checklists. He explains why in his New York Times best-selling book, Checklist Manifesto, which Malcolm Gladwell (another global expert) summarizes well in his review of the book:

“Gawande thinks that the modern world requires us to revisit what we mean by expertise: that experts need help, and that progress depends on experts having the humility to concede that they need help… Experts need checklists–literally–written guides that walk them through the key steps in any complex procedure.”

Not surprisingly, the research backs up Gawande’s belief. In 2001, Peter Pronovost, a critical-care specialist at Johns Hopkins Hospital, found that doctors were making simple mistakes leading to 11% of patients acquiring line infections (infections occurring in tubing fed into patient’s bodies). With 1 out of every 3 patients, the doctors skipped one of the simple steps necessary to keep the lines clean. So, Pronovost created a checklist and had them use it. The results were incredible: 

Pronovost and his colleagues monitored what happened for a year afterward. The results were so dramatic that they weren’t sure whether to believe them: the ten-day line-infection rate went from eleven per cent to zero. So they followed patients for fifteen more months. Only two line infections occurred during the entire period. They calculated that, in this one hospital, the checklist had prevented forty-three infections and eight deaths, and saved two million dollars in costs.

How could these accomplished, highly trained, super intelligent doctors and surgeons forget a simple cleaning step 33% of the time? And how could a simple checklist make such a big difference? 

The answer lies in the fact that our brains have a limited working memory capacity. This means your brain can only hold 3 to 7 chunks of information (e.g., 7 numbers, 7 ideas) in your mind at one time. Most tasks today require more than 7 steps – and to complete 7 steps, you must remember more than just the steps. You must also remember each step’s status and sequence. 

World-leading experts and high performers can’t overcome these cognitive limitations, but even if they could, they shouldn’t and neither should you. Your brain has limited resources to use each day. Without a checklist, you spend resources keeping track of what you have to do and whether you did it, rather than doing deep thinking work that drives real value and creates differential impact. That is why comprehensiveness (doing everything you’re asked to do) is on 1 of 16 milestones in the Critical Thinking Roadmap. 

When to Use Checklists

Checklists lay out everything you need to do to complete a task or project. Once you’ve listed the steps, determine the sequence in which those tasks need to be completed, remembering that some tasks may be able to be done in parallel. Then, if you’re working in a team, assign someone to each step in the process and develop an accountability protocol to ensure everyone uses the checklist. 

Accountability protocols are essential because our intrinsic desire to avoid confrontation and power dynamics can keep us from calling out others who skip a step. Here’s how Provonost countered this dynamic in hospitals:

The next month, he and his team persuaded the hospital administration to authorize nurses to stop doctors if they saw them skipping a step on the checklist; nurses were also to ask them each day whether any lines ought to be removed, so as not to leave them in longer than necessary. This was revolutionary. Nurses have always had their ways of nudging a doctor into doing the right thing, ranging from the gentle reminder (“Um, did you forget to put on your mask, doctor?”) to more forceful methods (I’ve had a nurse bodycheck me when she thought I hadn’t put enough drapes on a patient). But many nurses aren’t sure whether this is their place, or whether a given step is worth a confrontation. (Does it really matter whether a patient’s legs are draped for a line going into the chest?) The new rule made it clear: if doctors didn’t follow every step on the checklist, the nurses would have backup from the administration to intervene.

Once you or your team have checked off everything, you know you’re done.

Checklists are most valuable when you’ll be completing the same steps multiple times. However, you may also want to use one for a one-time task that involves a significant number of steps. 

To determine if you should create a checklist, ask yourself 5 questions:

1. Are there more than 3 steps involved? 
2. Will you be doing this again? 
3. Will you have to delegate this to one or more other people?
4. Do you know what steps you’ll need to take?
5. WIll these steps remain relatively constant through future processes?

If the answer to question 1 is “yes,” you probably want to create a checklist. If the answers to 2 and 3 are also “yes,” then you definitely want to create a checklist. Questions 4 and 5 determine whether it is feasible to create a checklist. To create a checklist, you need to know what steps you’ll need to take and those steps need to remain relatively consistent over time. 

Automating Checklists

Practically speaking, how should you go about creating and managing checklists?

You can create a simple checklist on a piece of paper or in a notebook. However this option comes with a host of inefficiencies. The toolkit of the modern worker has much more at its disposal.

For example, most task management apps enable you to create tasks with subtasks that can be assigned to other people and given deadlines. Some apps also include automations that can help facilitate re-assigning steps or updating due dates or the status of tasks.

ClickUp, for example, has both subtasks and checklists that can be used for this purpose:

Asana, Monday.com, and many other apps offer similar features. 

In any of these apps, you should consider going a step forward and creating a task template if you are working on a recurring task. Then you can automatically generate the checklist every time you need to do that task. 

You can also choose to go with an application dedicated exclusively to this idea, called Listables. Listables is a social checklist app. It lets you make copies of other users’ checklists and invite other users to collaborate on yours. 

As Malcolm Gladwell said, it’s time we rethink what expertise and high performance mean and how we achieve it. Checklists are not below our highest performers. They enable our highest performers.