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Undo – How history's outliers got stuff done
How to make fewer mistakes – The Checklist Manifesto
00:23:47
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- [00:01]
Aisha Khan
Okay, patient is a 22 year old male with a stab wound to the chest, likely from a small blade. I'm going to make the first incision just above the fourth intercostal space, mid clavicular line. Scalpel, please, nurse.
- [00:13]
Mark Stedman
Yes, Doctor.
- [00:14]
Aisha Khan
Making the incision now. Suction. He's bleeding out. Get me more gauze. He's losing too much blood. He's about to go into cardiac arrest. Thank you, nurse. Right, keep packing gauze and you apply some pressure. I'm going to clamp the vessel. Wait a minute. What the hell is this? Nurse, I thought you said this was a shallow stab wound. For crying out loud, man, this thing's a foot long.
- [00:40]
Mark Stedman
That actually happened? Not exactly like that. Obviously no one talks like that in operating theaters. But scenes like it have been played out not just in glossy medical procedurals, but in the messy and less satisfyingly real world for decades. Simple mistakes like not getting an accurate history or even double checking the right patient is on the table, are more common than it's comfortable to admit. But there's a dirt simple technique that has dramatically reduced the number of preventable deaths. And it's stuff we can use to make our own lives run more smoothly. No scalpel required. I am Mark Stedman and this is undo. Flushing out productivity bullshit and pumping the patient with 50C seas of clear, easy to implement and subtly life changing goodness. And also saying stat. What is it they say? To ER is To err is human. To err is human. So humans make mistakes. It's part of our brand. Along with potato salad, income tax and Bluetooth toasters. Mistakes are part of what make us us. But mistakes can also cost lives. And while there is a certain amount of shit that will always just happen on any given day, many of our bigger boo boos are preventable. Over 50 million surgeries are performed each year in the US of that number, around 0.3% will result in a death. And around half of those Deaths are avoidable. 0.15% doesn't sound like a lot, but it equates to 75,000 people dying needlessly every year. Try making a wry joke out of that, Mark. When we look at big events like deaths, we often want to attribute them to big causes, right? That's why people look for conspiracies around assassinations, for example. It just doesn't make sense that something so monumental can be caused by something so mundane. But that's often the way of things. And mistakes are no different. They're basic. Just like Janet from Accounts Receivable is basic. Sorry, Janet, but you know what you did. We make mistakes for two main reasons, ignorance and incompetence. Some mistakes we make because we don't know what it takes to do a good job, and others we make because we know what it takes. We just didn't do it for some reason. Maybe we skipped a step because we thought it wouldn't matter, or time was ticking and we need needed to get something out the door. As I write this, America's mascot in chief, the one who looks like a piece of burnt toast as opposed to the one who looks like a big old scrotum, has ordered that his new Air Force One plane be ready now because he wants it. Part of the delay in getting the new 747s Airborne is a bunch of safety checks, which Trump would ostensibly rather bypass if it means he can play with his new toy quicker. We'll talk about flying in a bit, but I mention this not to open another can of political worms at you, but to make the point that mistakes happen when we skip important steps. Okay, so fine, mistakes happen. How do we stop them? Or at the very least, dramatically reduce the probability of them happening? Let's turn our attention back to those 75,000 people dying preventable deaths every year in the U.S. that was the state of affairs surgeon Atul Gawande was confronted with in 2009 when he was asked to look into ways surgeries could improve. He studied other industries and found that the simplest, dumbest thing is the solution. Make a list. Now, surgeons are careful, methodical, and have brains packed full of history and anatomy and chemistry and probability. They're clever dudes, is the point. Now, if you tell a clever dude that the first thing they need to do is check that they've got the right patient, they're probably going to give you a look that would wither an oak tree.
- [04:55]
Atul Gawande
There's a deep resistance because using these tools forces us to confront that we're not a system, forces us to behave with a different set of values. Just using a checklist requires you to embrace different values from ones we've had, like humility, discipline, teamwork. This is the opposite of what we were built on. Independence, self sufficiency, autonomy.
- [05:23]
Mark Stedman
That's the voice of Atul Gawande, author of the Checklist Manifesto, who we'll meet in a sec. Let's not get ahead of ourselves. So the fact is, it's questions like, do we have the right patient? Or do we know which side of the body we're operating on? Or do we have the right blood on hand that are so basic that people often don't think to check. Now, we're a few minutes in at this point and you might well be wondering what all this has to do with your work. Well, tell me you've never made a typo in an important email or, heaven forbid, sent a text slagging someone off to the very person off whom you were slagging. Tell me you've never done that. And you have my permission to skip this one. But my suspicion is maybe you've made the odd unforced area yourself. And it'd be handy to know how to put some guardrails in place, just like the bumper lanes I insist on when I go bowling. So, back to our surgeon, Atul Gwande. Atul qualified as a medical doctor in 1995, the year that brought us Cotton Eyed Joe and Boombastic. Within three years, he he'd start work as a staff writer for the New Yorker and in the early 2000s would begin looking into mistakes in medical practice. Part of that research led him to the story of a three year old Austrian girl whose life was saved after she fell in a frozen pond. An hour and a half after her rescue from what would otherwise have been certain death. They got her heart beating again and after 24 hours she was breathing normally. The girl would go on to make a full recovery and the case was written up in a medical journal. When Gwande tracked the girl's doctor down, he discovered that the medical team had a checklist, as did the ambulance crew and telephone operators for these sorts of emergencies. The checklist is what saved this young girl's life. Gawande went on to research how effective simple checklists were, and in 2009 published the checklist Manifesto, which would go on to become a New York Times bestseller. Before we get on to how we can make our own bulletproof checklists, I want to introduce you next to Captain Joe. Joe Dieboulder is a pilot and aviation YouTuber with over one 1.7 million subscribers. He uses checklists in three key areas. Flying planes, natch, publishing his YouTube videos and running his morning routine. If you've heard my episode on eating the frog, you'll be familiar with some of this. But this routine starts with a list of his top five tasks for the day in order of importance. He then works through them one by one, ensuring that each task is fully complete before moving to the next. In surgeries, this can cause delays, as Atul discovered for himself. But if you're going to operate on someone's leg, you want to make sure you've got the right one or the left one, even if it takes you a little bit longer to double check. Captain Joe says a good checklist defines what done looks like. So if exercise is on your morning routine checklist, you'll want to write run for half an hour next to it, for example. We'll talk about that specific example in a bit. Both Gawande and Dieboulder know from checklists. So after this momentary pause, we'll get into building our own checklists, both for our life at work and for the work of life. Yeah, back in a sec. We'll get back to the show in 30 seconds. I just wanted to let you know that Undo plus is now open for business. When you become an Undo plus member, you get access to your own private podcast feed where you can pick my brains, join a Discord community with other listeners and show your support for the show. Your money goes directly into making the show better. So if you enjoy Undo and you'd like a little bit more of it, you can head to undo FM plus. That's undo FM plus. Ooh, bang on. 30 seconds. So we know that making mistakes is part of being human, but there are things we can do to prevent them. The best way to do that is via the methodical deployment of a checklist. So what goes into making an effective checklist? Firstly, we want to make them as short as possible. These should be around five to nine items that need to be completed, and it shouldn't really take more than a minute to read. Any longer than that and we're liable to get distracted. I can't think why. In an age when it's not enough to watch just one TikTok video at a time, we now have to watch how Graham Norton clips on one half of the screen while someone builds a Minecraft tower on the other. I get it. I'm old. Someone yesterday asked me if the Blair Witch Project was my generation's exorcist. Anyway, he's dead now. So checklists need to be simple, but they're not just dummies guides. If you use shorthand to get your stuff done, you should use that shorthand in your checklist. If you've encountered sops before. Standard operating procedures. These differ from checklists because checklists are supposed to be followed by people who already have the requisite knowledge but need reminding not to skip the basics. Next up, you want to define some pause points. These are moments where you stop and make sure everything's done before you move to the next stage. If you've ever had to send an email newsletter to more than five people, you'll know the sense of abject terror that accompanies the clicking of the Senate send button. I mean, it doesn't matter, because however much you scour your copy for typos, some brainiac will invariably drop you an FYI to point out your error, and it's usually the same person each time. Thank you, Francis. The work of sending an email newsletter might not end once you've hit the big send button. You might then want to queue up some social posts or create a graphic for the website version. In that case, one pause point in your newsletter checklist comes before just before you hit send. Pilots have a number of pause points one before the plane starts to move, one before the wheels leave the tarmac, and one for when the little light goes on to tell the flight crew they can dish out the snacks. Oh, speaking of snacks, you'll no doubt have heard the story about Van Halen and their demands concerning Brown M&MS. If you're unaware, it was a rule written into their contract stating the band should be given a bowl full of M and Ms. With all the brown ones removed. Turns out this wasn't a story of rock and roll excess, but a rather prudent safety precaution. If a venue the band were going to perform at had read the rider fully and delivered said bowl of de browned M&Ms, they could be assured that they were dealing with people who sweated the small stuff. But if that request went ignored, so the logic went, what other, more important details might the venue have missed? We're talking about stuff like lighting and pyrotechnics, where if the right safety procedures aren't followed, people could get seriously hurt. Those are what, in checklist manifesto terms, might be called your killer items. Those are the things that absolutely, positively have to be done at all costs. You may not be Eddie Van Halen, but if you're going to go out and play the guitar in front of people, you definitely want to make sure you've packed your plectrum and your guitar for that matter. Now, if you're working with a partner or a team, your checklist should follow one of two paths. Either someone needs to read off each item and then complete it, or they need to complete the step and confirm it's been done. Communication is essential here, and you might want to consider getting someone else to sign off on the checklist. Lastly, you need to keep your checklist up to date, this can be a pain in the bum. But if you're constantly skipping a step or remembering to do something slightly differently because your procedures have changed but the checklist hasn't, that could land you in some pretty hot water. Now, checklists aren't just useful for avoiding mistakes, they can also be handy. The operating manuals for life in general. Captain Joe, our YouTubular pilot, uses them to manage his morning routine, list of jobs for the day, tick exercise tick, breakfast tick, and so on. Like I said earlier, defining the action is good practice. So not just saying what should be done, but maybe how you know it's done. So clear inbox might be on your daily checklist. So in order for that to be ticked off, that means filing, replying to, delegating, or deleting the stuff in your inbox before marking that item as done. We're going to get into clearing your inbox next week, by the way. And if you thought my Bullet Journal episode might have ruffled some feathers, just you wait till I start in on Merlin Mann's crowd. Anyway, one of Captain Joe's additions to the checklist life is this.
- [14:37]
Atul Gawande
I would like you to add a tick box after your action. So the pilots, they read out the checklist and the action required. Now, instead of you calling out the action, I want you to come up with a chant and a victory pose. If pilots do it, sports athletes do it, happy people do it, why can't you trust me? Once you get into that flow state of completing one task after the other, it is so rewarding to shout out.
- [15:02]
Mark Stedman
Your chant after every successful completion of a task. Joe's co pilot confirmed, confirms it's done. And Joe shouts, yeah, buddy. And does a little victory pose. I mean, that's what the TED Talk version of Joe does. At least that feels a little like those things they teach in seminars, but each to their own. And while we're picking nits, let's be real about a few things. Checklists are boring and they slow us down. You're a creative person. You don't want to be bogged down by a bunch of bureaucracy. You want to be in flow. But I think once you get used to it, the checklist actually becomes part of the process. We talked a bit about pen and paper in that Bullet Journal episode, and there's something really satisfying about writing an item down and ticking it off or drawing a big line through it. Some people even write down to do items that they've already to done, because putting a big fat tick in the box Gives them that little endorphin hit. I know it might come off as a bit wanky, but stuff like that does work. It does for me at least. Another way to think about checklists is like the designated driver that lets you have a good night. A good checklist means past you is taking good care of future you, because, let's face it, past you is a genius, whereas future you is an idiot. Every time you complete a checklist, you're proof proving your mastery. You're showing you can not only get the work done, but do it consistently. That might please a boss well enough, but it's a great signal to send to your brain because the more your little lizard brain truly believes you know what the shit you're doing, the more you'll genuinely feel it and the less like an imposter you'll feel. Now, your day might not be compatible with someone like Captain Joe's. Turns out I've never so much as said three words to a pilot, let alone had a drink with one. So I can't imagine our days have similar structures. But if you have a day job, checklists can help you ship work with fewer mishaps, which can get the higher ups off your back. But you can still have a morning routine based on checklists. Okay? So you can't delay getting the bus to work because you needed to complete your morning 5k. The so instead of putting runner 5k down on your checklist, just write down run for 30 seconds. Insanely low bars like this are what help us get better over time. But that is a subject for another day. Now lastly, don't overload your checklist. Only put on the stuff that absolutely needs to be done, not the stuff it would be really great to accomplish today. Too many things and you'll end up being disappointed if you're not able to finish them. This isn't a to do list after all. Listen to what your body's telling you. In the language of chronic illness, if you don't have the spoons to get through your checklist, you done made it too long. You're gonna have days when even getting the bare minimum done is hard enough. So why make that your everyday experience? Pare it back and look after yourself, man. It's the small things like this that help us accomplish the big things. Things frameworks and systems like this give us the safe structure we can play within. If you do any kind of work that crosses a threshold, like writing a blog, singing in front of an audience, or running a food truck, checklists help protect you from that threshold, making sure that only the best of what you do is seen by the world. And with that, I'm marking this episode. Done Tick Undo is written and produced by me, Mark Stedman. The voice you heard at the beginning was that of Aisha Khan. Ayesha hosts the phenomenal podcast every single Sci Fi film ever. And you can check out her work@everysci fifilm.com Naturally, there's a link in the show notes. Those show notes live along with other links and videos at Undo Undo FM Checklist, which is also where you can sign up to Undo plus to get my monthly book reviews and pick my brains. If you want to stick around, I'll be in the shed talking about the time an abandoned checklist made my boss cry and why bedtime routines are better than morning routines. Otherwise, I shall see you next week when we shall nose dive into Inbox zero. This here is not a commercial message, but a thank you. The response to the first few episodes of Undo has been nothing short of amazing. So to anyone and everyone who's binged the back catalogue or shared them with a friend, you have my heartfelt thanks. If you like the show but aren't in a position to support it financially, just telling people about it is the best way to help it grow. And if you ever have any questions or feedback for an episode, hellodo FM is where you can find me. Alrighty, let's get to the shed. Ah, here I am in the shed. So, yeah, I made my boss cry once because I sent an email that had typos in it and it was about the third time that this email had gone through some sort of proofing process and there was an issue and she'd obviously copped a bunch of shit from the client and came in and gave said shit to me. So, yeah, we developed a bit of a system in the office where when we had anything like this, because we used to. This is back in the early 21st century when we used to have to send these newsletters on behalf of our clients. We would go through a bunch of checklists, made sure we do all the links worked and all the artwork was correct and all the grammar and punctuation, all that stuff was correct, done. We'd run through that and then we'd physically print off a piece of paper, sign it, and then we'd run it across to a colleague who would then do the same thing. He would check through the checklist, make sure that all those things were in place and then sign it off. That was a theory I think I feel like in practice the other person just sort of went, yeah, it all looks good and signed it. But at least we had that sort of sci fi, you know, to keys being turned in a lock, you know, in two separate locks operated by two separate people. You know, that trope. I think it, you know, it does work. So I said I would talk about shutdown routines or bedtime routines and why I kind of think they might be better than morning ones. It's something I'm going to dive into at some point to see if there is some actual literature on this rather than it just being a reckon I have. But my reckon is that morning routines are very important. But, but if you're knackered from the night before, then it's just gonna make your focus just go out the window and you're not really gonna be inclined to sort of follow the, you know, follow, follow the plan. So that is something I'm going to be investigating and, and trying to cultivate a shutdown routine. And I'd love to know what your thoughts are on that. If you want to drop me an email, hellondo fm, do, do let me know. And if you want to join Undo plus, then that's something that we can chat about in the members only podcast. But you know, I'll be thinking about stuff like what a really good daily routine looks like and how we can set that up the previous day. How can we put as many pieces in place for future you done by past you. You know that that's going to be, that's going to be the thing. So one of the things I think we have to do is sort of mark the point at which you say, like, this is the end of my day, I'm done. Like, that should be part of the kind of ritual of this routine to be able to say, like, I'm off the hook now. No one gets to ask anything of me anymore. But part of that, that routine means whether it's like setting up your calendar for the next day, writing down your priorities, making sure your lunch is packed, you know, all that kind of stuff, making sure you've got the right things in for breakfast, like those kinds of things again, you using a checklist or something similar. I think the last sort of few things we do before bed or before we decide to sit down and watch severance. Like, I think those kind of things can, can be really helpful. So that's the kind of stuff I'm going to be beginning to explore sort of behind the scenes. So if you do want to follow along for that. You can check out Undo plus or just drop me an email and let me know what you have in in that kind of area. If you know of any books that I should read on that particular topic, then do let me know. Otherwise, it's been fun. I will see you again next week where we do get into Inbox Zero and the Merlin man of it all. So wish me luck on that one and I look forward to chatting again to you next Monday.