The power of checklists

Spotted this one in the BMJ again: kind of illustrates the power of the pilots’ simple ‘pre-take-off checklist’ – or in this case a similar checklist for surgeons:

Research by World Health Organization (“New England Journal of Medicine” 2009 Jan 14, doi:10.1056/NEJMsa0810119 ) shows that use of a simple 19-point peri-operative checklist – checks immediately prior to and during surgical operations – reduced complications by one-third (from 11% to 7%) and deaths by 40% (1.5% to 0.7%).

The results, from a large statistical base (c.7500 cases) were much the same in rich and poor countries. The English-language version of the checklist is at .

On the same day, I came across this op-ed piece in the London newspaper The Independent, by columnist Dominic Lawson: “I blame computers for this crisis“:

The astonishing power of computers is a wonderful thing, enabling us to do things we would never have dreamed of even a decade ago. Electronic calculation, however, is not the same thing as wisdom; and there are great dangers in confusing the one with the other.

Figures which might cause a nervous collapse when analysed within the human brain, seem soothingly manageable when generated by the click of a mouse; and, of course, there is the usual tendency to think that because it is generated by a computer, it is in some sense ‘right’ – even if the assumptions were originally fed in by a human who had never spoken to, still less met, the end user of the financial instrument. … As the former banker Charles Morris notes, “In 1983, modelling the payout scenarios on a comparatively simple three-tranche CMO [Collaterised Mortgage Obligations]  took a mainframe computer a whole weekend. But by the 1990s, when Sun workstations were standard furniture, CMO shops gleefully turned out phantasmagorical 125-tranche instruments that no-one could possibly understand.” …

If that’s the case, then just how much of the present mess is the fault of enterprise architects, from failing to carry out even basic safety checks? Perhaps more useful, how much is it – or should it be – our responsibility to create some similar means to help get of this mess? Seems to me that if a simple checklist can have that much impact in medicine – 20-30 lives saved just in that relatively small sample, along with vast effective reductions in pain, suffering and financial and other costs – what impact would the equivalents have in enterprise architecture and business architecture?

So what equivalent ‘peri-operative’ checklists could and should we develop? What improvements might we achieve with such checklists? And how would we verify their business value, and value in general?

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