By Jon Miller | Post Date: January 6, 2008 11:59 PM | Comments: 2
This is the first post in the 101 kaizen templates series. Only 100 more kaizen templates to go before December 31, 2008! Takt time is 3.5 days per template. I considered planning out and structuring this series but for now we'll just go with the flow and pull. How can follow what and why.
We'll begin this series with the checklist. The format of the checklist template is very flexible. Essentially it is a list of things to check, commonly with a block or a lined space next to each item for putting an X or check mark. In the example below, the checklist is incomplete.
Check is one powerful word in the glossary of gemba kaizen. It is the most important step of the PDCA cycle and the hardest thing to do properly. A good checklist not only gives your kaizen efforts sustainability, it will identify future kaizen ideas.
Anyone who is competent or better becomes comfortable thinking "I know how to do my job" and this leads to the cognitive pitfall known as "confirmation bias" where you tend to interpret all information to your favor. You may falsely recall performing a step, even though you have forgotten. People don't check. This is where a checklist comes in handy. Yet the checklist is not used nearly often enough.
I confess that the checklist above has never been used, and was made up moments before writing this article. Even though the process listed in the checklist for blogging at Gemba is followed, I have never checked things off, and the result has been errors. In the posting of this article, as if to prove my point, an error was made that a checklist would have caught.
Shirking of check sheets is an act of arrogance and pride, and the use of a check sheet is an act of humility. If you can use checklists effectively it is a sign of strength, not weakness. Using a checklist is not only process kaizen, it is personal kaizen. There is a recent article which illustrates this idea in the life and death realm of intensive care in hospitals. The article titled The Checklist ran in the December 10, 2007 issue of The New Yorker and was written by Atul Gawande.
A tag line in the article reads, "If a new drug were as effective at savings lives as Peter Pronovost's checklist, there would be a nationwide marketing campaign urging doctors to use it." And yet the article also notes that the use of checklists "pushes against the traditional culture of of medicine, with its central belief that in situation of high risk and complexity what you want is a kind of expert audacity" or a craftsmanship mentality, if you will. "Checklists and standard operating procedures feel like exactly the opposite, and that's what rankles many people." This is a theme we will return to many times in this series: the importance of communicating the thinking or intent behind the use of the tool so that these kaizen templates can be practically applied.
The results of the use of checklists in intensive care units are convincing. The article cites a 2006 study by the Keystone Initiative on the use of checklists in intensive care units in Michigan. According to the article:
"Within the first three months of the project, the infection rate in Michigan's I.C.U.s decreased by sixty-six percent. They typical I.C.U. - including the ones at Sinai-Grace Hospital-cut its quarterly infection rate to zero. Michigan's infection rates fell so low that its average I.C.U. outperformed ninety per cent of I.C.Us nationwide." And these hospitals saved an estimated $175 million dollars in eighteen months with results sustained over four years "...all because of a stupid little checklist." Checklist, you may not be the brightest star among the 101 kaizen templates, but we love you.
"How to design a checklist?" I hear all of your champions of lean healthcare eagerly asking. In a beautiful example of recursion, internal consistency and "kaizen the kaizen," we have GUIDELINES FOR DEVELOPING EVALUATION CHECKLISTS: THE CHECKLISTS DEVELOPMENT CHECKLIST (CDC) from Western Michigan University. This document is great checklist for developing checklists.