by Jim McGee
March 29, 2010 at 4:07 pm · Filed under
Book Review
The Checklist Manifesto: How to Get Things Right, Gawande, Atul
The idea of a simple checklist to raise the quality of a routine practice seems innocuous enough. It also seems to rankle those with lots of education and experience as an unnecessary intrusion on their autonomy.
The canonical example is the story of the effort at Johns Hopkins Hospital to reduce central line infections in critical care settings. A central line is a catheter inserted into someone’s jugular vein in order to deliver medications. It’s a routine step for many patients in a critical care unit. It’s also a primary source of infection for patients in hospitals. While inserting a central line is straightforward for someone with the proper training, medical professionals will skip steps in the hustle and bustle. Peter Pronovost, a critical care specialist at Hopkins, developed a five-point checklist of the steps necessary to avoid central-line infections.
There’s absolutely nothing on the list that practitioners aren’t already trained to do and absolutely nothing controversial about the steps called for. Many of those professionals considered it an insult to have the obvious pointed out to them in written form. Yet when this checklist was deployed at Hopkins, central line infections dropped from 11% of patients to zero. Comparable results have been routinely achieved elsewhere.
Gawande reported these results first in an article in The New Yorker. In this book he expands on that story to look at
- the origins of the modern checklist in WWII aviation
- multiple examples of checklists deployed in other health care settings
- the challenges inherent in developing checklists that work well in complicated environments
- the difficulties in gaining meaningful acceptance of checklists among highly autonomous professionals
We live in an increasingly complicated and faster-paced world. But our memories are limited and fallible. The right piece of paper in the right place can compensate for those limitations and increase our capacity to deal with that world. The first balancing act is to design a checklist that increases our capacity to handle a situation significantly more than it increases the load on our limited memories. Pronovost’s checklist only touched on the five items most critical to preventing infections. It made no attempt to spell out every possible step in the process.
A checklist shouldn’t be confused with a procedure manual. Avoiding that confusion is an essential element in making organizational acceptance of checklists possible. Checklists are intended to improve and systematize the performance of those who are already proficient. In themselves, they are poor tools for developing proficiency in those still learning their craft.
This confusion between checklist and procedure is at the root of most resistance to efforts to deploy checklists in suitable settings. Unfortunately, Gawande contributes to this confusion himself when he conflates checklists with project plans. Both are useful documents but they serve different purposes and are constructed differently. I’d suggest that you skip the chapter on "The End of the Master Builder" on first reading. It makes the core argument clearer.
Even when properly designed and targeted as relevant aids for the proficient, there is still a change management and leadership challenge to address in deploying a checklist to support more effective practice. While Gawande offers a number of excellent stories and examples of implementing checklists in various settings, he isn’t looking for or tuned into the relevant details of organizational change. This book provides excellent insight into why checklists work and what to think about when constructing them. Expect to look elsewhere for comparable advice on managing the associated change. Expect to need to do so as well.
As compelling as the rational evidence for checklists may be, orchestrating their adoption into the work practices of professionals presents a large hurdle. The hurdle, of course, is emotional. A checklist can be viewed as diminishing one’s expertise rather than as reinforcing it. Reversing that perception for both the expert and the rest of the organization is the key.
by Rob Paterson
March 29, 2010 at 9:14 am · Filed under
Advertising, Trust
Here is the game changer. What if more applied this ethos to what they offered? Look also at how the woman in the ad was shot. Look at how Kotex has brought in bloggers via Facebook to help.
In today’s world what is the most scarce thing of all? Trust!
Being truthful earns it. The real new economy.
by Rob Paterson
March 28, 2010 at 11:48 am · Filed under
Content, Hugh McLeod, Social Contact, Social Media, Social Objects
Facebook has over 400 million members and growing. Why?
Now it is clear that people are finding that online is THE PLACE to find a mate. Average time on site 22 minutes! Average age is 48. Customer spend on average $239 a year. The industry is worth over a $1.0 billion a year. Why?
What this says to me is that:
- People are alone and cut off – they want to find safe ways of connecting
- What we want is social contact more than content
- If you have content, then you have to wrap contact around it - a Jane Austen Book Club will do it – As Hugh says make it into a Social Object
- Your content becomes a Trust builder- Is this why so many personal ads say “I am an NPR listener”? It could just as well say “I am a Tea Bagger” – still tells others who you are
Contact – real human contact is what people want. The proof is in the sex statistic – 1/3 of women have sex on the first date – why? I think because the online dating algorithms work – both feel that they are indeed a match and the barriers go down
And your online social strategy is based on what ideas?
(Via Online Schools)
by Bill Ives
March 26, 2010 at 4:14 pm · Filed under
Enterprise 2.0, Microblogging
I recently read an interesting study by my friend Kate Ehrlich at IBM and her colleague Sadat Shami, It is titled, Microblogging Inside and Outside the Workplace and looks at how corporate employees use microblogging tools. This effort conducted a content analysis comparing over 5,000 posts between March and June 2009 from individuals who were using an internal proprietary tool and Twitter simultaneously. Within these 5,000 plus posts, 58% were done with twitter and 42% were done with the internal tool so there is a reasonable balance for the comparison.
The abstract reports that in “both settings, posts that provided information or were directed to others were more common than posts on status. Within these categories, it was more frequent to provide information externally than internally but more common to ask questions either through broadcast or directed posts internally than externally.” In other words, questions were more likely asked of colleagues within the trusted environment of the enterprise. This makes sense and it is nice some empirical evidence to support this assumption.
The users reported that Twitter was a great source to learn about and share breaking news that other sources, However, they were more likely to ask a question with their work community and more likely to proactively look for questions to answer within this same community. The study reported that “participants talked of using Twitter as an alternative to an RSS feed or feed reader, because the information was already filtered to match their interests and they knew enough about the people providing the information to be confident in the quality of the information they provided.” This resonates well as it is exactly one of my main uses is Twitter.
On the other hand, people inside the enterprise used micro-blogging, in part, to enhance their reputation as someone who is knowledgeable and helps the community. In contrast many of the external posts were done to enhance the reputation and awareness of the organization by providing company news. In keeping with the differences in usage, 15% of the internal posts had links and 26% of the external ones did.
I think this is very useful study and more systematic work needs to be done in this space to supplement our intuition and anecdotal observations.
by Rob Paterson
March 26, 2010 at 10:04 am · Filed under
Public Media, Public Radio, Public TV
Things are moving so fast! In a month the iPad will be here. The shift from traditional computers to Mobile will take off.
But Pub Media are still coming to terms with the web itself. There are still holdouts for Digital Radio. Many hope that Digital Stations for TV are the future. After all huge sums have been spent on them. Many still deny the web. We can see this in the resources applied to it – in most stations less than 20%.
But it is clear now. The Web is it. The web is where we will consume media.
The decisive shift will be 2011 after the iPad has taken hold.
And the part of the web that will be THE place will be Mobile and I include iPad in Mobile.
So is all lost? No!
The Public Radio Player is surely the place to use as a beach head? It has been very popular with 2.5 million downloads in the Apple Apps store (includes upgrades). It has great functionality. It ties nicely back to the stations.
Let’s get a project to build of this and to include TV!
The iPad is ideal for watching video – please please please – make it easy for me to watch the great content of the public system and to integrate it into radio too.
Here is my vision:
- Radio and TV content is integrated – I can search for say Jane Austen and find video and audio and text – I can find other Jane Austen fans in my city – we can get together – we can create a community around out topic
- I can do this for news and opinion – I can follow a topic and draw on all sources – AND from my local community
- I can do this for music, documentary, whatever
The key is to offer the place where the full resources of all the system comes together in one device and in one place and where the community is added too.
