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The Power of a Checklist

The number of surgeries performed every year in the world is growing at a staggering rate, averaging now nearly 250 million per year. Since the 2000s, it has been reported that the number of surgeries performed even exceeds the number of childbirths. However, a 2009 New England Journal of Medicine article reported that at least half of all surgical complications are avoidable. So, while the number of surgeries is growing every year, we still don’t seem to be getting any better.

To address the growing concerns, the World Health Organization started a Surgery Saves Lives program in 8 hospitals in 8 different countries across the world, which represented diverse populations and economic situations. The Surgery Saves Lives program dropped the mortality rate by nearly 50% and the rate of complications by nearly 40%.

How did they do this? It was simple and affordable. They used a checklist.

This checklist is of very simple things, like verifying the person’s identity, introducing all team members in the surgery, and making sure all the needles, sponges, and other instruments are accounted for. Now, it would be easy to remind people of the importance of these various tasks during surgical procedures. The tasks on this list are easy to do. However, they are also easy not to do.

Checklists have a special power and influence that verbal reminders, email notifications, and sticky notes don’t seem to carry. Checklists have been proven to help reduce errors and improve performance in aviation, business, and education.

Setting Standards and Expectations

Early in my consulting days, my workshops consisted of working with teams to help them create a team mission statement, define team values, and create standards and expectations for the season. It was the alternative approach to goal setting. It focused on who they wanted to be and the behaviors which aligned with that identity. Teams would make a list of 10-20 standards on various aspects of their training, practice, games, and off-the-court conduct.

But, then what? Well, it was up to the coach to encourage them, help them reflect on where they were, and hold them accountable to these standards. The challenge is that this can be overwhelming for coaches and players who have high standards but lack the habits and system to sustain those standards. Like the surgical teams, you could remind them of the importance of those standards, but they would often either forget or just choose to not do those things, because as easy as it is to do them—it’s just as easy not to do them!

Imagine if you never worked out, ate fast food once a day, and took the elevator at every opportunity. January 1st comes, and you make a list of all the New Year’s resolutions that someone aspiring to be healthy would make: Working out daily for 30 minutes; a diet of unprocessed, high-protein, low-carb food, consuming vegetables with every meal, and taking the stairs at every opportunity. Following through on one of these new commitments is easy, but consistently following through on all of them would be overwhelming. Even if you only make one commitment (for example, taking the stairs), following through on it can be challenging because again, these things are easy to do, but just as easy not to do.

And it gives you daily feedback on your process and follow-through.

Develop Your System

“You do not rise to the level of your goals; you fall to the level of your systems.”

—James Clear

On Episode 56 of “Coaching Culture”, New York Times bestselling author James Clear states that what people need to build good habits and follow through on them is not more motivation—they need a better system. Our team needs a system in place to help facilitate consistent reminders, reflection, and refinement of their process.

Commitments should be measurable and controllable. One type is objective “yes or no” commitments, such as getting 9 hours of sleep, making 50 baskets, or hitting 100 balls.

Another type is more subjective, self-evaluated commitments, such as effort. Choose a grading scale, for instance, from 1-3. Clearly define the behaviors on that scale. What does a 3 look, feel, and sound like? What about a 2? And a 1? Now, players can simply reflect on their behaviors and evaluate their effort.

Take Action

  1. Visual Post-Practice Reflection: Set a weekly or daily commitment. Then, at the end of your practice, in the huddle, quickly use your grading scale to assess how well this commitment was followed through on. Now, you have a team average. The goal is to improve on that average during the next practice.
  2. The Team Commitments Checklist: Some coaches I work with are already charting wins and losses during a practice. Charting commitments is a way to chart mindset and help both players and coaches see growth in those areas. Create a checklist for players or coaches to record whether or not they followed though on that commitment. Use this to assess individual and team follow-through.
  3. Pennies in a Jar: Every day, for every commitment the team follows through on, they will put a penny in the jar. You can also use rocks, buttons, whatever! The idea is that players start by filling a jar. Then, once the jar is full, you switch to a bucket, and once that’s full, you move on to something larger. Then, by the end of the season, you will have a really big container full of all the commitments the team has followed through on, and they will have a visual representation of the work they put into following through on those commitments.

For more information on these systems, please send me an email to jpnerbun@thriveonchallenge.com

Notes:

  1. James Clear, Atomic Habits
  2. http://www.hartfordbusiness.com/article/20140623/PRINTEDITION/306199955/seven-management-benefits-of-using-a-checklist
  3. https://www.nejm.org/doi/full/10.1056/NEJMsa0810119#
  4. https://www.baatraining.com/flight-safety-discipline-and-importance-of-checklists/

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