In this episode, Nancy Gamble and I dug into Atul Gawande’s book “The Checklist Manifesto“.
You can listen to the episode here:
For more on Nancy, check out her company at Hire-Profile.com.
Mickey: [00:00:00] There are two types of failure. The first is ignorance. We may air because science has given us only a partial understanding of the world and how it works. There are skyscrapers. We do not yet know how to build snowstorms. We cannot predict heart attacks. We still haven’t learned how to stop.
The second type of failure, the philosophers call ineptitude because in these instances, the knowledge exists, yet we fail to apply it correctly. This is the skyscraper that is built wrong and collapses. The snowstorm who signs the meteorologist? Just plain mist. The stab wound from a weapon the doctors forgot to ask about
That was from Altul Gawande’s book, the Checklist Manifesto. And joining me to discuss it today is Nancy Gamble. So Nancy, welcome. Tell the folks a bit about yourself.
Nancy: Hey Mickey.
For having me. Um, my name again is Nancy Gamble. I run a company here in Atlanta called Hire Profile, and we are a staffing and recruiting firm for marketing, advertising, design and creative, uh, in the southeast.
Mickey: Awesome. So when we were talking before, you had some interesting thoughts on how you sort of came around on the value of this book. So I think that might be a good place to start. So tell me kinda your overall thoughts and, and where you’ve ended up [00:01:00] with what you think of the book.
Nancy: Well, I just wanna start by saying that I’m, I’m a planner by nature. I, I’m probably very enthusiastic about paper planners and I like writing things, and my husband can attest that I love to make lists many for him, uh, that we check off every weekend. It was a natural choice for me, and I loved a lot about the book.
I think at first, My impression was that it was a bit heavy on, you know, surgical and medical checklists for, you know, emergency room care and things like that. And I was wondering for a few first few chapters how I was going to apply this to my business. Uh, but as he broke things down, it started to become more clear and more, uh, of a system that I could adapt to my own business and even personal life.
Mickey: Yep. Yeah, same kind of thing for me. And I think he went with aviation and medicine probably because those two have the biggest implications. Like in either case, if you don’t do things properly, people die. Either you fall out of the sky in [00:02:00] your plane or Yeah, medical procedure goes wrong. And so I think.
And that’s what he also did is he implemented these in those arenas and saw the, the great results there. And what’s interesting is people often resist this kind of thing thinking their oversimplifications are not needed and they’ve got this. But I mean, the numbers, he, he, he showed a lot of numbers and data that support that.
This makes a huge difference if you follow simple checklists and you know, they don’t replace your expertise, your intuition, but, If you use it along alongside of what you do, can help a lot. And I’ve seen that with us at GreenMellen, where adding process sheets and checklists help us tremendously. Like we’ve done this for a long time, we’re 14 years in, but we still have lots of processes and lots of checklists and it makes a big difference.
’cause we probably would’ve done most of that. We might’ve missed an important step somewhere. And having the checklist really helps us avoid that. And really for us, it also helps give . Potential client’s confidence that we know what we’re doing. ’cause we can say, we don’t say we’re gonna do this thing.
We say, here’s exactly how we’re gonna do it and here’s how it works and here’s what you can expect. And even showing off that checklist, I think helps quite a bit.
Nancy: Yeah, I, I definitely liked when he about the results that he got from implementing [00:03:00] checklists. And one thing I found really interesting is that the surgeons that were meant to use the checklist were the most resistant. They felt that that was more of a job.
Nancy: When the nurses basically started telling the surgeons, oh no, you have to do the chest checklist. Most importantly, they started to see the value, but they had to be pushed to it. They saw it as administrative and it was gonna slow them down. But in the long run, catching one mistake could make all the difference. And I think that stab wound, uh, I think that was one of the opening stories is they had skipped the step of asking. The victim in the emergency room, what his, uh, what the weapon was, and they a very shallow stab wound, ended up being a machete that almost went like through his heart.
Nancy: and just missing that small question, uh, saved his life. Or once they realized they
Mickey: right? Yeah. With physicians. That’s interesting ’cause you think back to like [00:04:00] when the germ theory first came around and how it was proven pretty quickly that washing your hands between, you know, working with cadavers and helping women in labor makes a big difference and physicians ignored it for years ’cause they didn’t want to think they were wrong.
And I think we see that again just because they are so smart generally, and don’t think they can be wrong, but knowing you can be wrong is a powerful thing. Um, There’s a quote from the book, I think that summarizes pretty well what you said. Um, he said in the book, quote, faulty memory and distraction are a particular danger in what engineers call all or none processes.
Whether running to the store to buy ingredients for a cake, preparing an airplane for takeoff, or evaluating a sick person in the hospital. If you miss just one key thing, you might as well have not made the effort at all. And so you kinda said that with that stab wound, they missed one key thing and that just about counted any other effort they might make ’cause they ignored that one piece.
Nancy: I, I love baking the cake because I’m not a baker
Nancy: it is so exacting and if you don’t level off something just right or follow every step, go out of order, it’s ruined
Nancy: That kind of stuff. It just proves that a [00:05:00] checklist, it’s not a crutch, it’s not a sign of weakness, um, but it can make your results so much better.
Mickey: Can. Yeah, that one’s interesting for me too. ’cause my wife is a fantastic cook and so she does not round things off and kind of does things by ear and it works out pretty well for her. But for most of us, yeah, for myself included, having that checklist is, is certainly key to it. Uh, another, another thing I thought that was great, talking about balance balancing different things, and he said in the book here, he said, quote,
That routine requires balancing a number of virtues, freedom and discipline, craft and protocol, specialized ability and group collaboration. And for checklists to help achieve that balance, they have to take two almost opposing forms. They supply a set of checks to ensure the stupid, but critical stuff is not overlooked.
And they supply another set of checks to ensure people talk and coordinate and accept responsibility while nonetheless being left. The power to manage the nuances and unpredictabilities the best they know how. I like this one because again, looking back to our team, you know, your point was, you know this, it’s hard to bring this back to a business setting, or it can be.
And so that’s something I’ve looked at a lot with this book is how does this come back to us? And I see two things, the stupid [00:06:00] but critical stuff is a big one. I see in WordPress, you know your site’s on WordPress, you’ve seen sites before. There’s a little checkbox very deep in the settings that says, Block this site from being seen by Google and it’s very effective.
If you check that little box, Google will ignore your site completely. It’s a very stupid but critical mistake that happens a lot because people don’t have a proper checklist and it’s easy for, easy to forget about that little checkbox, and so that makes a big difference. But then, yeah, allowing people to the power to manage the nuances I think is important too.
You know, let our designer say, here’s kinda what we’re trying to accomplish, but now you use your expertise to make it the best you can. And so it’s an interesting balance that’s tricky to find.
Nancy: And I think sometimes our egos can get in the way. If you’ve been doing this job for you 14 years, I’m 20 years, know, you think I’ve got this.
Mickey: It’s a big danger.
Nancy: Tell me how to recruit, how, tell you how to build a website. I. But it’s when we get that attitude that we can easily make a mistake. And a lot of people, the bigger we get as a firm and the bigger you get, the more people that are [00:07:00] affected. If, if you’re skipping steps, what does that say to the people you just brought on? They’re gonna look to you as an example. So it’s best that we all the steps come together as a team and agree, these are the steps.
First, we have to agree these are the right. Checklists and that we’re all going to adhere to them. Because I know for me, I’m the first one to skip a process because I think
Mickey: agreed. Same.
Nancy: And sure enough, every time you skip one, the that comes back to you. It’s like everyone, all the other ones go smoothly except for the one I, I skipped a step and like.
Mickey: I’ve seen the same thing a lot too. So it’s kind of funny. I have my list of notes here and you’re kind of walking right through ’em without even seeing what I have. ’cause the next one I had ties exactly into that. So this is about how they’re embarrassing. This is from the book. He said, quote, we don’t like checklists.
They can be painstaking. They’re not much fun. But I don’t think the issue here is mere laziness. There’s something deeper, more visceral going on when people walk away. Not only from saving lives, but from making money, it somehow feels beneath us to use a checklist, an embarrassment.
It runs [00:08:00] counter to deeply held beliefs about the truly great among us. Those we aspire to be, handle situations of high stakes and complexity. The truly great are daring. They improvise. They do not have protocols and checklists. Maybe our idea of heroism needs updating, so I think we see. Yeah.
Nancy: So true. I, I had a career coach, uh, several years ago named Mariet Edwards, she, during one of our sessions, said, I want you to take the words winging it or wing it out of your vocabulary. You will no longer be winging any meetings. You know, you’re going to prepare, and then you will look as though you are spontaneous and a natural, but it is through that preparation that you can make things look easy.
Mickey: Yep. That’s a great way to put it. I love that. I see that with Robert on our team that does a lot of messaging work. Like he looks like he’s winging it at meetings, asking great follow-up questions, kind of going where it flows. But man, he prepares so much for the meetings to be able to wing it effectively or seem to wing it effectively.
So I hadn’t, hadn’t thought of it that way, but that’s a a great point. [00:09:00] Um, there was one story in here. This is a longer one that you and I had both heard before, but for those that haven’t heard it, I’m gonna read this, this whole quote to you. ’cause I thought it was a fascinating way to make sure others are adhering to checklist.
’cause one thing for you and I to say, we need to use a checklist, let’s use it. But if you’re counting on someone else, use a checklist. It’s hard to know whether they’re it actually following it or if they’re winging it. So I’ll read this quote from the book about, uh, van Halen and an interesting thing in their contract.
So he said, , Quote, listening to the radio, I heard the story behind Rocker David Lee Roth’s. Notorious insistence that Van Halen’s contracts with concert promoters contain a clause specifying that a bowl of M&M’s has to be provided backstage, but with every single brown candy removed upon paint of for forfeiture of the show with full compensation of the band, and at least once Van Halen followed through prematurely canceling a show in Colorado when Roth found some Brown M&M’s in his dressing room.
This turned out to be, however, not another example of the insane demands of power, mad celebrities, but ingenious ruse as Roth explained in his memoir. Crazy from the heat. Van Halen was the first [00:10:00] band to take huge production engine to tertiary third level markets. We’d pull up with nine 18 wheeler trucks full of gear where the standard was three trucks max, and there were many, many technical errors.
Whether it was the girders couldn’t support the weight or the flooring would sink in, or the doors weren’t big enough to move the gear through. The contract rider read like a version of the Chinese yellow Pages because there was so much equipment and so many human beings to make it function. So just as a little test buried somewhere in the middle of the rider, Would be Article 1 26, the No Brown M&M’s Clause.
When I would walk backstage, if I saw a brown M&M in that bowl, he wrote, well, we’d line check the entire production. Guaranteed you’re going to arrive at a technical error, guaranteed you’d run into a problem. These weren’t trifles. The radio story pointed out the mistakes could be life threatening. In Colorado, the band found the local promoters had failed to read the weight requirements and the staging would’ve fallen through the arena floor.
This is one of those you hear about where like how silly they don’t want brown m and ms what divas. But it was actually just, it was brilliant, like the things that, it was ingenious just to make sure others are reading this entire long, ridiculous thing because it matters so much and I thought that was a great [00:11:00] way to handle that.
Nancy: Yeah, it’s a great, a great story. I’ve heard it before from some musicians that I know that they have also put things like that in contracts like. I think there was something about bananas in the dressing room. You know, just something ridiculous.
Nancy: was really there as a proofreading catcher. And I think it’s, it’s a brilliant story.
And that one I remember a lot. In fact, I’m thinking of what I can put in my contract now that to make sure you read it.
Mickey: Yeah, I’ve been thinking of that too with our contracts, and I’m not sure it matters too much ’cause our contract is more, more to protect us. It protects both sides. But if someone doesn’t read it all the way, I don’t think it really matters,
Mickey: but maybe it does. I have to. Yeah, I have to. I have to think through that.
Yeah. No, yeah. Nothing’s sinking through the floor like . They need to provide content to us and we’re gonna do our job. But it, it does make me think like what could we do to make sure people are following it? And really makes me think of other things. If someone’s building us a house or doing some project for us, how do I make sure they’re following the, the steps they need to do?
And I’m not sure I can do that either ’cause I’m not writing their contract. But I think that’s where you just have to find reliable companies that have done things well for years. And if they’ve done things well for years, it’s probably because [00:12:00] they have good checklists to make sure their processes are solid and they do good work.
Nancy: Well, that exact, uh, happened to us recently. We remodeled our kitchen and we could have gone with a cheaper quote that had, you know, Hank and his brother Pete, and they would make the cabinets and they were coming in and they’d get, you know, their plumber to come over. And it just seemed probably, it would’ve been fine. but we ended up going with a company who had, uh, project management software. You were assigned, uh, a dedicated project manager that you could call at any time. Never met them, but we texted and they told me every day ahead of time who would be there that day and what would be accomplished and
Mickey: Oh, nice.
Nancy: when I needed to have the house available and it. Well, especially for my husband who was not happy about having to do a remodel but he said, if that’s the way it’s gonna work, I will do that. I want checklists and contracts and dedicated people communicating with you every day. We knew all the names of all the workers. It was, it was just a phenomenal [00:13:00] experience and will do any remodel that I had with, with a company like that, if not this one.
Mickey: That’s awesome. Yeah. That shows yeah, what they’ve done and you didn’t see the checklist and stuff, but you know, they had ’em back there just because of how they behaved. So yeah, it makes, makes.
Nancy: constant communication, knowing all the people on your team, you know, like that was part of the book as well, is a simple of nurses and the doctors and all of the technicians in the surgery center to meet each other and call each other by name most of the time. Those people have never, may have never even met, not to mention work together on a surgery, just that simple act of humanizing everything, made it flow so much better.
Mickey: Yep. That’s awesome. So yeah, I think we’re gonna wrap up here shortly. This is, yeah, a fantastic book. I think most people listening have probably read it already, and if not, they absolutely should. Any final thoughts or encouragement to read or anecdotes or anything else you’d like to add?
Nancy: just wanna encourage that, that ego part of it to come out [00:14:00] and make yourself a checklist and, and really watch your results. Because I believe if you write out all the steps, not only do you do a better job, but the people around you, uh, can do a better job. So I think if you bring this into business, uh, you’re gonna really see, uh, some benefits.
I think it’s a great book, great
Mickey: Yep. I think so too. He gave me just two quick thoughts with that too, with just making a checklist for yourself. One, it’s just satisfying. Most people enjoy just checking something off, you know, even especially physically on a piece of paper,
Nancy: I’ve written something down just so I could cross it off even if it hadn’t been on the list before.
Mickey: Yeah, back in the day we used to use Asana, the project management software. When you check something off there like NAR Narwals fly through the air and it’s brilliant. Like I love checking things off in there. It was fantastic, but you also made the point of making checklists for yourself. It can be good to make a checklist of what you do that you already do, so you can help other people to do it for you.
As your company grows and stuff, you need to be able to hand off tasks to others. If you write down what you’re doing, it’s a great way to be able to hand it off. So, I thought I’d end with one final quote from the book that I thought tied things up pretty nicely. He said, quote, [00:15:00] when we look closely, we recognize the same ball is being dropped over and over.
Even by those of great ability and determination, we know the patterns, we see the cost. It’s time to try something new, try a checklist. So I think that’s a, a good way to leave it there, uh, folks.
Nancy: You can make ’em yourself.
Mickey: Exactly. Yeah. There’s great software for it and all that, but there’s pieces of paper do just as well for almost everything.
So well said. Um, Nancy, if people wanna find out more about you, how can they find you online?
Nancy: Oh sure. We’re at and just, uh, contact me or find me on LinkedIn. Nancy Gamble.
Mickey: Thank you so much. I appreciate your time.
Nancy: Thank you, Mickey.
Mickey: All right. Thank you.