Opinion

A view from Dave Trott: Checklists beat brains

Atul Gawande is the professor of surgery at Harvard Medical School.

Photo credit: Julian Hanford
Photo credit: Julian Hanford

The World Health Organization asked him to help reduce the number of deaths during surgery.

Did we need more training or more technology?

Gawande found they were looking in the wrong place.

He talked to experts in other high-risk professions, such as aviation.

What he discovered was that there are usually three main problems.

1) Problems of ignorance;

2) Problems of technology;

3) Problems of ineptitude.

All surgical attention had been focused on the first two.

They had solved the problem of ignorance: the average surgeon now had ten to 15 years of training.

They had solved the problem of technology: surgeons performed up to 4,000 different procedures and prescribed up to 6,000 drugs.

But, unlike the aviation industry, they had ignored the third problem: ineptitude. 

The problem that highly skilled people often make basic mistakes.

In the airline industry, this was covered by checklists.

Before any pilot takes off, he and his co-pilot run through a basic call-and-response checklist.

"Brakes – set. Elevator trim – set. Rudder trim – set. Autopilot – disconnected. Fuel mixture – rich."

Double-checking the absolute basics don’t get overlooked.

Gawande recommended checklists before surgical procedures.

Reading aloud and checking off the basics: "Patient’s identity. Name of procedure. Area for procedure. Anticipated blood loss. Complement of instruments. Known allergies."

At first, surgical staff resisted – it felt demeaning.

But then the results came in.

At the end of the trial, death rates across the hospitals tested had fallen by 47 per cent.

If they had seen that result from any drug or technology, it would have been hailed as a miracle cure.

But, here, the result came by checking the most basic things.

And using a simple checklist to ensure the basics got done.

Because the basics were actually the most important of all.

It’s a normal human reaction to forget the importance of getting the basic things right.

Human beings get seduced by complexity.

Which is exactly what’s happened in our business.

We are so hypnotised by complexity, we forget the basic checklist.

Does our advertising have the basics: 1) Impact; 2) Communication; 3) Persuasion.

We don’t run a basic checklist because we’re too busy worrying about heuristics, algorithms, programmatic, big data, mobile-optimised, metrics and all the other complex training and technology.

But look at the facts.

We know, in the UK, £18.3 billion a year is spent on all forms of advertising and marketing.

We know 4 per cent is remembered positively, 7 per cent is remembered negatively, 89 per cent isn’t noticed or remembered.

That’s £17 billion wasted because no-one runs a checklist on the basics.

"Impact – check. Communication – check. Persuasion – check."

So 89 per cent of advertising dies right there.


Dave Trott is the author of Creative Mischief, Predatory Thinking and One Plus One Equals Three