An electrician with twenty years’ experience finishes a job, packs up his tools and drives to the next one. Halfway there, his phone rings. The customer can’t find the compliance certificate, and the estate agent needs it today. It’s sitting on the passenger seat, signed and ready, where it has been all along.
He knows perfectly well that the certificate should be handed over. He’s done it hundreds of times. He simply forgot this once, in the rush of a busy afternoon.
Most business owners have a quiet resistance to checklists. They feel bureaucratic, faintly insulting, the sort of thing you give to a new trainee rather than an expert. But some of the most persuasive evidence for checklists comes from settings full of highly skilled experts, where the stakes could hardly be higher. Their lesson is that expertise doesn’t prevent simple mistakes. Systems do.
One Like insight: A checklist doesn’t assume you don’t know what to do. It assumes you’re human.
Two minutes in the operating theatre
In 2007 and 2008, a team led by Alex Haynes of the Harvard School of Public Health, working with the surgeon and writer Atul Gawande, introduced a 19-item surgical safety checklist, developed with the World Health Organization, in eight hospitals in eight cities around the world, from Seattle and London to New Delhi and Ifakara in Tanzania.
The checklist wasn’t about advanced technique. It covered basics every surgical team already knew: confirming the patient’s identity and the procedure, checking for allergies, making sure antibiotics had been given at the right time, and having team members introduce themselves. Going through it took about two minutes.
The results, published in the New England Journal of Medicine in 2009, were striking. Across 7,688 patients, the death rate fell from 1.5% to 0.8%, and inpatient complications fell from 11% to 7%. One telling detail: appropriate use of antibiotics before surgery rose from 56% to 83%. The antibiotics and the knowledge had been available at every site all along. They just hadn’t been used consistently.
The study compared outcomes before and after the checklist rather than running a randomised trial, so other changes may have contributed, and later studies have found more mixed effects when checklists are introduced without real buy-in. But the central lesson has held up well: even highly trained experts skip essential steps when they’re busy, and a short, shared routine helps catch those slips.
What makes a checklist work
The surgical checklist worked partly because of what it left out. It didn’t try to describe how to perform an operation. It focused on a small number of critical steps that are easy to skip and costly to miss, at the specific moments when they matter: before anaesthesia, before the first incision, and before the patient leaves the theatre.
That’s a useful template for a small business. A good checklist is short, focused on the steps people most often forget, and used at a natural pause point in the work. It isn’t a full manual. The electrician doesn’t need a checklist explaining how to wire a socket. He needs one for the last five minutes on site: test, photograph, tidy, explain, hand over the certificate.
The researchers also emphasised that the checklist changed how the team talked to each other. Saying items out loud, with everyone involved, made it more natural for a junior nurse to speak up if something seemed wrong. In a small business, reading the opening or closing checklist together for a minute can have a similar effect, creating a moment where anyone can raise a concern.
[Infographic placement] Anatomy of a good business checklist. A sample card titled End of job: five checks, with tick boxes: Tested and working · Photos taken · Site tidied · Customer shown how it works · Certificate and invoice handed over. Around it, four annotations: Short (five to nine items), Critical steps only (the ones people forget), At a pause point (end of job, opening, closing), Said out loud (where a team is involved). Caption: Haynes et al. (2009): a two-minute, 19-item checklist cut surgical deaths from 1.5% to 0.8%.
Where to start
Think about the mistakes that have cost your business most in the past year. Not the dramatic ones, but the small, avoidable ones: the forgotten certificate, the unsent invoice, the order that went out without the free sample, the alarm nobody set. Most of them happened at a handover or at the end of a task, when attention had already moved on.
Pick the one routine where those slips happen most, and write a checklist of no more than nine steps for it. Test it for a month. Ask the people using it what’s missing and what’s pointless, and adjust. A checklist that nobody uses is worse than none, because it creates a false sense of security, so keep it short enough to be practical.
A few questions can help:
- Which small mistakes keep happening in our business, however experienced the team?
- At what moment in the work do they tend to occur?
- Could five to nine checks at that moment catch most of them?
- Would the team feel comfortable saying “we missed a step” out loud?
Which brings us back to the electrician and the certificate on the passenger seat. He doesn’t need more training. He needs a laminated card on the dashboard with five lines on it, glanced at before he turns the key. It would take thirty seconds, and it would have saved him a phone call, a U-turn and a slightly awkward conversation with an estate agent.
Sources
- Alex B. Haynes et al., “A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population”, New England Journal of Medicine 360(5), 2009 (DOI 10.1056/NEJMsa0810119). Figures checked via Medical News Today and other contemporary reports.
- David R. Urbach et al., “Introduction of Surgical Safety Checklists in Ontario, Canada”, New England Journal of Medicine 370, 2014 (general reference for the more mixed later findings).
- Atul Gawande, The Checklist Manifesto (Metropolitan Books, 2009), for further reading.
