The New Yorker has an article called “The Checklist.” While it is pretty long, I found it an enjoyable read. A checklist is not cure all, i.e. it is not a way to replace skilled labor with unskilled. However, it is in a basic sense a recognition of human weakness and fallibility. People are much better at recognition than they are at recall.
It should be no surprise that doctors chaff at idea of checklists. In a certain way, it goes against the cult of individuality ingrained in American culture. This resistance is also a response to scientific management. As “Measuring and Managing Performance in Organizations” by Robert D. Austin explores, the best case scenario for measuring highly skilled professions is partial supervision, that is one can measure some aspects of performance but not all. Austin persuasively argues that in such a situation, tying compensation to observed performance on measurable indicators actually leads to dysfunction. Dysfunction being a state where the measured indicators are improved, but actual performance goes down. Eventual dysfunction is not just coincidental, it is guaranteed. When faced with this dilemma, the die-hard scientific manager will either attempt to move into complete supervision, which is untenable because of the highly skilled nature of the task, or more wisely, recognize their mistake and untie compensation directly to measured indicators.
If a skilled labor’s weakness is to fail to see the value of regimentation, then equal or greater blame must be placed at the feet of scientific managers. While division of labor and industrialization have led to some great breakthroughs in worker productivity, actual dysfunctions of unmeasured economic indicators, such as pollution, safety, and basic human dignity have repeatedly been victims of scientific management’s pursuit of higher productivity and lower costs. Again, this is not just the accidental result of unfettered capitalism, which is the environment that some scientific managers try to mimic internally, it is the ensured result. The problem of with scientific management is fundamentally reductionism. The belief that one has a better picture of what is taking place than they actually do, or that other aspects are unimportant or irrelevant.
The challenge is to mix the proper degrees of regimentation with improvisation; some acceptance to conformity while allowing for individuality and innovation. James Fallows shares his observation of two Eastern cultures in this regard. If a checklist is seen as an end in itself, then it is a failure. If it is seen as tool to enable a person to do a better job, then the results can be pretty astounding. In short, a checklist must not be a crutch or an excuse for failure, but a proven aid for doing a better job. There is a natural tension between routine and spontaneity. So while exploring to find a new balance between these forces, it is important not to lose a basic appreciation of the other. Fundamentalism, in either direction, leads to inefficiency and potentially disaster.