Checklists & Solution-Focused Coaching


I am reading the latest book by Atul Gawande: The Checklist Manifesto: How to Get Things Right.

I have always been a fan of checklists: I think they are immensely useful. When I think of checklists I think of pilots in the cockpit of a jetliner getting ready to take that marvel of technology and complexity into the air.

Moreover, I had the chance to appreciate the writing style and the insights of Dr. Atul Gawande in the past.

So it was pretty obvious to me that I had to get his latest book.

And it is no surprise that I loved it.

A little bit more surprising are the connections that can be made between Checklists and Solution-Focused practice.

  1. to begin with, checklists are a simple and elegant solution to a complext problem – and we already talked in this blog about how Solution-Focused is elegantly simple yet very effective.
  2. Dr. Gawande makes a distinction between two issues when facing problems: ignorance and ineptitude. Ignorance means that we do not have enough knowledge to deal effectively with the problem – as an example, Dr. Gawande mentions the differences in treating heart attacks now vs. in the 60s. Back then, we simply did not know. Now we know much more about heart attacks and we have a whole array of surgical options, interventions and drugs to treat heart attack victims. Ineptitude is a different thing altogether – it means we have the knowledge to deal effectively with a problem but somehow we fail to take the necessary steps. For example, on average, according to Dr. Gawande, less than 50% of patients with suspected heart attacks receive the proper protocol within 90 minutes of their admittance to the hospital – after 90 minutes the chances of making it through a heart attack significantly drop. It is not a question of lack of will or improper training – it is just that procedures can be very complicated and require the coordinated performance of many specialists. Checklists, then, are a way to deal with this problem: making sure that nothing is missed, making sure that the knowledge acquired is properly applied right here and right now with the patient. It then struck me that SF questions are just that – a way to help clients appy their own experience, successes and insights to the problem at hand. As SF practitioners we assume clients have all the knowledge they need to solve their own problems – they are the experts. They come to us because, for whatever reason, they got overwhelmed by the problem – the sheer complexity seems too much. But our questions, such as the Miracle Question, or the Scaling Question, are ways for clients to make a checklist of their successful strategies and apply them to the problem they are facing now.
  3. I admit it – I have a pre-session checklist. Things to do before a session, to make sure the session runs smoothly. I also have a post-session debrief checklist – with a Solution-Focused twist, since it is a checklist made of scales. But it is still a checklist.
  4. Another point that is made in the book and that I felt was very interesting is that checklists can be used also to deal with emergencies. Such checklists are not made of routine operations. Rather they make clear who needs to talk to whom and when in case of emergency X – as Dr. Gawande shows, that is a brilliant solution. The checklist still gives structure and tells people who to talk to – but it allows for maximum flexibility in responding to the emergency, shifting responsibility to experts and people on the ground rather than on a single decision-maker.
Like all simple solutions checklists seem dumb in retrospective – yet as recently as 2001, as an experiment, a simple 5-step checklist to avoid infections when putting in a central line in ICU patients was tried in a Boston hospital. The infection rate went from 11% to 0. In that one hospital that meant preventing 43 infections, 8 deaths and saving 2 million US$.
Do you still think checklists are dumb?
Update: and here is a video with Atul Gawande himself talking about the book