Checklists: a matter of life and death?

We've all seen movies with the captain and co-pilot of a plane or spaceship going through their checklists before they take-off to make sure the craft is airworthy. But why do checklists work so well – and how can we use them to improve our web content?

 Checklists: a matter of life and death?

In 2001, one Peter Pronovost, a doctor looking after patients in intensive care at Johns Hopkins hospital in the USA, began thinking about how checklists could improve service levels. 

He started small, looking at the problem of avoiding infections when a line is being put in. He devised a 5-point checklist – starting with doctors washing their hands with soap and ending with a sterile dressing. He got the nurses to monitor what the doctors were doing and discovered that around a third tried to skip a step. Then he made sure that the nurses were authorised to make sure the doctors followed procedure.

Once the system was in place the infection rate went down from 11% to 0%. In the next year or so they had only two infections. The hospital calculated it had prevented 43 infections, 8 deaths and saved £2m in costs, all thanks to Pronovost’s checklists.

This success prompted the hospital to introduce checklists for pain medication and mechanical ventilation. These too provided great benefits – 21 fewer patients died than in the year before in intensive care.

Pronovost took his ideas to other hospitals. Infection rates dropped and a group of hospitals in Michigan saved an estimated $175m and 1,500 lives in the first 18 months. He continues to spread the message.

Benefits of checklists

Pronovost worked out that checklists provide 2 main benefits: 

  1. Checklists help with memory recall – especially the small things that are easy to miss when dealing with a crisis – so, for example, when a patient is having fits it might be hard to remember to make sure their bed is at the right angle to prevent saliva going into the windpipe and potentially giving rise to pneumonia.
  2. Checklists spell out the minimum standard expected. By making sure all steps are followed, the standard baseline performance is improved. 

Why checklists work

Surgeon and journalist Atul Gawande has also pioneered the use of checklists in medicine. He designed and implemented checklists for a World Health Organisation project designed to cut down on deaths from surgery. He then went on to write The Checklist Manifesto: How to Get Things Right

Gawande thinks checklists work because some of our systems have now become so complicated they are difficult for our brains to master. He set a target that no step would take more than 60 seconds, and in routine situations the whole process should take no longer than 2 minutes. One hospital reduced operating times because the teams prepared better.

We are all human. We all make mistakes. The trick is to learn how to minimise them. So Gawande suggests we assume that individuals will fail but put in a system that will catch the mistakes – the checklist.

Checklists also work because they break down the task into simple steps. Having completed one step, you can then concentrate on the next. No-one gets frightened or paralysed by the scale of the whole task and the bigger picture. You just move on to the next step and then the next.

Two kinds of checklists

Daniel Boorman of Boeing, who was consulted by Gawande, identifies 2 kinds of checklist:

  • Read-Do: you read each step of the task, and then perform them in order, checking them off as you go, like following a recipe.
  • Do-Confirm: you go through steps of the task from memory until you reach a defined pause point, when you go through the checklist and confirm that each step has been completed. 

Gawande recommends no more than 10 items on a checklist – if it takes too long, people ignore it. But no more than 7 is ideal, as that’s the about the limit for most people’s short-term memory. If you need longer checklists, then break the tasks down even further and have a checklist for each part of the task.

How you can use checklists on your website

Checklists can be a way of making complex copy scannable and user-friendly, simplifying and distilling down what is needed.

Think about where you can be helpful to your customers or your users by providing them with printable checklists that are relevant to their needs – for a DIY job, a holiday packing list, things to check on your car before setting off on a long journey, what you can and can’t carry on as hand-luggage, how to make a complaint, organising an event or moving home. 

With online forms, checklists can be useful for helping users to understand what they need to have ready before they dive into the full process. For example:

What you need before you start: 

Before you start this application, make sure you have the following documents to hand.

  • your bank account number
  • passport number
  • name, address and email address
  • contact details of your referee

 Checklist for great web copy

If you don’t have one already, putting in place a checklist to follow before putting your copy live on the web will raise the general standard of content on your site. If you go through all these steps and think your content passes all these tests with flying colours then publish. If not, spend time rewriting until it does... 

  1. Is your content well planned? Do you know the purpose of the content and the audience for it? Are you sure the content is mapped to your website and business goals?
  2. Easy to navigate? Does the content have clear signposts, helpfully worded, keyword-rich links, and sensible suggestions for where the user might go next?
  3. Scannable? Can the pages be easily understood at a glance through the use of sub-headings, bullets, bold text, short sentences and consistent structures?
  4. Everyday English? Is the focus of the content on user needs and priorities? Is it written in the active voice, in everyday language? Does it use lots of personal pronouns (“we” and especially “you”)?
  5. Optimised for search? Are the right keywords that users search for in the title tag, subheads and body copy? Are there keywords in any text links to and from the page? Is the content worth reading and will other people want to link to it?
  6. Brand tone of voice? Is the tone of voice on brand and consistent with the rest of the site? Don’t forget the buttons, menus and help text associated with the content – they’re part of your brand too.
  7. Credible? Is everything up-to-date and logically ordered? Are there any spelling, grammar or formatting errors? Is the information likely to go out of date, or does it have any cultural references that could exclude users?