Checklists Save Lives – and Businesses

Imagine if you discovered a new medical procedure that could be used in every Intensive Care Unit in the world.

One proven to reduce infection rates, save lives, and reduce hospital operating costs by millions of dollars a year.

That costs next to nothing to manufacture or deploy.

That is so simple to operate that a kindergartner already knows how.

And that most doctors refuse to use, despite the clear evidence for its safety and efficacy.

That's just the position that Peter Provonost, a critical care specialist at Johns Hopkins University, found himself in 2001.

He wanted to tackle a specific problem: infections that occur when an IV line is put into a patient.

5 Simple Steps

Theoretically, these infections are 100% preventable if doctors just follow five simple steps:

(1) wash their hands with soap
(2) clean the patient’s skin with chlorhexidine antiseptic
(3) put sterile drapes over the entire patient
(4) wear a sterile mask, hat, gown, and gloves
(5) put a sterile dressing over the catheter site once the line is in

In case you've never gone to medical school, this isn't exactly the sort of stuff that causes would-be doctors to flunk out in despair. Not exactly rocket science, or heart surgery, or even organic chemistry. Basic procedure that every med student, resident and intern has been taught – and done – a thousand times.

Yet when he asked ICU nurses to record how well doctors performed these five steps, he was shocked: fully one-third of the time, at least one step was skipped.

Leading to infections among ICU patients, who are among the last people in the world you want to infect. They don't respond that well to opportunistic infection, turns out.

In response, Provonost instituted a simple 5-step checklist that doctors had to complete for every line they put in. They balked at the "extra paperwork," so nurses were authorized Nurses were authorized to stop doctors who skipped a step, with administrative backup to intervene if necessary.

What happened? Atul Gawande, writing in The New Yorker, relates:

Pronovost and his colleagues monitored what happened for a year afterward. The results were so dramatic that they weren’t sure whether to believe them: the ten-day line-infection rate went from eleven per cent to zero. So they followed patients for fifteen more months. Only two line infections occurred during the entire period. They calculated that, in this one hospital, the checklist had prevented forty-three infections and eight deaths, and saved two million dollars in costs.

The lowly checklist, as powerful as any drug or procedure developed in the past 50 years?

Checklists for Everything

Gawande makes a strong case for the use of checklists in his new book, The Checklist Manifesto. Anywhere you have a complicated situation and a high cost of failure, create a checklist.

Not any checklist will do. It turns out, Gawande discovered, that there's an art to writing good checklists. (For full details, read his book.) The right kind of checklist can save 200 lives when a plane loses an engine and has to glide to a landing in the Hudson River. The wrong kind can discombobulate the co-pilot so much that he can't think.

Your Free AdWords Checklists

I realize that AdWords is not the same as critical medical care or air safety, but it's still a complicated situation, and if it's your business, a high cost of failure.

With that in mind, I've created a bunch of AdWords checklists, following the AdWords best practices I teach in Traffic Surge, Profit Surge, and AdWords Checkmate, and the checklist best practices I learned from The Checklist Manifesto.

They include:

1.    Keyword Research Checklist
2.    Ad Preparation Checklist: Search Network
3.    Ad Writing Checklist
4.    Ad Split Testing Checklist: Top Level
5.    Ad Split Testing Checklist: Lowest Level

You can download them here, absolutely free.

And you can find out how to get a video and PDF tutorial on using the Checklists for only $2.30. Just scroll to page 6 in the download.

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  1. #1 • Carlos said on February 13 2010:

    Good point! I also think checklists are very useful and can save time and money in most topics. That's why I created, a website with all kind of checklists to help planning a wedding.
    Looking forward to reading AND studying your Adwords checklists. Or even better, print them and have them near the computer when I work for the adwords accounts I manage.

  2. #2 • Howie Jacobson said on February 13 2010:

    Nice site, Carlos! I never thought about the complexities of planning a wedding before (we were so haphazard, we were delighted when one of the guests showed up with a camera), but I’m sure there are plenty of things that can go wrong due to tiny slip-ups.

    Check out Gawande’s book and let me know what you think. It’s already had a profound impact on my business.

    It’s interesting to me that your model appears to be to give away the checklists and then monetize the site on the back end. I’m thinking about how many other professionals can give away their checklists and make a lot of money so doing.

    If I were a wedding planner, for example, I would definitely give away my checklists. Anyone thinking of doing it themselves would just go, “Wow, that’s a hell of a lot of work. Why don’t you just do it for me?”

  3. #3 • David Szetela said on February 13 2010:

    REALLY nice, Howie – thanks, and Tweeted!

  4. #4 • Alex Newell said on February 13 2010:

    Thanks for the Adwords Checklist Howie. I have a love hate relationship with checklists and use them and ignore them frequently. Now that I have proof that they stand up to hard scrutiny I'll get back to my checklists with more fidelity!

  5. #5 • Ron W said on February 13 2010:

    I have several friends who are pilots, and in aviation, the checklist is a very important (almost sacred) thing. When Delta took over Northwest recently, one of the major sticking points was which set of checklists to use for pilots and maintenance crews. Both sides had developed their lists over years and years of use.
    One of my friends also told me that you ALWAYS read the list out loud and check it off together. If a co-pilot starts reciting it from memory, the captain will reprimand them and they start over. It's considered a serious faux pas.
    So my point is: if some of the most demanding professions in the world rely on checklists because they have to get it right every time… shouldn't you give it a try? Thanks for making this available Howie. Good on ya.

  6. #6 • Nick Gregan said on February 13 2010:

    Howie already tweeted, great common sense tactics – often overlooked in the quest for speedy results. I know I work best when I follow a list or step-by-step. Over at my site I have checklists for actors to make sure they've prepared correctly before a photography session. Thanks.

  7. #7 • Dave Vranicar said on February 14 2010:

    Howie, I'm glad to see that you read and enjoyed The Checklist Manifesto and are putting it to work in your  business so creatively. It's a terrific book, and I think you may have come up with an almost-great promotional idea. 
    Here's my takeaway: 1. Offer a cryptically brief checklist for which the user feels s/he needs an explanation to use it effectively. 2.  Provide the explanation of the checklist at a deeply discounted introductory price for a recurring subscription for a continuity offer. 
    Here's why I say it's "almost great." When people like me get to the end of the checklists and see that they have to sign up for a $29 monthly recurring fee (even if they can cancel it) in order to get an explanation for how to use the checklists, will they bite or will they feel manipulated?
    I've signed up for such offers in the past and found that I rarely remembered to cancel them before the first full payment, even if I didn't like the content.  As a result, I just don't take the bait anymore. No matter how good you make it look. 
    I think your approach may work for the unwary, but not for us more wiley coyotes who have bought into too many continuity programs in the past.
    It will be interesting to see how well this works for you. Why not split test?
    I really value your work. And as a potential customer, I personally would value a little more up-front disclosure. I  felt a little "sucked in" when I got to the bottom of your offer, and that's not good  if you're trying to build a long-term relationship. This tactic, the way you've executed it at least, is more worthy of Mike Filsaime or Russell Brunson than of, say, Perry Marshall or Glenn Livingston. Canny, yes. Trust-inspiring, no.
    In any case, I wish you success.

  8. #8 • Howie Jacobson said on February 14 2010:

    Thanks for the feedback, Dave.

    I can see how you would feel that way. A couple of responses leap to mind…

    First, I spent about 2 hours putting together the checklists document. So giving it away does feel generous to me.

    Second, if you read Google AdWords For Dummies cover to cover, you can already implement the checklists.

    Third, I meant what I said about offering refunds after the 30 day period, for people who forget to cancel. I take very seriously the concept that if I haven’t provided value, I don’t deserve or want your money.

    Fourth, one month of the Ring of Fire for $2.30 truly is an insane value, even if someone outside the Ring doesn’t understand that yet.

    Up-front disclosure is a tricky thing. If you’re married, did you engage in up-front disclosure on your first date? Nobody in a successful relationship begins with a discussion of their snoring habits, strange rash around their ankles that they picked up in summer camp and never quite shook, and deep fear of intimacy caused by being born Caesarian and bottle-fed. If I began the post with, “Be warned, there’s an offer coming at the end of the PDF offered in this post,” I’d lose a lot of people who wouldn’t benefit from the discussion of checklists, who wouldn’t download the AdWords Checklists, and who wouldn’t give the Ring of Fire a try.

    I believe so strongly in the benefit of a supportive mastermind environment for business people (and specifically one moderated by me, where I can vet the content and contribute to a generous and kind atmosphere, that I wish every reader would sign up. Not for my sake (I work way too hard answering posts and producing content for the Ring of Fire for the money it makes me), but because I sincerely want this experience for you.

    If someone has been burned by continuity programs in the past, they may never give mine a try, and I accept that. I also accept that continuity programs are hard to sell – that’s why Sports Illustrated gives away Swimsuit calendars and doesn’t hardly mention the magazine. But if someone truly wants to benefit from my marketing expertise and coaching acumen, they need to enter into an ongoing relationship with me.

    I realize that I’ve written quite a lot here, and all of it is justification. So I have to look inside, whether part of me agrees with you and feels that I’m being sleazy here. At the moment, I can’t find that voice. But I certainly appreciate your sharing your reaction and your experience, especially as you’ve used your full name and written in a graceful and generous manner.

    All the best,

  9. #9 • Moe Muise said on February 19 2010:

    I can't find that voice, either, Howie. No justification necessary. You've provided (yet another) valuable service for free, and have merely made a (ridiculously inexpensive) offer at the end.
    The problem with the Web these days is that some people expect to take everything for free – and be thanked for doing so!
    Moe Muise

  10. #10 • Jim B said on February 23 2010:

    Here a link to Jon Stewart interviewing the author of the Checklist Manifesto.  Interesting point – note how many times he mentions 80/20