Checklists: Saving Lives, Transforming Education?

In the December 10th, 2007, issue of the New Yorker (it takes me a few months to catch up these days), Atul Gawande wrote an eye-opening piece, “The Checklist.” The article describes how the implementation of a simple medical checklist, developed by Dr. Peter Pronovost of Johns Hopkins Medical Center, slashed the rate of oftentimes-lethal intravenous catheter infections for patients in intensive care units in the state of Michigan. How? By including simple, no-brainer steps like “Step One: Doctors must wash their hands with soap” that doctors and hospital staff were skipping, thus causing easily preventable deaths and infections in their intensive care units.

It’s pretty mind boggling. If Dr. Pronovost could actually implement his checklist across the US (easier said than done), it would largely wipe out the multiplier effect of thousands of human error deaths from skipped steps across thousands of diagnostic and procedural combinations. The power of the Gawande article is that it underscores that some of the most basic tools are the most effective ones. The checklist is brilliant in its very simplicity, and I’m sure it can have dramatic applications across all sectors.

Though checklists of all kinds (revising, editing, homework, behavior) can be found in elementary and secondary educational settings, it is harder to find individualized, purposeful use of checklists at the higher ed level. I don’t think the need for them has necessarily diminished. Though students in the online classroom aren’t dying of infections in intensive care units, they are spending unnecessary time getting lost and confused about when and where to submit assignments and are having difficulty managing their time in the absence of face-to-face accountability in the online environment. I hear professors complain about late assignments, ignored e-mails, and work submitted that is hardly reflective of critical thinking.

I think that a greater use of individualized checklists would improve communications between instructor and student and allow students to spend more time on substantive, creative work. In the online classroom, students need specific instructions on how to submit their work and how to participate in online discussions. They need assistance and they need writing papers and guideposts for completing assignments. Instructors provide all of these instructions, but typically in an elaborate course syllabus supplemented with lengthy e-mails in addition to whatever is posted in the course itself. Too frequently, instructors’ e-mail communications to students are lengthy documents that students may barely read all the way through. Professors aren’t joking when they say: “My students don’t read the syllabus,” or, “My students don’t read my e-mail.” They probably don’t. Why not provide students a more direct, simple path to success?

Checklists are simple and direct. They filter out extraneous details and give students a priority list of items to read and do. Checklists could be provided for specific parts of the syllabus. A “Welcome Checklist” supplementing a very brief welcome note from the instructor could replace the traditional long welcome letter from the instructor that tends to contain entirely too much information. Checklists could ensure that students edit and check their papers, properly reflecting on each step. I suspect that instructors would receive an elevated quality of writing, in response to clearer and cleaner communication to students.

I think professors have been reluctant to use checklists because they involve this simplification of language, and so to some extent, instructors may feel checklists would enable students. Instructors expect students taking online courses to be able to read lengthy e-mails and take large tasks (reading and analyzing a case study; writing a paper) and automatically divide and sequence them out into a series of tasks independently.

But I think part of using checklists is adjusting to a need for an entirely simplified way of writing when communicating guidelines and expectations in an online course. We need to give over to this need for simplicity, standardization, and predictability that is not necessarily the standard way of communicating in academia. I think most instructors might be uncomfortable with embracing this format because it involves thinking and writing in a largely different way. Like most instructors, I’ve established a routine that was created before the age of e-mail and Facebook and text messaging. I grew up writing letters by hand, relishing the pure art of correspondence for its own sake. A checklist, in contrast, seems cold, and hardly feels like responsible and full communication. But I believe there is a way we can integrate checklists judiciously. You can still impart tone and personality in your email and your communications with your students, yet not lose them in a sea of verbiage.

I’ll spend the next few weeks integrating a few checklists into the design of the online class, to showcase the checklist as being an important, very low tech tool. I am purposefully keeping fancy checklist/tasklist applications out of it for the moment, though I sometimes feel I have tested out every checklist/tasklist application that exists. This is more about the mindset than the technology. It’s captivatingly simple.

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