The Performance Improvement Blog

Checklist Culture

Surgeon, author, and medical crusader Atul Gawande, in his book, "The Checklist Manifesto", presents theory, research, and personal experience in support of using checklists in complex work situations, such as performing surgery, flying a plane, or building a skyskraper. He writes:

Here, then, is our situation at the start of the twenty-first century: We have accumulated stupendous know-how. We have put it in the hands of some of the most highly trained, higly skilled, and hardworking people in our society. And, with it, they have indeed accomplished extraordinary things. Nonetheless, that know-how is ofen unmanageable. Avoidable failures are common and persistent, not to mention demoralizing and frustrating, across many fields - from medicine to finance, business to government. And the reason is increasingly evident: the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us.

That means we need a different strategy for overcoming failure, one that builds on experience and takes advantage of the knowledge people have but somehow also makes up for our inevitable human inadequacies. 

Gawande's solution is to use a checklist - the "minimum necessary steps" that must be taken to ensure safety, quality, and success. I would argue that it is not the list of critical steps that makes the difference, but the organizational culture that emerges as a result of using a checklist that makes the difference. In order to use a checklist effectively, employees must work together to identify the items to go on the checklist, requiring a careful and thorough assessment of work processes. Then they must hold each other accountable for completing each of the steps (e.g., nurses must have permission to remind surgeons to use sterile gloves). When something unpredicatble happens they must be able to react as a cohesive unit. Then they must collaborate on reviewing the process and making modifications to ensure safety, quality, and success in the future. 

Susan Kistler, Executive Director of the American Evaluation Association, writes this about Gawande checklists:

They provide a means for harnessing variability, lending structure and guidance amid what may be chaos, and controlling risk if not eliminating it. He explains the ways in which checklists can be empowering – providing line workers with the information needed to make decisions and the leeway to act rather than be stymied by a bureaucracy awaiting permissions from superiors. The most ‘a-ha’ moment I had while reading was Gawande’s indication of how checklists might detail not specifically what to do but rather, when the unexpected strikes, with whom to collaborate, connect, and communicate in order to leverage the collective knowledge of a group to respond and resolve.

In other words, checklists in complex work situations are instruments for creating a positive culture, contributing to breaking down the hierarchies and mistrust that are barriers to high performance teams. A checklist is the focus for a shared process for managing the complexity and risk that everyone feels. The tool will only be effective if it is used within a culure in which doctors listen to nurses, architects listen to structural engineers, and captains listen to their first officers.  

How to Use PowerPoint

Having viewed many TED presentations, I had the mistaken belief that leaders were finally learning how to use PowerPoint (and other presentation tools) effectively. Recently, however, I’ve attended presentations by very smart people (doctors, lawyers, CPAs, professors, etc.), who are leaders in their organizations, who insist on putting as many words and numbers on a slide as possible. Because I want to hear what they have to say, I don’t read the slides. And, besides, I can’t read and understand that fast. Their slides become a distraction rather than a tool in helping me draw meaning from what they are saying. It would be better if they didn’t use PowerPoint at all.

You might wonder why I have returned to this topic from time to time in a blog devoted to Improving management and leadership. It is because PowerPoint (and other presentation software) has become a ubiquitous form of management communication in organizations. Garr Reynolds estimates that millions of presentations are given every day using some form of slideware. It is an important communication tool of managers. Yet, the messages are not getting across. I frequently hear from CEOs that their employees clam they didn’t know something that had been mentioned in an all-staff presentation, or that they didn’t realize its importance, or that they didn’t understand what it had to do with them. Apparently, PowerPoint slides are, in many cases, failing to communicate key messages.

The problem is that managers assume that if the technology lets them do it, they should.  If PowerPoint makes bullet points, animation, charts, and graphs easy to insert in slides, then that’s what they should do, and as much as possible. What they fail to realize is “the medium is the message.” A cluttered, incomprehensible slide creates the impression that the presenter is cluttered and incomprehensible.

Let me repeat the suggestions from Eleni Kalakos:

1. Use very few slides.
2. Use very little text.
3. Use big, legible fonts and striking colors.
4. Use one striking visual instead of text.
5. Practice the presentation aloud - with props and technology - until it becomes second nature.
6. Bring back-up notes on paper in case the technology goes kerflooey.
7. Use one big, bold bar graph or pie chart instead of a slide full of numbers.
8. Use the "B" key on the computer to temporarily blank out the screen to assure complete attention when making a crucial point.
9. Ask for guidance and direction from a professional coach.
10. Always - and above all - connect deeply with the audience, one human being to another.

Garr Reynolds also offers some excellent suggestions in his blog post, Top Ten Slide Tips. He demonstrates his suggestions with the following two slides.

These slides show the difference between slide clutter and slide
succinctness. Both are intended to communicate the same message about gender equality in Japan. Which would you rather see in a presentation? Which one are you more likely to remember?

Another reason why many speakers resort to putting as much as they can on slides (and then, horror of horrors, reading the slide to the audience) is that they don’t want to take the time and invest the energy needed to sort out the headlines. Effective use of slides requres identifying the story that you want to tell, thinking of a headline for it, and putting that message on the slide in a way that quickly communicates the idea, either through a few words, an attention-grabbing graphic, or both.

PowerPoint (and other slideware) can be a powerful tool for enhancing a speech or presentation. As with any tool, it should be used in the appropriate situations and in a manner that helps the audience learn. What are your suggestions for using PowerPoint effectively?

 

Deep Listening

This is a guest post from Bernard Donkerbrook:

The term you used in your last post, "deep listening", in context with employers (bosses mostly) connecting/communicating with employees on a personal level, made a big impact on me because this is such a compelling theme for me in working with clients or mentees at EQmentor.com. I understand that you are making a distinction between "deep listening" and "active listening".

My view of "active listening" is that it is a mechanistic process, as one of a set of listening tools/techniques. Active Listening is for me synonymous with paraphrasing, conveying back what you thought you just heard, both in content and in emotions/feelings.  I love the concept of 'deep listening' embodying caring, genuineness, empathy, self-awareness and  being other-person focused. A tall order for many managers, sadly.

I believe that a manager's core listening should include these quite-teachable skills:

• Nonverbal attending
• Open-ended questions
• Reflecting feelings
• Listening for understanding
• Active listening/paraphrasing
• Supportive communication/supportive feedback in the moment

The ability of managers (I use that phrase generically to represent any management level person who has people working for them, such as supervisors, executives, and other leaders.) to recognize, appreciate, and demonstrate that they (and even the company) personally value what employees are doing and contributing (and learning, growing, exploring, etc... all these kinds of things) is powerfully influenced by a manager's "deep listening".  'Deeply listening' is a way of demonstrating respect and genuine appreciation for another person. The list goes on and on of the power, influence, and value of deeply listening to people, one-by-one.  And the good news is that good listening skills by a manager can be learned! 

"People honor a culture that honors them."

Deciding as a manager to really deeply listen, deciding to be authentic and genuine in understanding what people are saying who work for you (and with you), is a powerful way to build relationships that are so critical in getting business done and in demonstrating that you value and appreciate employees as individuals and as contributors to meaningful work. 

 

High Touch vs. High Tech

Technology is putting up barriers to the kind of deep listening that helps two people learn from each other. This is especially true in healthcare. Medical patients, often nervous, scared, and in pain, are comforted by the personal caring and touch of their doctors, yet technology (and time pressure) is getting in the way of that relationship. Abraham Verghese, Stanford University physician and best-selling author, argues that the tendency today is for doctors to order tests before or in lieu of conducting a thorough physical exam. By doing this, they risk missing information that can help them make a more accurate diagnosis and enhance the patient experience. He makes that point in this TED talk:

 

An emphasis on “high tech” at the expense of “high touch” is happening in other workplace situations as well. We seem to be moving away from closeness and the expression of caring between employees and their supervisors. The work relationship has become automated and digitized, putting more distance between people who should be continuously learning together. Email, texting, conference calls, and Skype meetings are replacing face-to-face conversation. The efficiency of these technologies is wonderful; I couldn’t accomplish nearly as much if I didn’t have them.  But something is lost when performance feedback is emailed and difficult conversations are held over the phone.

The effect is limited when performance reviews are reduced to an annual exchange of evaluation forms between employee and supervisor. Employees are more likely to respect the sender, hear the message, and change behavior when the encounter between these collaborators is in-person and over a dedicated and sufficient amount of time. Maybe it doesn’t require physical touch, but proximity and deep listening, especially in western culture, conveys a level of respect and caring that cannot be felt from the latest communication technology.