April 20, 2011

A Checklist for Christians

  On October 30, 1935, the U.S. Army Air Corps held a flight competition for airplane manufacturers vying to build the military’s next generation of long-range bombers.
It wasn’t supposed to be much of a competition. Boeing’s bomber had trounced the designs of Martin and Douglas with a plane that could carry five times as many bombs as and fly faster than and twice as far as previous bombers could.
But when the plane roared down the runway and took off, it climbed sharply to 300 feet, stalled, turned on one wing, and crashed in a fiery explosion, killing two of the five crew members, including the pilot.
What had gone wrong? Pilot error! This plane was substantially more complex than previous aircraft. Among other things, it required the pilot to attend to the four engines, each with its own oil-fuel mix; the retractable landing gear; the wing flaps; electric trim tabs that needed adjustment to maintain stability at different air speeds; and constant-speed propellers whose pitch had to be regulated with hydraulic controls.
2011 1511 page22While doing all this, the test pilot had forgotten to release a new locking mechanism on the elevator and rudder controls. “Too much airplane for one man to fly” was the response of the experts. Douglas’s smaller design was declared the winner. Boeing nearly went bankrupt.
Afterward, however, a group of test pilots got together and reflected on the problem. They did not come up with the idea of better pilot training. Instead, they came up with an ingeniously simple approach: they created a pilot checklist, perhaps one of the first checklists ever. They made it simple, brief, and short enough to fit on an index card.
The checklist contained the kind of basic steps all pilots know. But with the checklist in hand, pilots went on to fly this airplane 1.8 million miles without one accident. The Army ultimately ordered almost 13,000 of the aircraft, which you and I know as the famous B-17. That was the plane that gave the military a decisive air advantage during World War II.
This anecdote appears on pages 32-34 of a book entitled The Checklist Manifesto (New York: Henry Holt and Co., 2009). Author and surgeon Atul Gawande makes the case for the lowly checklist to become a tool to help all of us to be more successful in a world in which increasing complexity and TMI (too much information) cause increasing mistakes and failures. He says checklists are used today to enable people to do some of the more difficult things, from flying airplanes to building skyscrapers to performing surgeries.
Life Application
I was fascinated and decided to create my own checklist to help me more successfully live a Christian life. I present mine here in a sidebar as just one example. It helps me to stay on course during my prayer time and not meander, especially early in the morning before I’m fully coherent. It has helped me in so many ways that I’d like to encourage you to create one of your own.
A checklist, experts say, should contain no more than five to seven points and should fit on a 3" x 5" index card. It need not encompass your entire prayer life, but should cover the essentials.
Hospital Checklists
Because Gawande was leading the way for checklists to be used in hospital surgeries throughout the world, he began using them in his own surgeries. Not because he thought he needed them, but because, as he put it, he didn’t want to be a hypocrite.
He writes in his book: “In my heart of hearts—if you strapped me down and threatened to take out my appendix without anesthesia unless I told the truth—did I think the checklist would make much of a difference in my cases? No. In my cases? Please” (p. 187).
Then he goes on to report: “To my chagrin, however, I have yet to go through a week in surgery without the checklist’s leading us to catch something we would have missed. Take last week . . . for instance. We had three catches in five cases.
“I had a patient who hadn’t gotten the antibiotic she should have received before the incision, which is one of our most common catches. . . . I had another patient who specifically didn’t want the antibiotic. . . . The checklist caught it. . . . The third catch involved a woman in her sixties for whom I was doing a neck operation to remove half of her thyroid. ?. . . She’d had trouble breathing after two previous operations and had required oxygen at home for several weeks. In one instance, she’d required a stay in intensive care” (pp. 187-189).
Gawande continues: “This was a serious concern. The anesthesiologist knew about it, but I didn’t—not until we ran the checklist. . . . The anesthesiologist asked why I wasn’t planning to watch her longer . . . given her previous respiratory problems.
“‘What respiratory problems?’ I said. The full story came out from there. . . . We made plans to give her inhalers during surgery and afterward. . . . They worked beautifully. She never needed extra oxygen at all” (p. 189). But Gawande said he had no idea about this potential complication until the checklist caught it.
In his book Gawande reports that in 2001 Johns Hopkins Hospital in Baltimore, Maryland, began using one of the first checklists employed to minimize central line infections in patients. The checklist was a no-brainer, almost an insult: Doctors to (1) wash hands with soap; (2) clean patient’s skin with chlorhexidine antiseptic; (3) put sterile drapes over the patient; (4) wear a mask, hat, sterile gown, and gloves; and (5) put a sterile dressing over the insertion site once the line is in (see pp. 37, 38).
Check 1, check 2, check 3, check 4, check 5. These steps have been taught for years. It seemed silly to make a checklist for something so obvious. But the medical teams did so, despite some initial resistance from physicians.
After one year of use the 10-day line infection rate at Johns Hopkins fell from 11 percent to zero, prevented 43 infections and eight deaths, and saved the hospital an estimated $2 million.           
A checklist helps other hospitals, too. Because I live in Portland, Oregon, I was delighted to read in The Oregonian last year that the Adventist Medical Center in Portland—with the aid of checklists—achieved a top position among area hospitals with an infection rate of zero in its surgeries.
A Personal Checklist
My personal spiritual checklist is helping me in many ways: 
1. My checklist reminds me to seek first the kingdom of God before I check the weather report, read the paper, or pray about other matters.   
2. Going to the cross does amazing things for me. When I personalize looking at Jesus hanging on the cross (I do this with 1 Peter 2:24), my old compulsions and obsessions have less control over me. I receive the amazing new life that Jesus promised.  
3. Getting a new heart enables me to love more fully as Jesus loved, and obtaining the mind of Christ gives me the software to think correctly and reprogram the hardware that is my messed-up brain.     
4. Knowing I have received both power over “all the power of the enemy” (Luke 10:19) and wisdom (James 1:5) gives me far more courage to face my day than if I hadn’t obtained these gifts.  
5. For me, being “changed into a different person” (1 Sam. 10:6) every day is huge—a wonderful new way to live the Christian life. I don’t become a nicer person; I become a different person.     
6. Nothing beats heading into the war zone of each new day knowing that I’m fully protected by “the shield of faith” (Eph. 6:16). With the “sword of the Spirit” (God’s Word) (verse 17) in my mouth I can even win my battles because “the Lord will fight for [me]” (Ex. 14:14).    
7. With Jeremiah (“When Your words came, I ate them” [Jer. 15:16]), I “eat” Jesus’ promises every day and ingest His love, wisdom, grace, and power into my life. Think about the implications of having Galatians 2:20 become your reality rather than just words: “I have been crucified with Christ and I no longer live, but Christ lives in me.”
It Works!
Recently my checklist impacted my relationship with my wife, Diane. One Sabbath morning Diane made a minor critical comment about me. Thanks to my having processed my checklist earlier that morning, I was able to receive her criticism instead of rejecting it. Instead of my responding defensively or retaliating (which I usually would do), I was able to be positive. This was because my checklist—which calls for me to be emptied of self and to be changed into a different person every day—had done its work. So I was able to receive what was, in fact, a valid criticism.
This incident might seem minor, but usually it’s the little things that ruin or enhance relationships. So thanks to my checklist, Diane and I did not have the conversation that might have ruined our day. And my checklist helps me to have much more success in all areas of my Christian life.
If checklists are important enough to be used for surgeries, flying airplanes, and building skyscrapers, doesn’t it seem likely that they might be effective enough for us to use as we prepare for the day ahead? For me, the answer is a resounding yes!
Perhaps a checklist will help you on your journey as well.
Mike Jones is the author of two new books, Help, Lord, I Blew It Again and Sometimes I Don’t Feel Like Praying. He conducts seminars on revival and reformation as well as on how to reconnect with inactive and former members. This article was published April 21, 2011.