How Would You Rather Fly? How Do You Like Your ICU Stay? Checklists or Not?

Let’s say you’re the General Counsel of a company on a business trip. At the airport, you find, to your surprise, that you have a choice of two flights, equally convenient, at the same price, both going to your destination directly. There’s only one difference. On one, the airline is like every US carrier today: the cockpit crew, even though they have flown innumerable times, goes through a thorough checklist prior to take-off. On the other, the professional pilot and cockpit crew view themselves as professionals. They think they know how to do the job. How dare someone else tell them how to do what they’ve been doing for years. They would not dream of using checklists – after all, they’re professionals. So which flight do you take?

Yesterday, the Wall Street Journal (8/4/03 at D9) ran an article, ICU Checklist System Cuts Patients’ Stay in Half. The lead sentence: “A simple checklist for doctors and nurses in intensive-care units can cut a patient’s ICU stay in half and perhaps save lives, a study shows.” The study was conducted at Johns Hopkins. Prior to using the checklist, there was “no systematic method of ensuring all the necessary steps were taken before” moving a patient out of ICU. Quoting a doctor, the article reports “[t]hings sometimes fell through the cracks.” The same doctor said the checklist forces staff to remember to ask and answer all necessary questions.

I have previously written that law firms should adopt best practices (Consistency in Service Delivery on July 29, 2003 and When Clients Come Knocking on July 24, 2003). Pilots and doctors are highly compensated professionals who, in many respects, operate independently and exercise tremendous judgment. And, unlike with lawyers, lives are at stake. So the question seems obvious – why don’t lawyers develop and use best practice checklists?

Presuming the GC selects the typical carrier – where pilots do use checklists – and arrives safely at her destination, let’s say a law firm she’s considering retaining, what should she do? We don’t ask to see pilot or doctor checklists because we lack the expertise encapsulated in them. The GC, however, has sufficient expertise that, were a law firm to have a checklist, she could evaluate it.

It will be interesting to see if any GC starts down this path. And if they do, what will law firms do? Of course, a forward thinking law firm could, even one known for unique and high-end work, could take the lead and create a real competitive distinction.