When Virginia Apgar, an American obstetrical anesthesiologist, was asked somewhat casually by a student how to make a systematic assessment of a newborn, she responded “that’s easy.” Apgar jotted down five variables (heart rate, respiration, reflex, muscle tone and color) and three scores (0, 1 or 2 depending on the robustness of each variable). Apgar herself began to use this rating scale in her own work. She began applying this assessment about sixty seconds after birth to all infants she handled. A baby of eight or greater was likely to be in excellent condition. A baby with a score of four or less was in trouble and needed immediate attention. What is now called the “Apgar Test” is used in all delivery rooms every day. She is credited with saving thousands of infant lives.
We offer another example from the medical field. A report on CNN.com (Hudson, 2014) indicated that about one in twenty-five patients that seek treatment in US hospitals will contract an infection while add the hospital. Patients acquired some 721,800 infections in 2011. This statistic, however, ii is significantly better than in previous years. The rate dropped about 44% from 2008 to 2012. This result came from “requiring hospitals to follow a simple checklist of best practices”. It seems that simple checklists focused on complex situations work!
Resistance to assessment, prediction and tracking methods
Given the efficacy of simple check lists, why aren’t they universally deployed? Kahneman writes in detail about the level of resistance, even hostility, that he and other researchers have met when presenting results of his research on this topic. Lewis Goldberg would concur. He was not welcomed by other psychologists—especially though engaged in highly complex (and highly paid) clinical assessments. From medical professionals to psychologists and wine producers, experts either rejected or ignored the results—and in some cases responded with derision.
Perhaps this is predictable, because these results challenge the assessment and predictive capabilities of these same experts who have developed their skills over many years and have rightly developed high opinions of their capabilities. Kahneman quotes Gawande (2010) who offers The Checklist Manifesto:
We don’t like checklists. They can be painstaking. They’re not much fun. But I don’t think the issue (people resistance) here is mere laziness. There’s something deeper, more visceral going on when people walk away, not only from saving lives, but from making money. It somehow feels beneath us to use a checklist, it’s an embarrassment. It runs counter to deeply held beliefs about how the truly great among us – those heroes we aspire to be – handle situations of high stakes and complexity. The truly great are daring. They improvise. They do not need protocols and checklists. Maybe our idea of heroism needs updating.
We agree that this negative sentiment is prevalent—even today. Both of us have experienced this kind of response, verging on disdain. We often find pushback when developing various checklists related to change and transformation in organizations that are undergoing transformation and change. Somehow a checklist, algorithm or computation trivializes the personal sense of expertise held by those offering much more complex analyses. The simple analyses make them feel less expert. Trusted leadership coaches can greatly help to overcome these kinds of fears and resistance. These coaches might even work with the “experts” themselves—helping them readjust to the new realities. The experts can become what they are advocating for their clients. They can become more “agile.”
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