Among Gawande’s findings: “[Checklists help] with memory recall and clearly set out the minimum necessary steps in a process. … In this one hospital, the checklist had prevented forty-three infections and eight deaths and saved two million dollars in costs. … [Checklists] provide a kind of cognitive net. They catch mental flaws inherent in all of us — flaws of memory and attention and thoroughness. … I have yet to get through a week in surgery without the checklist’s leading us to catch something we would have missed.

Good Riddance Reviews

Methods for Finding Subtraction Targets

• Identify “stupid stuff.” Lisa Bodell, CEO of FutureThink, asks, “If you could kill all the rules that frustrate you or slow down your efficiency, what would they be?” A similar spirit propelled the Getting Rid of Stupid Stuff effort at Hawaii Pacific Health. Dr. Melinda Ashton asked healthcare workers to nominate anything in the electronic patient records system that “was poorly designed, unnecessary, or just plain stupid”—which generated 188 subtraction targets.

• Figure out the value and cost of your meetings. In their Meeting Reset, sixty Asana employees rated each of their standing meetings. They identified more than five hundred meetings that were of low value. And don’t forget the time that people spend getting ready for meetings. Bain, the management consulting firm, calculated that one company devoted three hundred thousand hours a year preparing for a weekly executive team meeting.

• Measure the burdens imposed by performance measurement. Are you spending so much time evaluating one another that you don’t have time to do your work? Deloitte’s leaders were appalled after they “tallied the number of hours the organization was spending on performance management— and found that completing the forms, holding the meetings, and creating the ratings consumed close to two million hours a year.”

• Catalog sources of email overload. The average employee spends 28 percent of their time dealing with emails. Is this true at your company (or is it worse)? Review the number, length, recipients, and timing of the emails that people send and receive. What can you subtract? Perhaps an email policy like that used at the consulting firm Vynamic will help. They call it zzzMail, as in catching some z’s: “team members are to refrain from sending emails to other team members between 10pm and 6am Monday through Friday, all day Saturday and Sunday, and all Vynamic holidays. In urgent matters, a call or text is preferred over email.”

• Observe and interview users. To identify unnecessary and confusing questions in a benefits form completed by more than two million Michigan residents each year, Civilla researchers conducted over 250 hours of interviews with residents and civil servants—and observed them as they filled out and explained the form. Civilla identified dozens of obstacles that jeopardized residents’ ability to get benefits.

• Build a journey map. Diagram the stages that customers or clients travel through as they try to get information, obtain services, or buy products from an organization—and how they, and employees, feel along the way. Our students Elizabeth Woodson and Saul Gurdus used interviews and observations to map the slow and bewildering process imposed on families of disabled children who sought services from the Golden Gate Regional Center, a social services agency in the San Francisco area. They identified numerous bottlenecks that marred clients’ journeys—especially botched handoffs between silos.

• Try a perfectionism audit. In The Systems Bible, John Gall proposed the Perfectionist’s Paradox: in complex systems, “striving for perfection is a serious imperfection.” Pressures for perfection cause needless effort and delay, interfere with learning from imperfect prototypes, and provoke despair. Many things that are worth doing—or are required by others—aren’t worth doing well. Or, as Gall preaches, ought to be done poorly. In that spirit, ask people to identify tasks where the standards are too narrow or too high, or that are enforced with too much zeal.

Second, building on chapter 5, friction fixers who battle jargon monoxide embrace venture capitalist Michael Dearing’s advice to embrace the “editor in chief” role.

Appendix

“We wrote a friction article for Gallup.com, “Too Many Teams, Too Many Bosses,” and for Times Higher Education, “Our To-Do Lists Can’t Grow Forever. It’s Time to Try Subtraction.

A piece for Harvard Business Review, “Meeting Overload Is a Fixable Problem,” provided a “playbook” for “meeting resets” that we helped develop and test.