When the Whole is More than the Sum of its Parts

In recent years, we at The Back School have encountered a recurrent topic worth addressing. It seems from time to time individuals may conflate or confuse Ergonomic Analysis with the tools it employs. Some appear to appoint too much influence on data-gathering checklists. While useful to gain a quantified perspective on a given ergonomic condition, checklists are not an end in themselves. Far from it. We’ll unpack this misconception below.

We agree checklists are highly prized and valuable tools. Collecting information both before and after execution of an ergonomic intervention depends on them. They serve as a measuring stick for contrast and comparison. But as we teach in our coursework, the bulk of problem-solving exists between application of these two bookend measures.

Much of this confusion can be traced back to well-deserved attention and popular praise for checklists in modern life. They provide clarity to an ever-increasing complexity in our working environment. Checklists can sharpen focus and keep details contained. They provide a linear, stepwise framework when aimed toward a targeted goal. We’ll discuss the recent approbation of this phenomenon below. It’s a good story worth telling.

All this enthusiasm itself was borne of a larger trend toward continuous improvement. Work environments, productivity, safety, and much more have benefitted from this impetus. The spirit behind these related movements is laudable. When day-to-day operations can be viewed as a process, big picture perspective reveals itself. What were once disparate elements are now seen as interrelated components of a whole. We’ll touch on this beneficial development, too.

But as often the case with well-deserved enthusiasm, the message got confused with the messenger. A sense of depth perception was lost on an easy answer, two-dimensional canvas. Please allow us this opportunity to shed a little light. We’ll share a broader view on the important distinction between the tool and the task, the utensil and its utilization, and the forest for the trees.

When the Finger Pointing to the Moon Isn’t the Moon

“Failures of ignorance, we can forgive…But if the knowledge exists and is not applied correctly, it is difficult not to be infuriated.” – Atul Gawande MD, ‘The Checklist Manifesto: How to Get Things Right’ p. 11

New York Times bestselling author Atul Gawande MD MPH is a Harvard Medical School professor, surgeon, writer, and public health leader. Globally renowned by The WHO for delivering better outcomes safely and efficiently, he was recently appointed CEO of the healthcare venture formed between Amazon, Berkshire Hathaway, and JPMorgan Chase.

In his 2009 groundbreaking book ‘The Checklist Manifesto: How to Get Things Right’, Dr. Gawande posits an unsettling proposition. The volume and complexity of knowledge in modern life has far exceeded our innate ability to deliver that knowledge consistently and safely. Dr. Gawande makes a compelling case that many fields can do better. By using the tool aviation has relied upon to keep us safe for decades – the checklist – we can conquer complexity.

“The checklist gets the dumb stuff out of the way, the routines your brain shouldn’t have to

occupy itself with…and lets it rise above to focus on the hard stuff…”

– Atul Gawande MD, ‘The Checklist Manifesto: How to Get Things Right’ p. 176

As Dr. Gawande explains, our technological age races forth in a perpetual state of creative upheaval. The form of error we now see made more readily – in disparate fields including ergonomics – has shifted. It used to be more common for errors to be made from sheer ignorance to basic knowledge about a given situation or condition. Our understanding was incomplete and thus, we forged ahead unknowingly. Sometimes we discovered new solutions. Other times we blindly courted disaster. What we didn’t know could hurt us, but fault was forgivable.

What is seen more often now are errors where the knowledge to perform appropriately, clearly exists. There is just a failure to apply it correctly to the given circumstance. Interpretations are ill considered. Signs and symptoms are missed. The wrong questions were asked. These days, ineptitude applying existing knowledge is causing more problems. The answers are often readily available. What’s impeded us is our ability to call forth that knowledge when it’s needed most.

“Just ticking boxes is not the ultimate goal here. Embracing a culture of teamwork and discipline is.”

 – Atul Gawande MD, ‘The Checklist Manifesto: How to Get Things Right’ p.159

Enter the checklist. One area where checklists are often applied for efficiency, effectiveness and safety is production. In common parlance, this emphasis is described as ‘Lean Processing’. It defines an ongoing mission to identify and eliminate waste without sacrificing quality. Toward this end, checklists fit perfectly into honing our efficiencies.

First invented in the US by Henry Ford to keep the production line productive, Lean Processing is designed to ultimately benefit the final customer. Later adopted in Japan, the concept itself was embraced, supported and steadily perfected. Lean’s overarching goal is to continually create ‘value’ from which your customer will gain. This is where the term ‘value-added’ originates in the world of process improvement. When applied appropriately, checklists lubricate this principled aim toward ongoing excellence.

When the End Justifies the Means

When seen from our broader historical perspective, applying checklists to our Ergonomic Analysis is advisable. It’s a way to bring our many observations into one neat central location. Where some have lost direction is mistaking data-gathering for final analysis. They’re confusing the beginning of our process with its end. In fact, checklists don’t solve anything. They simply organize our observations for ease of retrieval later.

The information our ergonomic checklists provide offers us focus, not answers. It delivers us facts, not conclusions. We are still tasked with the heavy-lifting of interpreting our data and problem-solving from there. The job’s not done. In fact, it’s just begun. Implementation is what requires most of our considered brainpower.

“It’s ludicrous, though, to suppose that checklists are going to do away with the need for courage, wits, and improvisation.” – Atul Gawande MD, ‘The Checklist Manifesto: How to Get Things Right’ p. 161

In application of Lean Processing, we often employ stepwise procedures. Ergonomic problem-solving follows a similar path. This helps us better interpret and apply our responses appropriately. As helpful as our ergonomic checklists can be for compiling data, the information isn’t beneficial until a solid plan of action is devised and executed.

Here’s just a few examples of common variables that are often beyond the scope simple ergonomic checklists:

Example 1) It’s Not That Simple…

Ergonomic execution often starts by reviewing information with those workers most directly affected. They’re frequently best able to evaluate our proposed solutions. Based on their knowledge of the facility, the equipment and the work processes, their input can prove vital to success, or failure. Onsite personnel are commonly our true subject matter experts. This critical influence isn’t found on many common ergonomic checklists.

Ranking our suggested interventions – to eliminate more serious hazards first – helps create immediate impact. Interim steps can better prepare budgets, staffing and structures for our longer-term solutions. Safe work practices, administrative controls, and personal protective equipment smooth the way toward bigger ticket items to come later (elimination, substitution or engineering) – and may soften their inevitable financial blow. Good luck finding these interrelated variables on many canned ergonomic checklists. Every workplace scenario is unique in these respects.

Example 2) There’s Skin in the Game…

Use of SMART Goal methods in our ergonomic exposure reduction plan offers both measurability and accountability. Arriving at an agreement between management and labor to assign responsibilities is both helpful and instructive. Establishing realistic target completion dates based on our ergonomic exposure rankings keeps schedules verifiable. Organizational Ergonomics is at play here – and way beyond the scope of simply checking boxes.

Planning how to track progress toward completion of our stated goals should be a joint accord involving all affected parties. Agreeing on just how the effectiveness of controls are corroborated should be sought from the outset of any ergonomic exposure reduction plan. Gantt Charts may help in this endeavor, but they’ll be customized to unique benchmarks along the way. There’s nothing pre-fab about employing them. See a recurring pattern forming?

Example 3) A Fly’s in the Ointment…

As ergonomists, we may be called upon to help our client evaluate their ergonomic control measure effectiveness. Not all ergonomic interventions are ‘one-and-done’. It’s not uncommon for our best laid plans to need further updating and modification. When we involve the leadership and workforce together, they’ll be the best arbiters of both the functionality and the value of our suggestions. Again, these are areas where isolating our checklists can fall short.

Finally, the ergonomic suggestions we make that are not effective need to be identified. Once selected, new ideas must provide adequate protection. There are rarely one-size-fits-all silver bullets when complex challenges present themselves. Be ready to go back to the drawing board. Sometimes again and again. And bring your checklists as ongoing outcome measuring tools. That’s where they’re best suited.

When You Only Work with a Hammer, Everything Looks Like a Nail

Just these few examples of common ergonomic wrinkles illustrate only some of the complexity involved in Lean Ergonomic Processing. The checklists are our friends. They are our tools. But they don’t make up for the intricate, dynamic and fluid conditions most encountered in the modern workplace. Muddle the tool and the task at your own (and your client’s) risk.

We hope this discussion helps better illustrate why relying simply on checklists is not the same thing as delivering detailed Ergonomic Improvement. A well-drafted, well-crafted ergonomic intervention is a living, breathing game plan. It follows Deming’s PDCA (Plan / Do / Check / Adjust) Cycle of Lean Continuous Improvement. Checklists give us a preliminary map to follow. But they tell us next to nothing about the journey we’ll take to arrive at our destination.

Ergonomic Improvement employs OSHA’s Hierarchy of Controls in order to provide multifaceted problem solving instead of drive-by band-aids. Our work utilizes SMART Goals, reassessment, and contingencies when things don’t go right the first time. Checklists don’t do that. They’re great at compiling data. As Dr. Gawande taught us, they’re exceptional at organizing thought. But they’re only the first step in what’s required of the serious ergonomist.

Let’s not confuse the two any longer. Our clients should rightfully expect more from us. And we’re called upon to deliver more, every day. Let’s keep learning. Let’s keep growing. And let’s resist the impulse to grasp at quick-fixes and facile interpretations. Organizational aids are powerful tools, but they’re just the hammer in our deep, comprehensive toolbox. And in the real world, not everything we encounter is a nail.  

A little about our author, Matt Jeffs DPT PSM CEAS –

Dr. Jeffs is a health and safety performance advisor for national and international firms. He’s also a seasoned ergonomics educator here at The Back School. Years ago, he excelled as a big-wave surfer and an experienced ocean lifeguard – with numerous rescues – prior to earning both his clinical undergraduate and doctoral degrees in physical therapy.

With well more than 13,000 working hours onsite across US industrial settings performing physical demand analyses, ergonomic analyses, post-offer employment testing, onsite job coaching, onsite injury triage, rapid return-to-work rehab benchmarking and more, Dr. Jeffs is sometimes lightheartedly known as the ‘Mike Rowe (from Dirty Jobs Fame) of Physical Therapy’. You name it, he’s tried it. And he’s learned something from every experience along the way.