Credit insurance brokers improve performance and results by using yesterday’s progress as the zero point and aiming higher each day

By Rob Downey

Commercial airline passengers benefit everyday from flight crews who, by law, tradition and training, follow pre-flight checklists. My view is that the use of checklists to maintain high standards in the performance of important recurring team tasks should be studied in business schools.  What has this got to do with trade credit insurance, trade finance and the management of political risks?  ICBA USA uses a wide variety of lists in our global brokerage business to assist, educate, and guide ourselves as well as our global credit-insured clientele.

One of the most recent and striking confirmations of the efficacy of using lists as touchstones to guide high performance comes from the medical profession.  In case you have not heard it, I synopsize below the story of how empowered nurses armed with checklists in the Intensive Care Unit (ICU) at Johns Hopkins Medical Center managed to dramatically improve patient outcomes at what was already one of the world’s finest hospitals.

Less than a decade ago, 50% of ICU patients at Johns Hopkins were developing serious but preventable complications after surgery from pneumonia, blood clots or infection. Dr. Peter Pronovost studied Hopkins’ ICU practices and learned that each patient had 178 daily interactions with hospital caregivers. Even with 99% perfect performance, patients were subjected to one or two sub-optimal procedures each day.  Since survival rates may drop by 2% to 55% with each complication, it was a matter of life-or-death to reduce the number of mistakes.

Dr. Pronovost believed the staff had reached the limits of technology and expertise for improving outcomes without improving teamwork.  He provided Hopkins ICU caregivers a checklist of mandatory procedures to guide each  patient contact.  On the list were such items as wash hands, clean skin with chlorohexidine, and provide sterile dressings over catheters.  There was no measurable improvement in outcomes!

The doctor then gave ICU nurses checklists to track observed behaviour.  There was an almost 15% reduction in negative patient outcomes.  Finally, Dr. Pronovost won permission from Johns Hopkins to give ICU nurses authority to enforce compliance with the listed procedures over everyone in the unit from custodians to senior surgeons and all attending staff.  Deaths from pneumonia, blood clots, and staph infection dropped to near zero!

(More about cutting down on errors and “ticking off” a checklist can be found at this book review at The Economist.)

In May 2009, I provided, at this blog, a list called, “The Top Ten Reasons for Claim Denial” and I stare daily at a wall of paper lists we use to screen for oversights or problems. Three examples, from my current “wall paper”:

• Fourteen questions with thirty sub-categories to pre-vet Ex-Im Bank medium-term applications
• Nine categories and ninety-four sub-categories, for assessing general Property & Casualty cover
• A two-page list of thirty question categories to guide a standard multi-buyer renewal

Our work does not involve brain surgery or landing aircraft with two hundred passengers aboard, but my partners and I use lists to limit presumption, to avoid ignorance, to increase productivity, and to maintain a shred of sanity.  Without innumerable lists to guide the workaday applications of our craft and trade, our team would not be able to compare the work we do so relentlessly to “yesterday’s zero”.

(Rob Downey is one of the founding partners of International Risk Consultants, Inc. (IRC) www.irc-group.com – a globally-integrated trade-finance and credit insurance specialty brokerage, which serves as the operating member of ICBA for Asia, Brazil, India and the USA)