The Checklist Manifesto puts forward that no matter how much of an expert you may be, well-written checklists will improve outcomes and performance.

By Mark S. Sanchez, DDS

How is rock band Van Halen’s contract demand of “no brown M&M’s®” related to orthodontics? It’s a circuitous route, but I promise it’s interesting. Read on.

Lead singer David Lee Roth notoriously inserted into the band’s contract a clause specifying that a bowl of M&M’s had to be provided backstage, but with every brown candy removed. Violations could trigger last-minute cancellation of the show, with full compensation to the band. Indeed, at least once, Van Halen cancelled a show when Roth found brown M&M’s in his dressing room.

We’ve all heard of movie and music star excesses when it comes to dressing room demands, but the “no brown M&M’s” clause actually had a legitimate, if clandestine, purpose.

As Roth explained in his 1998 memoir, Crazy from the Heat, “Van Halen was the first band to take huge productions into third-level markets. We’d pull up with nine 18-wheeler trucks, full of gear, in towns where the standard was three trucks, max.”

At first, he said, there were many technical errors—the girders couldn’t support the weight, or the flooring would sink in, or the doors weren’t big enough to move the gear through. There was a lot of equipment, and lots of people were needed to make it function.

So, as a little test, Roth added Article 126—the “no-brown M&M’s” clause—in the middle of the contract rider. “When I walked backstage, if I saw a brown M&M in that bowl,” he wrote, “well, we’d line-check the entire production. Guaranteed you’d run into a problem.”

The mistakes could even be life-threatening. In the cancelled concert mentioned earlier, the band found that local promoters had failed to read the weight requirements—and that the staging they’d set up would have fallen through the arena floor if the show had gone on.

When Van Halen found those brown M&M’s in the bowl, they line-checked the entire production. Or, as Atul Gawande, MD, MPH, noted in his 2009 best-seller, The Checklist Manifesto: How to Get Things Right, the band used a checklist.

Now, Gawande is a surgeon and public health researcher. He’s been named one of the world’s 100 most influential thinkers by Foreign Policy and TIME. And he’s written several best-selling nonfiction books.

Yet when I first read The Checklist Manifesto, I was skeptical of his premise that no matter how much of an expert you may be, well-written checklists will improve your outcomes and performance consistency. (Checklists? Seriously?) But Gawande provided example after example of skilled professionals making serious errors, then turning things around with the use of checklists.

Gawande believes that, because routine responsibilities have become very complex in the modern world, “mistakes are virtually inevitable.

“It’s just too easy for an otherwise competent doctor to miss a step, forget to ask a key question, or, in the stress and pressure of the moment, fail to plan properly for every eventuality,” he wrote.

A few years ago, I put the “checklists will help you” theory to my own little test by carefully composing, then implementing, a few checklists for my team at tops Software. After a bit of tweaking, we soon realized that checklists are an excellent way to ensure everyone involved in a job understands the goals and follows prescribed processes.

That’s when I decided that orthodontists would benefit from checklists, too, and that the checklists should be highly portable. We began working on an iPad app that will do much more than allow someone to compose a simple to-do list.

Orthodontic checklists can ensure thoroughness in lab procedures, accuracy in an inventory of supplies, consistency when on-boarding new patients, and time savings when adding medical history to a patient’s record, among other things.

topsChecklist will be available soon in the Apple App Store. The app is free for those who have topsOrtho practice-management software, and it syncs automatically with topsOrtho for a seamless user experience.

Now, does anyone know where I can find David Lee Roth? I’d like to ask about the fate of all those brown M&M’s. Such a waste! OP

MarkSanchezMark S. Sanchez, DDS, is the founder, CEO, and chief developer of tops Software. He practices in Atlanta. Sanchez developed his programming skills while pursuing a doctorate in physics at Georgia Tech. He earned his dental degree and certificate in orthodontics at Emory University.