The Checklist Manifesto [Kindle Edition]

Atul Gawande's The Checklist Manifesto: How To Get Things Right has come close on the heels of Umberto Eco's The Infinity of Lists. Both are about lists and both admit to the ability of lists to bring about order and control. Both books attracted me because I am a consummate checklist-maker. Despite my prejudicial preference for lists and reading about lists, it is a credit to the quality of Atul Gawande's writing that the book kept me absorbed for the 3 hours it took to read all 193 pages of it.

The author proposes "checklists" as a functional tool to deal with the limitations of human knowledge and the possibility of making mistakes in the face of complex problems. Using stories from construction management, airline piloting and disaster management, and surgery, he shows how checklists can be used to break down complex tasks into simpler steps, thus helping prevent expensive mistakes. The author delves further into two kinds of lists (Do-Confirm or Read-Do) using a story from how the airline manufacturing industry writes their "user manuals".

Early on, he points out that checklists are not some silver bullet, and that there is judgement involved. Some situations may benefit from checklists, while others may not need any. Later in the book, he also admits that to many, lists are protocols and embody rigidity. He then proceeds to illustrate why this needn't be so and to demonstrate the importance of team work and how checklists enable that discipline, especially in disasters.

I found Chapters 7 and 8 most fascinating. The stories told so far describe the complexity of the work/ task itself but these two chapters introduce another layer, that of institutional complexity.

Chapter 7 details the WHO sponsored study to examine if checklists made any difference to safety, infections, post-surgery deaths in 8 quite disparate hospitals around the world. The results, from using the checklist, regarding reduction in technical problems, complications, infections and deaths were encouraging, for all cultural settings and even allowing for the Hawthorne Effect.

In Chapter 8, much mainstream media coverage of Jan 2009's "Miracle on the Hudson River" is debunked while the author tells the story of the pilots Sullenberger and Stiles and their calm use of appropriate procedures, while their cabin crew prepared passengers for and then monitored safe evacuation, to strengthen his thesis. The other half of Chapter 8 particularly resonated with me because I work with investors and entrepreneurs. I was fascinated by the stories of the 3 investors who have incorporated checklists into their investment decisions, favouring dispassionate analysis over irrational exuberance, so to speak.

The title is deceptively simple for this is a profound book, written accessibly and clearly. It is a defence of rational, systems-thinking approach to solving complex problems, to creating team work and collegiality amongst narrow specialists while ensuring desirable outcomes, no matter what the setting. Managers, entrepreneurs, investors as well as professional project managers such as event planners would do well to read, ponder and practise the idea proposed by the book.

This book puts forward a very compelling case for the use of simple check lists to assist in healthcare. These check lists should not be the controlling factor but should act as an aid to helping improve the levels of care given. This is an idea which has been received quite well in the healthcare profession in the U.K. With checklists for bothe Pre and post operative procedures being part of Lord Darzi's recommendations.

I first came across this book after Atul Gawande appeared on the Daily Show with John Stewart, and the common sense arguments that he put forward for the use of checklists were very compelling. Their use in scenarios such as Pre-flight have been invaluable and saved counless lives, and not by being monotonous list that dumb down procedures but provide an aide memoir to a skilled individual which helps ensure no critical element of a procedure is overlooked.

October 30th, 1935. It doesn't seem that special a date until you realise that the consequences of a plane crash that day which raised the comment "too much airplane for one man to fly" resulted in the creation of a pilot's checklist to ensure that all the correct elements of the plane were checked and set in accordance with safe flight.

And so what you may ask? Well a number of years later the acclaimed surgeon Atul Gawande used the checklist to reduce death, injury and hospital re-admittance by dramatic amounts as his book ably testifies. But it's not just the medical profession that have benefitted from the humble checklist. Atul found checklists developed, used and refined by restaurateurs (if you don't follow the recipe then things change over time), builders, business investors (the checklist helps them keep their head, and their money) and even rock bands (there's truth in the M&M story after all!).

Within his book, Atul describes example after example where the simple checklist saves lives, increases profits and maintains quality.

This is an exceptionally well-written book with simple messages that can be translated into all walks of life. Excellent!