Even though checklists seem like a simple, effective solution to the problem of mistakes in procedure, there are behavioral problems to surmount in adoption. Institutions seem more willing to pay for multimillion dollar surgical robots with limited cost-benefit than try to imprlmeent checklists. Doctors are reluctant to accept them, and see the true spirit of these tools, which are to encourage teamwork and strive for discipline. The medical field is still a little liek the test pilot culture of the 50s. There is a cultural legacy that seems threatened by checklists. In finance, there is also hesitation to adopt the checklist as a tool. Psychologist Geoff Smart found the same hesitation in venture capital. Those investors dubbed “Airline Captains” take a methodical approach but most are “Art Critics” or “Sponges.”

Gawande talks about US Airways Flight 1549 and its emergency landing in the Hudson, which was a triumph of the pilot checklist, rather than a single heroic victory of the captain.

All professional occupations have three elements in common:

• selflessness
• skill
• trustworthiness
• pilots also have: discipline

Maybe we should all strive for more dsicipline? Systems are an integral part of the complex system of heath. The way the health system is designed now is piecemeal. There needs to be more integration. Checklists can be the tool to improve this integration.