The Checklist Manifesto – How to Get Things Right
by Atul Gawande
- Introduction
- The Problem of Extreme Complexity
- The Checklist
- The End of the Master Builder
- The Idea
- The First Try
- The Checklist Factory
- The Test
- The Hero in the Age of Checklists
- The Save
Summary
The book offers a lot of great anecdotes about the efficacy of checklists, especially in their use as memory management devices and in building communication and team work. Gawande investigates the management of complexity in medicine, finance, construction, restaurant management, and aviation. In doing so, he finds that the checklist is the tool of choice. Checklists offer a means of limiting mistakes regarding the known. There’s an old saying about the devil you know being better than the devil you don’t. Checklists are charms against the devils we know. Gawande goes on to talk about implementing a patient care checklist for the World Health Organization (WHO) and some of the obstacles he overcame in developing and delivering it. His team measured the effects of implementing the checklist in several different venues. The results were largely positive, with minor modifications needed here and there, and difficulties with regards to cultural differences. Finally, he discusses some of resistance to using checklists. Part of it is the machismo of being a hero in a “master builder” profession such as surgery. Surgeons are expected to be virtuosos who will earn the win by their own ability. Checklists limit this mythos. Gawande was not a firm believer until he had his own life-and-death situation in which checklists saved his patient’s life. It goes to show that sometimes it takes a personal calamity and emotional distress to create true buy-in.