The Checklist Manifesto

From flying a plane to life saving surgery, checklists have grown to play an important role. Checklists can be a trusted solution to govern the vital few steps for any complex process to be successful.

My expectation when I bought this book was that of picking up a book on productivity. Well, it is, but also so much more than what I imagined. Some of our sophisticated systems are too complex for a single individual to handle. Checklists are one of those very simple solutions to mighty and complex problems that give phenomenal results.

Atul Gawande is such a skilled storyteller that this book reads like a collection of short stories. Some of them read like a thriller where intense suspense moves you to the edge of your seat - and - Yes, this is not a book of fiction.

The core premise of the book is to show simple checklists as a solution to complex and life-threatening problems. Gawande draws on inspiration from wide variety of fields ranging from construction to aviation, even weird sounding celebrity contracts, to build a case for checklists.

With the skill of a seasoned surgeon, he sews different aspects of checklists and human nature together to prove that our brains have evolved to think and synthesize higher level abstractions. The bright side.

He also shows the dark side through some of the stories. When it comes to a simpler task of remembering mundane and repetitive steps, they let us down. They are quite poor at remembering a sequence of actions, especially when the room is full of distractions. More so when you are under pressure fighting for your life or another life.

Let’s see a few themes from the book.

Let Go of Ego

Gawande shows why the sheer simplicity of checklists was also a key factor that harmed the adoption of checklists in the first place.

The book talks about the general tendency of knowledge workers to see checklists as something beneath their intellect.

Checklists insult our ego.

He, then, goes on to say that transferring important but stupid tasks to a checklist, we allow our intellect to solve much more difficult problems while taking comfort in the knowledge that the checklists got us covered. That way, any damage to the ego is prevented.

Measure

Another important lesson that weaves through the book is about measuring status quo before introducing any change. The research team from WHO spent equal amount of time collecting data before and after introducing the Safe Surgery checklist.

You’ll find why such an elaborate data collection is required before a chance is introduced. The data comes to your aid and answer many questions once the research is over, at which point, you may not have the luxury to go back and measure what was it previously.

Simplify

He leaves little gems of wisdom about forming checklists that work, again drawing inspiration from aviation industry. Checklists cannot be too short that they are inadequate. They cannot be too long to hinder progress either. The book gives you answers to doing it the right way.

Finally, you can never escape the testing part of it. Every checklist had to be put to good amount of testing and optimization based on the results of testing. Monitoring and improving the checklist becomes part of its life cycle.

Be Flexible

Freedom for each practitioner to amend it as they see fit is also an important aspect of installing checklists, especially when you roll one out all over the globe. The example of a London hospital that administers anesthesia in a separate room away from the operation theatre shows the difference between hospitals in other cities where anesthesia is administered within the operating theatre. Hence the checklists also need to be modified to support their local structure and procedures.

Give Up Authority

In organizations with a top-down structure, it may not be easy for some to give up authority. We get to see examples where surgeons were quick to override suggestion from nurses to follow the checklist. It doesn’t work if surgeons are the only one responsible for checklists with no power to any other stakeholder. But several battles later, nurses are stopping surgeons if they have forgotten something in the checklist.

Conclusion

The book is bound to ignite thoughts of different checklists that you can prepare for work and outside.

Do you know why FLY THE PLANE is indeed an item in the checklist for the pilot to focus on when there is an emergency? Gawande says why and it makes perfect sense.

Buy it and read it. Treat it like an education on arriving at simple solutions to complex problems while learning from a variety of industries.

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