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The Checklist Manifesto - Book summary

Over the past few decades, mankind has acquired extensive knowledge—we can predict hurricanes and tornadoes, build skyscrapers and save people from critical diseases and injuries. Yet smart, highly-trained, and experienced people still make avoidable mistakes regularly. Concerned by the number of errors in the medical field—many of which are fatal—surgeon Atul Gawande set out to investigate the possible causes and solutions to such avoidable failures. He discovered a simple but powerful solution to getting things right: using checklists. In our free version of The Checklist Manifesto summary, we’ll outline Gawande’s learning journey and key insights on how to use and develop checklists.

The Checklist Manifesto: An Overview

It’s a common misconception that checklists are merely about ticking boxes and mindlessly following protocol. In reality, checklists are about facilitating a culture of teamwork and discipline, which are crucial for a wide range of contexts, including complex problems that involve expert skills and knowledge. The Checklist Manifesto chronicles Gawande’s discoveries about checklists, the insights he learned from various industries and his personal experiences, with specific tips and examples on how you can develop and use checklists. Gawande calls for checklists to be adopted more widely to reduce avoidable failures and improve performance standards.

Getting Things Right in a Complex World

Complexity and Human Fallibility

Gawande believes that smart, highly-qualified people make avoidable mistakes because the amount and complexity of knowledge today has exceeded our individual capacity to remember/apply them correctly and consistently. Mistakes and failures happen when (i) we lack the skills, knowledge or experience for a task, or (ii) we have the requisite skills and knowledge but fail to apply them correctly.

One common solution is to increase the level of training and specialization. Doctors undergo such extensive education and training that they typically start independent practice only in their mid-thirties. There are now super-specialists within an area of specialization, e.g. anesthesiologists are further divided into pediatric, cardiac, obstetric, and neurosurgical anesthesiologists.

In spite of all these, mistakes are still being made, because:

  • We may forget details or lose focus when we’re distracted by urgent stuff or when we’re overwhelmed; and
  • Even if we remember what to do, we may skip certain steps or take shortcuts.

In a nutshell, human fallibility leads to avoidable errors in increasingly complex environments:

The Checklist Manifesto summary_human fallibility-errors

Why checklists work

Checklists explicitly spell out the essential steps in a task. This creates a verification process to safeguard against human fallibility and enforce discipline to maintain performance standards. In the book, Gawande covers numerous examples and case studies, ranging from restaurants to theaters, medicine, aviation and construction. You can get a detailed overview of the key examples in our full 13-page summary.

Tackling Complex, High-Stakes Problems with Checklists

Even if checklists can reduce mistakes, can they be applied for all types of scenarios and problems? The simple answer is YES.  In our complete book summary, we elaborate on 3 types of problems—simple, complicated and complex—and why/how checklists work for all of them including unexpected issues or complex problems with no fixed formula.

In fact, checklists are even more crucial in facilitating teamwork and decision-making in complex high-risk situations. In such scenarios, no single person can have all the info or experience to make all the right decisions, and people may have to operate under stressful circumstances which increases their chances of errors.

In our full book summary, we explain (i) the common challenges with decentralized decision-making, teamwork and communications, and (ii) how you can/should improve performance and reduce errors using checklists. In particular, the checklist manifesto calls for 2 types of checklists for complex problems: task checks (to ensure that routine, simple items are not overlooked) and communications checks (to ensure people coordinate and make decisions effectively).

Creating an Effective Checklist

Gawande met with Boeing’s Daniel Boorman to gain additional insights from his years of experience developing checklists. He found that pilots have “normal” checklists for routine operations (e.g. checks before starting the engines), and “non-normal” checklists for non-routine or emergency situations.

Effective checklists aren’t developed in an ivory tower or office–they must be developed with real-world analysis, testing and revisions. In our complete 13-page summary, we zoom in further on how to draft effective checklists in 3 parts: (i) pre-planning, (ii) developing the checklist and (iii) testing your checklist in the real-world.  Here’s a quick overview:

The Checklist Manifesto summary_how to develop a good checklistUsing Checklists to Get Things Right

Checklists have the potential to solve countless problems and improve results in many domains, because they help us to overcome human errors, facilitate communication and teamwork. This is evidenced in the various examples presented in The Checklist Manifesto summary, and in Gawande’s own experiences.

Unfortunately, checklists are still not widely or systematically adopted due to a number of cultural and perception issues.  In our full book summary, we explain some of the common misconceptions that stand in the way of checklist adoption, and what you can do to start using checklists in your work and organization.

Getting the Most from The Checklist Manifesto

In this article, we’ve briefly outlined some of the key insights and strategies you can use to achieve desired change. For more examples, details, and actionable tips to apply these strategies, do get our complete book summary bundle which includes an infographic, 13-page text summary, and a 26-minute audio summary.The Checklist Manifesto summary - book summary bundle

In the book, Gawande dives into several other detailed examples and case studies of how human errors occur in complex environments, and how checklists can and have been used to address the problem. He urges medical professionals to learn from the building and aviation industries, to instill greater teamwork and discipline using checklists. For more details, you can purchase the book here for the full details and examples, or check out more resources/details at http://atulgawande.com/book/the-checklist-manifesto/.

About the Author of The Checklist Manifesto

The Checklist Manifesto: How To Get Things Right is written by Atul Gawande, MD, MPH–an American surgeon, writer, and public health researcher. He’s the CEO of healthcare venture Haven, a surgeon at Brigham and Women’s Hospital, a professor at Harvard T.H. Chan School of Public Health and Harvard Medical School, the founder and chairman of Ariadne Labs, and the chairman of Lifebox.
Gawande is also a staff writer for The New Yorker magazine since 1998 and written four New York Times best selling books. He has been awarded the AcademyHealth’s Impact Award for highest research impact on healthcare, and the Lewis Thomas Award for writing about science.

The Checklist Manifesto Quotes

“Under conditions of complexity,…there must always be room for judgment, but judgment aided—and even enhanced—by procedure.”

“In the face of an extraordinarily complex problem, power needed to be pushed out of the center as far as possible.”

“Just ticking boxes is not the ultimate goal here. Embracing a culture of teamwork and discipline is.”

“An inherent tension exists between brevity and effectiveness. Cut too much and you won’t have enough checks… Leave too much in and the list becomes too long to use.”

“The checklist doesn’t tell him what to do…It is not a formula. But the checklist helps him be as smart as possible every step of the way.”

“It somehow feels beneath us to use a checklist, an embarrassment… The truly great are daring. They improvise. They do not have protocols and checklists.”

Click here to download The Checklist Manifesto summary & infographic

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