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 The Checklist Manifesto summary, we’ll outline Gawande’s learning journey and key insights on how to use and develop checklists. For the full details, examples and tips, do get a copy of the book, or get a detailed overview with our complete book summary bundle.
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:
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 the book / full 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 the book / 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:
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.
Other Details in “The Checklist Manifesto”
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, please visit Do get a copy of the book for the full details and examples, get The Checklist Manifesto summary bundle for an overview of the various ideas and examples, or check out more resources/details at http://atulgawande.com/book/the-checklist-manifesto/.
Learn how to get things right in an increasingly complex world!