The Checklist Manifesto by Atul Gawande

The Checklist Manifesto by Atul Gawande

The Book in A Few Sentences

The Checklist Manifesto shows us that checklists can save lives, and shows us the correct way of implementing them. Checklists are helpful in complicated environments like air travel, building construction, finance, even award-winning restaurants. Today, checklists are being used in hospitals across the globe to save lives and reduce costs.

The Checklist Manifesto summary

This is my book summary of The Checklist Manifesto by Atul Gawande. My summaries are casual and include what I believe are the most important concepts, ideas and insights from the book, along with direct quotes from the author.

  • Research has uncovered two types of mistakes: 1) ignorance (lack of knowledge) and 2) ineptitude (existing knowledge was not applied correctly).
  • So much knowledge exists today that errors of ineptitude are as common as errors of ignorance.
  • In other words, the volume and complexity of knowledge is exceeding our ability to apply it correctly, safely and reliably.
  • Medicine today is so complex as to test anyone’s ability to effectively manage it.
  • Intensive care is as likely to harm a patient as help them.
  • Extreme complexity is now the rule in virtually every industry.
  • Daily mistakes are made, even among the most superspecialized .
  • Half of all deaths in medicine are avoidable.
  • Two challenges of complex environments: 1) the fallibility of human memory and attention, and 2) skipping steps even when they are remembered.
  • Checklists help prevent errors by reminding experts of the minimum necessary steps.
  • One study showed that using checklists in the Intensive Care Unit (ICU) cut the length of patient stay in intensive care by half.
  • There are three types of problems: simple, complicated, and complex.
  • Simple problems are like baking a cake from a mix. Complicated problems are like sending a rocket to another planet. Complex problems are like raising a child.
  • Complex environments, in particular, benefit from checklists.
  • “The biggest cause of serious error in business is a failure of communication.”
  • The avoidable failure rate of buildings in the U.S. is less than 0.00002 percent. Checklists work.
  • The philosophy of checklists that works is pushing power and decision making out to the periphery while requiring people to discuss decisions and take responsibility.
  • In complex environments, dictating every step from the center leads to failures.
    “…under conditions of complexity, not only are checklists a help, they are required for success.
  • Even Van Halen used checklists for their concerts.
    “…following the recipe is essential to making food of consistent quality over time.” - Jody Adams, award-winning chef
  • Both task and communication checklists are necessary for addressing proliferating complexity.
  • “That’s not my problem” is a dangerous way to think yet is all too common in medicine.
  • Two keys to successful medical checklists are: 1) Discussing the procedure as a team just before starting and 2) Ensuring the everyone introduce themselves by name and role.
  • Giving people a chance to speak activates their sense of participation and knowing each other’s names fosters teamwork.
  • Bad checklists are vague, too long, hard to use and impractical.
  • Good checklists are precise, to the point, easy to use and practical.
  • Good checklist clarify priorities and aid teamwork.
  • Pause points should be scheduled into checklists.
  • Wording should be simple and exact, free of clutter, include both uppercase and lowercase for ease of reading, and ideally fit onto one page.
  • No matter how much thought goes into a checklist, it needs to be tested in the real world, and will inevitably require revisions.
  • Checklists are quick, simple tools that distill information into its practical essence.
  • Good checklists are brief yet complete.
  • Using checklists improves communication, improves teamwork and reduces the number of errors.
  • Research shows that the prospect of making money stimulates the same areas of the brain as cocaine.
  • We tend to resist using checklists because we don’t think we should need them, and they can be painstaking and not much fun.
  • Humans are built for novelty and excitement, not discipline and attention to detail.

Related Resources

This is a list of resources, including authors, books, websites, podcasts and concepts mentioned in The Checklist Manifesto, which might be useful for further learning.

People

Samuel Gorovitz and Alasdair MacIntyre, philosophers
Brenda Zimmerman and Sholom Glouberman
Geoff Smart, psychologist

Books

Crazy from the Heat by David Lee Roth

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