The Checklist Manifesto
How To Get Things Right
Author: Atul Gawande
While checklists are extensively used across industries and even in our daily lives, rarely have any books been written on how to effectively draft and use checklists.
The book “The Checklist Manifesto” explains that even a simple checklist can have the effect of distributing power, minimizing any errors and prove effective to get the job done in the right order. It illustrates how checklists are useful not only in medical field but across industries and how they serve to improve a wide spectrum of tasks from simple daily tasks to complex industrial processes.
The author Atul Gawande is a noted American surgeon, popular medical researcher and writer. He serves as the professor of surgery at Harvard Medical school and has been named a part of US President Joe Biden`s CoVID – 19 advisory board.
Summary of Key Ideas
Despite a person having a remarkable individual ability, the capability of any individuals to make mistakes is apparent and failures remain frequent. However these mistakes are easily avoidable.
Even the highly trained, highly skilled, and hardworking people in our society from any major industry face the same problem simply because the certain things are beyond the capability of a single mind.
As the author, Atul Gawande says...
“Avoidable failures are common and persistent, not to mention demoralizing and frustrating, across many fields— from medicine to finance, business to government.
And the reason is increasingly evident: the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us.”
Creating a simple checklist often turns out the best strategy to overcome failures. If we are aware enough, by making these checklist we can even make up for our inevitable human errors in any situation.
The author states...
“That means we need a different strategy for overcoming failure, one that builds on experience and takes advantage of the knowledge people have but somehow also makes up for our inevitable human inadequacies.
And there is such a strategy—though it will seem almost ridiculous in its simplicity, maybe even crazy to those of us who have spent years carefully developing ever more advanced skills and technologies. It is a checklist.”
Checklists help simplify complex problems into a series of manageable steps
We live in an era of where expertise is the mantra of modern life. Often times we tend to think the expertise and experience that we have can help us to get a job or task done without any mistake.
But as it turns out having expertise and daily practice are still not enough. Take an example from a surgeon specialist, these clinicians that have taken time to practice every day will have advantages over ordinary specialist.
The author writes...
“Research has consistently showed that at least half our deaths and major complications are avoidable. The knowledge exists. But however supremely specialized and trained we may have become, steps are still missed. Mistakes are still made.”
Different checklists need to be tailored for different situations
The author states...
“Checklists seem to provide protection against such failures. They remind us of the minimum necessary steps and make them explicit. They not only offer the possibility of verification but also instill a kind of discipline of higher performance.”
“The researchers found that simply having the doctors and nurses in the ICU create their own checklists for what they thought should be done each day improved the consistency of care to the point that the average length of patient stay in intensive care dropped by half.”
“Checklists, he found, established a higher standard of baseline performance.”
The succession of checks for small milestones lead to a successful final result
Gawande writes...
“What results is remarkable: a succession of day-by-day checks that guide how the building is constructed and ensure that the knowledge of hundreds, perhaps thousands, is put to use in the right place at the right time in the right way.”
What the author is trying to tell us, with a succession of checks on a daily basis the final results are remarkable and is an example of how work can be easily done as a team.
Checklists are applicable in all kind of major industries, be it for building constructions, the medical field, aviation, and many more. As for an example, the author explains that one long checklist was just all it was for a construction schedule, and was proven to build a building with an efficient timing, despite the fact that construction work has grown more infinitely more complex over the decades.
“What results is remarkable: a succession of day-by-day checks that guide how the building is constructed and ensure that the knowledge of hundreds, perhaps thousands, is put to use in the right place at the right time in the right way.”
The idea of having a modest checklist had a definite effect of distributing power.
It is...
Researchers also have measured that checklists effect on teamwork. But having said that checklist are seen differently and ambiguous for many people.
People are skeptical of applying checklist in their field of work, thinking it might be time consuming and could be in their way of finishing their work.
“Even a modest checklist had the effect of distributing power.”
“At Johns Hopkins, researchers specifically measured their checklist’s effect on teamwork.”
“None of these studies was complete enough to prove that a surgical checklist could produce what WHO was ultimately looking for—a measurable, inexpensive, and substantial reduction in overall complications from surgery. But by the end of the Geneva conference, we had agreed that a safe surgery checklist was worth testing on a larger scale.”
When it comes creating a checklist, the most effective way is to create number of key decisions, defining a clear purpose and pause point at which the checklist is supposed to be used.
Keeping it simple and short between five to nine points is the best way to ally with the limit of working memory of a person.
“The power of checklists is limited, Boorman emphasized. They can help experts remember how to manage a complex process or configure a complex machine. They can make priorities clearer and prompt people to function better as a team. By themselves, however, checklists cannot make anyone follow them.”
“With a READ-DO checklist, on the other hand, people carry out the tasks as they check them off—it’s more like a recipe.”
“A rule of thumb some use is to keep it to between five and nine items, which is the limit of working memory.”
Checklists always work if drafted correctly
With putting the checklist into trial and reviewing the results, reveals the perception and skepticism of checklist are actually easy to use.
It did not take a long time to complete and prevents error to happen.
In the beginning, most had been skeptical, but in the end a checklists are reported that it increases the level of communication in a teamwork.
“We adopted mainly a DO-CONFIRM rather than a READ-DO format, to give people greater flexibility in performing their tasks while nonetheless having them stop at key points to confirm that critical steps have not been overlooked. The checklist emerged vastly improved.”
“Spot surveys of random staff members coming out of surgery after the checklist was in effect did indeed report a significant increase in the level of communication. There was also a notable correlation between teamwork scores and results for patients—the greater the improvement in teamwork, the greater the drop in complications.”
“No matter how routine an operation is, the patients never seem to be. But with the checklist in place, we have caught unrecognized drug allergies, equipment problems, confusion about medications, mistakes on labels for biopsy specimens going to pathology. (“No, that one is from the right side. This is the one from the left side.”)
We’ve made better plans and been better prepared for patients. I am not sure how many important issues would have slipped by us without the checklist and actually caused harm. We were not bereft of defenses. Our usual effort to be vigilant and attentive might have caught some of the problems. And those we didn’t catch may never have gone on to hurt anyone.”
“I had one case, however, in which I know for sure the checklist saved my patient’s life.”
The book summary is not intended as a replacement for the book. The quotes are attributed to the author and the images to their respective owners.
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