The Checklist Manifesto - How to get things right by Atul Gawande - Book Summary

This book has a very simple message:

• The world of the professions has become increasingly complex to the point where no one professional (be they a surgeon, a pilot, an engineer, or an investment manager) can retain sufficient working knowledge to know it all. 
• Human memory is fallible. 
• People can lull themselves into skipping steps even when they remember them. 
• Checklists seem to provide protection against such failures. 

Checklists “provide a kind of cognitive net” which “catch mental flaws inherent in us all.” (p.48) 

Gawande, a general surgeon, works out this thesis with extensive illustrative anecdotes. Gawande himself played an instrumental role in the development of the World Health Organisation Safe Surgery Checklist, which has established some basic norms around the world and has reduced the incidence of infection, complications and death during surgery. 

Drawing on the construction industry, he argues that the days of the Master Builder are long gone and that today skyscrapers are built by teams of professionals who work from daily work schedules (checklists) and who solve complex, unforeseen problems by effective communication and collective decision-making that is coordinated again through checklists. One of the key lessons that comes out of this is “When resolving complex problems, power needs to be pushed out of the centre as far as possible.” (p.75)

The origins of the checklist dates to WWII and pilots coping with the increasing complexity of planes. The aviation industry has been at the forefront of the implementation of checklists to ensure that established protocols are followed and to enable flight crews to manage the full range of possible disaster scenarios. They have identified two types of Checklist (p.123): 

1. DO-CONFIRM checklists: where team members perform their tasks from memory and experience; and then PAUSE to confirm that they have done all that they are meant to have done. A complex procedure might have a number of “pause points”. 
2. READ-DO checklists: people carry out the tasks as they check them off – like a recipe. 

Checklists = Discipline 

In conclusion, “Checklists improve outcomes with no increase in skill.” (p.168)