The Checklist Manifesto: How to Get Things Right

If, God forbid, you or a loved one ever need surgery, and you have an opportunity to ask questions before the operation, ask the surgeon whether he or she uses the WHO Safe Surgery Checklist. If you don't think this sounds like a big deal one way or the other, please read this book.

My former law firm's IP department used a variety of checklists to great effect. If you're not using checklists in your job, consider reading this book to understand how nearly every industry and profession can benefit.

This book, and the philosophy driving, resonate well with me as I have already come to similar conclusions independently. One great benefit of the book is it's not longer necessary to attempt to persuade anyone of the efficacy of checklisting, just point them at the book.

Loved this even when I wanted to bang my head against the wall and the reluctance of human beings to grasp how something so simple can be so effective.

“The Checklist Manifesto: How to Get Things Right” by Atul Gawande (2009)

This book shows the benefits of writing things down, compiling procedures into a checklist, and adhering to it during times of intense pressure.

The author covers different professions and how they've successfully incorporated checklists into their daily operation. He covers...

• Surgery
• Pilots checklist
• Patient vitals chart
• Project management for building construction
• Emergency Management
• Encouraging proper higeine in developing countries
• Deciding to invest in a company

It also goes way to into detail of some kinda gross surgeries. Got kinda needless after like the 4th surgery.

I've been saying this for years. I love checklists. I love creating standard operating procedures. I've done so for every job I've had since graduating from college. It's so much easier to just write down how to do things than to use recall. I'm lazy and forgetful. So documenting and adhering to procedure is a no-brainer.

The author helped craft the surgery checklists for the WHO in ~2007. Literally saving lives just by maintaining a basic checklist of procedures that sometimes get overlooked, resulting in a decrease in efficacy and increase in death.

It's insane to me that the revolutionary concept of...writing things down and following the set procedure...has successfully PLUMMETED the rate of surgery complications whenever implemented. And this revolutionary concept is somehow less than 20 years old? Like...my god. The realm of medicine really seems to have just recently evolved out of its infancy. I guess surgery before GWB was a crapshoot of renegade surgeons who just trusted their instincts. Insane.

Regarding the emergency management, the author talks about the failures of Katrina response in New Orleans. He points out that the most effective solutions involved flattening hierarchies and providing support via mutual aid at the local level. He then fails to see how this shows not just the failure of the federal government in that circumstance, but a failure of our economic system as a whole. Oh well.

Book was short. I really liked it.

Amazing doctor and author Atul Gawande leads the way in improving surgeries around the world. And how? With a technique that is both simple and cheap—Gawande initiates the use of checklists in surgeries.

It makes me think about other situations where checklists could be effective.

The TL;DR – this should have been an essay.

Listen, if there is anyone who is a proponent of lists, it's me. I make a to-do list every single morning, including weekends. I make packing lists, pro-con lists, and absolutely process checklists. Being that lists are so instrumental in the organization of any aspect of my life, I came into this read 100% a list proponent.

Perhaps for that reason, I didn't feel particularly interested by the argument. Yeah, lists are really helpful! They help people remember little things that are sometimes forgotten. I'm in no way surprised that they are fundamental to safe flights and medical procedures and building construction.

While the anecdotes were interesting to read, I feel like the point was made in the first 25 pages, and then continued on another 150+ too long after that. This is Gawande trying to be Gladwell, and it didn't work.

Checklists save lives. Yeah, that's the gist of the book! This book needed a serious trimming as a lot of it is just a reiteration of why checklists are awesome.

I've used checklists in many things in my life. Sometimes we resist using them because it seems so low tech and simple, but it works.

Fantastic real world account of how checklists have directly saved lives. Saved a lot of notes.
Made me rethink how I conduct my own work in order to codify it. Aviation has used it since the 1930's with far lower incident rates than software (that I work in), so why not use a checklist?

The Checklist Manifesto may look like yet another self-help or productivity book. But I found it to be a well-written book on the power of the humble checklist.

Its author, Atul Gawande, is a surgeon who has helped to create a checklist now used by hospitals worldwide. When hospitals began using the checklist, they reduced deaths and major complications during surgery by more than 30% (wow!)

The checklist itself is simple, only covering the most important steps during a surgery. Think things like confirming a patient's identity, or making sure they've received antibiotics. These key steps might _seem_ trivial, but on average, one of these steps was missed in two thirds of surgery patients.

In the book, Gawande also takes the time to explore how other industries use checklists, for flying planes, building skyscrapers or running investment firms. Altogether, he made a pretty compelling case for the power of checklists.

The 3 steps to implementing a successful checklist

1. Keep the checklists usable. In a high-stakes situation like surgery or flying an airplane, you want to keep your checklists brief and to the point. Only cover the most important tasks. If you miss these tasks, they could cause major or fatal consequences. This also ensures that people will actually _use_ the checklist and follow all the steps.

2. Have the checklists broken down into subsections, to occur before key trigger points. In a surgery, that might be right before you give a patient anaesthesia, or the moment before the first incision. Breaking it down makes it less overwhelming, and a trigger makes it easier to remember when to do a checklist.

3. Test the checklist, and refine it. A checklist is never going to be right on the first go. Through many iterations, you’ll be able to amend the bits that are confusing, or add and remove sections as needed.

How developers can use checklists

The book proves that checklists work in medicine and other industries, but what about for developers? A developer’s checklist could include things like:

* Writing test notes before a task, or talking through your approach with the stakeholder or another developer. This way, you can make sure that all your assumptions are correct.

* Making sure all tests pass before raising a pull request.

* Showing your work to another developer before letting the code hit production, to double-check for bugs.

It might seem silly to have such a checklist, but the idea here is to keep the tasks simple. If you miss them (and let’s face it, sometimes we do) they could have big consequences. Misunderstanding a requirement from a stakeholder could force you to rewrite part of your code. And if you shipped a bug to production you could have some angry customers on your hands.

Conclusion

The Checklist Manifesto was a fun read, with lots of interesting examples of how different industries are using checklists. Among the many productivity books I've read over the years, this one is up there! I can definitely see the value this could add to my own life - I just need to figure out what these checklists could look like.

I like Atul Gawande, and so I probably gave this one more leeway than I would have otherwise. I think Gawande has a good premise and he did a good job convincing me of that hypothesis, I just don't know that the book justified itself overall. But Gawande is a decent writer and did make me think about some things and bring awareness to just how easy it is for people to forget asinine or everyday things. I'll definitely consider using checklists more often, although thankfully there are no lives on the line if I don't do so.

★ ★ ★ 1/2 (rounded up)
This originally appeared at The Irresponsible Reader as part of a quick takes post to catch up–emphasizing pithiness, not thoroughness.
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First off: Gawande is a doctor/surgeon, and a lot of his illustrations and examples are surgical in nature. A bit too detailed for me early on—I'm a little more squeamish about real-life blood and guts than most people. I figure most readers won't be bothered by it like me (some may not even call it detailed).

Anyway, it's a simple premise, but seeing how checklists have been used by pilots, surgeons, investment bankers and the like is utterly fascinating. There's just no way that I can make it sound like it. Could've been a little longer, could've used a little more guidance on how to implement it for yourself.

Still, at the end of the day, more fun, more interesting than you'd think a book about checklists would be.

Interesting ideas. I'm stuck on why we resist using checklists. How do we avoid making them mindless and remain alert when using them?

While a compelling plea for using a checklist and a good read, most of the learning seem to be superseded by Agile. If I had read this 5-10 years ago I think it would have been more powerful.

I have developed a lot of respect for Gawande in the past year. Love his interdisciplinary tendencies & writing style.

An outstanding book, which I ended up picking at a great time. This will stick.

Really enjoyed this book - realistic outlook at how checklists can have value and their effects on humans in the wild. The stories were compelling and memorable, creating useful artifacts for future conversations. Not so much a “this is how to make amazing checklists” book, but with enough content there to go back and pull from, I'd characterize it as “must read” for anyone who sees this inconsistency as a challenge in their work or life.

This seems a very useful tool in the right place. Tricky.

Like most books of this kind, it's probably too long. Read the first two and last two chapters and you'll get it. I'll probably revisit the checklists I use for my work as a result of this book.

“The Checklist Manifesto” is a quick read that just about anyone can enjoy, whether you're in school, working, or retired. As an accountant, I always do better when I have a checklist or I forget about little things.

This should be titled THE SURGICAL CHECKLIST MANIFESTO. I get that the author is a surgeon, but about the only other example of checklist usage is from the early days of aviation. He seems to regard construction project management Gantt chart as being a great example of a checklist process, but that's a stretch. There is no attempt to show transference to other areas or regularly recurring processes. I know that an entire book could be written on checklists just in technology jobs. This may be a good book for the right audience, but it has been mis-marketed to business readers in general.

Quick read on the benefits of checklists

This is a good read which correlated to other topics such as the Power of Habit and Getting Things Done in its philosophy of keystone habits and making lists to keep reminders of what needs to be done. It also adds some design tips taken from the aviation community in making better checklists.

If you're looking for a how-to guide, this is not it (with the exception of Chapter 6).

It's about the need for checklists and a culture of teamwork in a technologically complex world. He draws heavily from the practices and examples of airline pilots, which he applies mostly to surgery. There is a brief discussion of government application (natural disasters) and investing as well.

As a professional list maker, I did not need convinced of the effectiveness of checklists, so I didn't get a whole lot from this book. I think the most interesting thing was considering the (American?) ideal of an independent hero who knows all and gets it done on his own, vs the real world necessity of a team working in unison.

I hope things have changed in the 8 years since he wrote this book, but this would still be a recommended read for those in the medical field.

If you think checklists can't be effective tools in improving performance of teams and individuals in repetitive tasks, think again, because they sure can!

I happen to be one of those people who gravitate towards checklists in any shape or form, and love to create them myself. So, this book was preaching to the choir. :-)

The usefulness and applicability of checklists, even by people who think they don't need or would use checklists, is well represented through the author's experience and research. Everyone can find exceptions to the idea, but in general, I would love to see his research taken into other fields, especially education.

Read this book if you're interested in how the aviation and construction industries have capitalized on the use of checklists, the history of checklist adoption, and the idea of discipline as a professional trait.

A little over a year ago I heard about this book at a medical conference I attended where we were discussing the benefits of CPOE (Computerized Patient Order Entry) for hospital patients. Based on the recommendations of others at the conference I went ahead and bought the book and finally got to it a few weeks ago. I highly recommend you read this book.

About the Author:
Atul Gawande is a surgeon who both maintains a private practice and consults for the World Health Organization (WHO) regarding worldwide health issues. He has written several other books, and based on this one, I'll definitely be getting his others to read in the near future.

Basic Premise:
Gawande was presented with a statistical problem (epidemic) by the WHO - the rate of surgery and surgical complications is exploding in the world. That issue raises the question of what can be done to improve outcomes, not just in economically advanced countries but also in third world sites where surgery is still being performed at accelerating rates. While expensive solutions may be an option for developed nations, that isn't likely to be an option for those developing countries.

Dr. Gawande opens with a look into several medical cases as examples of the complexity of the medical decision-making process. These are, by the way, fascinating cases. He shows some failures and incredible successes. What makes the difference in these outcomes? He then takes the reader on a journey in which he looks for answers in different industries that could apply to the medical problem he is confronting. He looks at the construction industry, where incredibly complicated buildings are constructed in clockwork fashion taking into account thousands of natural variables. Those guys end up being able to do that with an incredibly small failure rate. Of course, when a building fails, it is likely to lead to many deaths. The same is true for medical cases. He discovers the value of a checklist in the construction world, but decides the type of checklist they use isn't really practical in medicine because while construction occurs over months to years, medical decisions must be made in seconds.

He then moves on to the airline industry, which is fascinating. This is a much more accurate fit with the medical problem and he finds again that checklists are in place in that industry leading to their very low rate of failure. Again he covers several interesting cases and how the implementation of checklists saved lives. Then he looks at the financial trading industry and how checklists have potential impact for that industry, but they fail to benefit from it due to the culture of the industry.

Finally, he gives some personal anecdotes as he implements a checklist in his own O.R. With success the outcome, of course.

Despite the setting of the book in the context of a medical issue, this book probably should be required reading for anyone who makes important decisions. The whole theme of the book, really, is that implementing checklists which ensure critical elements of any “process” aren't missed can and probably will result in improved outcomes. It's true in the construction and airline industry. There is evidence that it works even for institutional traders, if they'd use it, and the same is true for surgeons. How likely is it that your particular industry could do better with a checklist? I would suggest very likely. The Checklist Manifesto really raises a lot of questions about where can I benefit from developing checklists for my work as a hospitalist. There may even be room for a second book discussing how an organization should go about developing a checklist, although he does describe the process his team used. Consider the same for your own situation.

Dr. Gawande's reputation proceeded him, meaning that much of the medical community had already read the NEJM article on the same topic, considered how it applied to subfields of medicine, personal practices, etc. and the reforms espoused had largely been adopted, at least by the American medical community by the time of publication.

Nonetheless, Dr. Gawande's journey to discover why checklists matter, the subtle ways in which they matter and the fields that have instituted them was an interesting, if slightly shallow read.