Customer Review

Reviewed in Australia on 26 October 2018
I’ve had the checklist manifesto in my “to-read” list for about 5 years now. It’s a book I’ve had reccomended to me many times and, in a nutshell, it’s a manifesto for the use of checklists. Atul Gawande who wrote it is a surgeon who has a history of process improvement projects. The checklist manifesto is his attempt to convince people that checklists, simple as they are, can massively improve the output quality and consistency of tasks that we repeat frequently. What is more surprising though, is that his research uncovers that even in areas where there are complex problems for which we can’t cheklist – checklists can help significantly in resolving complex and unforeseen problems.
The thesis is simple. Checklists raise output quality and consistency. The reason they do this is simple – we overestimate our ability to routinely perform series of tasks dramatically. In scenarios where there is stress or complication, the rate at which we overestimate our ability rises dramatically. Gawande examines three key scenarios – flight checklists, large scale construction projects and his own home – the operating theater.
IN each scenario, he tackles simple, routine problems and also complicated and complex problems. What emerges is a surprisingly strong case for checklists as a tool to ensure consistency, and to change behavior, and also as a tool to aid resolution in complex and unforeseen circumstances.
The bottom line is that we are inadequate repeaters of routine tasks, people routinely skip steps for one of two reasons – either they just forget through distraction or inattention, or they don’t know about, or don’t believe in the efficacy of a step – so they skip it. In each of these cases, checklists function as a kind of spot audit – telling people that they didn’t perform a step, and ensuring that they do. In many cases, authority was granted to people responsible for overseeing the checklist to stop a process if people didn’t perform it as written. What followed in each case, was a dramatic improvement in performance – in one case, a US hospital system had 1500 fewer yearly deaths after introducing checklists to key procedures.
Routine tasks aside, complex tasks were also found to benefit. IN routine simple and complicated tasks, the series of steps required to be carried out were documented in order so that they could be directly followed. In Complex tasks however, this wasn’t possible because what was required to be done was typically an emergent phenomenon like an accident or disaster and needed to be analysed and dearth with on the fly. While task based checklists were not capable of operating in this environment, what was shown to produce results was checklists describing mandating communication among team members and the best results were found in cases that included delegation of authority to act away from a central organisation.
The book contains excellent tips on how to make checklists work. It boils down to keep them short, precise, and practical. They don’t over-describe – they provide reminders of only the most critical and important steps. The point of invocation of the checklist needs to be clear for it to be useful. Checklists also come in two distinct types – Do-confirm and read-do. One is about an audit of what you carried out, the other provides steps to follow – which you do in order and tick off. Checklists should also be a maximum of 5 to 9 items – which is cognitively about all we can handle. There is also some very specific advice on formatting – right down to fonts and typeset.
One interesting point made repeatedly was that there were substantial improvements in the ability to cope with crises by teams that came together at the start of a surgery to work through the checklist.
Checklists are the simplest way to protect you, and others, from you – and the systematic mistakes you make by believing that you’re systematic – when you’re not. They’re also the simplest way to get an advantage without being smarter or first, you can be more thorough – EVERY time
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