The Checklist Manifesto
“One essential characteristic of modern life is that we all depend on systems—on assemblages of people or technologies or both—and among our most profound difficulties is making them work.”
Dr. Gawande ran a program sponsored by the World Health Organization. He proposed that hospitals institute checklists in the operating room, that would do two things. First, the checklists would help catch mistakes that can easily happen, as surgeries can be simple, difficult, or complex. Second, the checklists help bring the people in the operating room into a real team. The checklist helps to bring the timid people out, to give them the confidence to say things that are wrong, when otherwise they might simply defer to the chief surgeon.
Dr. Gawande was astounded by the success of his program. It was tested in four first-world hospitals, and also in four third-world hospitals. The checklists helped improve surgical outcomes in all of the hospitals, regardless of economic zone. Now, some of the surgeons reacted very well to the checklists, while others rebelled. But it didn't matter; in all cases, mistakes were noticed before harm was done, infections were thwarted, and the surgical teams were better prepared for the inevitable surprises and emergencies that occur.
The book also mentions several other areas. Everybody knows about the checklists that airplane pilots use. But most people don't realize that there isn't a single checklist; rather there is an entire hierarchy of checklists for all sorts of situations and emergencies. And, surprisingly, the book describes the checklists used by a few of the best investment companies; the checklists help save time, prevent mistakes, and improve profitability.
The title of the book seems so banal; I expected a rather trite description of the benefits of checklists. I was happily surprised; the book is not at all what I expected, and was even entertaining at times.
"Checklists seem to provide a 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."
