The Checklist Manifesto by Atul Gawande

The Checklist Manifesto - Cover

I first saw this book in the recommended section of a bookstore in my favourite mall. As usual when I visit the mall, I pay the bookstore a visit and let the magnificent collection of books tempt me. I always check the recommended section carefully and try to read the synopsis of each book there that looks interesting. When I saw the synopsis of “The Checklist Manifesto,” I was inclined to buy but not very interested and decided to give it a pass deeming it too expensive at almost four-hundred bucks.

Eventually, one day I saw it again and of course “Where is the human nature as weak as in a bookstore?” I gave in to myself and bought the book. Out of the three books I ordered, this was the first (and as of yet, the only) book I received. Usually, when I get a book, I keep it on my bookshelf and evaluate which one to read; however, in this case, somehow, I took it up and started reading at once. I had just got back home after work and I hadn’t much time then. I decided to start on it properly after dinner.

About the book

The book is a collection of stories that show how checklists have saved or can potentially save lives. Each story is accompanied by reflections of the author on how exactly the checklist helped. There is a thorough discussion on what kind of checklist was used, how it was used and enforced and how the process was made smoother and easier.

Apart from being a writer, Atul Gawande is a general surgeon at the Brigham and Women’s Hospital at Boston. Therefore, not surprisingly, most of the stories presented in the book are about surgeries. The book starts with a seemingly simple surgery that took an unexpected turn in the middle for the worse. It follows with another story of a surgery to remove cancer, when suddenly and unexpectedly, the heart stopped functioning. The purpose of these stories in the beginning was to show the complexity of medicine today and to highlight the need of methods to handle such complexity.

Then the book continues with a story of a drowning victim who spent half an hour under icy water and was revived after extensive and extremely complicated procedures. The book later reveals that a set of checklists were the reason why the procedures were completed one after another without missing any crucial step that resulted in saving of a life.

The author starts the story of the checklist with a US air-force incident and its aftermath where the simple tool of checklist was proposed to solve the problem of flying planes of ever increasing complexity. The results were astounding. The aircraft that did not even last the demonstration flew almost two million miles with the assistance of checklists and there wasn’t a single accident.

The book then continues with the first attempt to a doctor’s checklist by Peter Pronovost. He did not attempt to encompass everything in the list. Instead, he decided to tackle just one task: central line infection. He persuaded the administration to enforce the checklist and measured results in this hospital for more than two years. The checklist had prevented forty-three infections and eight deaths and saved two million dollars.

Similarly, with one story after another, the book shows how checklists enforce a higher standard of baseline performance.

The author continues with usage of the checklist in the construction industry and how a different kind of checklist is used to handle emergencies or prepare for them: communication task checklist. This checklist ensures all teams talk to each other periodically and solve problems. The rest of the book carries special emphasis on the team rather than a single person and how the hero of today is not the traditional idea of one person solving all problems against all odds but a group of people each of which do their job insynchronization with others’ tasks so that the overall objective, complex though it is, is efficiently achieved.

We then see checklists being used in various industries. First story is about the management of Hurricane Katrina emergency. Then, we see different forms of checklists used in concerts, restaurants, and finance industry and of course, the aviation industry.

The book heralds the story of Flight 1549 from La Guardia airport, New York City and how it struck a large flock of Canadian geese over Manhattan, lost both engines and famously crash landed in Hudson River. The story describes how aviation checklists saved 155 lives onboard the flight.

The book also describes guidelines and best practices to write checklists that actually work and are useful as opposed to being just a formality. It gives example of aviation industry checklists used worldwide and describes the principles used in framing them. This adds to the practical value of the book, which otherwise, would have just been a collection of stories and reflections.

Conclusion

My only disappointment with the book was that there was no story or scenario for software industry. Of course, I can search for such stories online but it would have made it a complete read as a part of the book. Apart from that, actual user stories and reflections would have helped me write checklists to sort out my daily work routine.

Overall, the book is a good and interesting read for all the stories it tells. It drives the point about managing complicated tasks using simple tools home and shows us how the simple tool of checklist has made a difference to many lives everywhere.

  • Zoy

    A book on checklist seemed a bit tricky… firstly because never heard book on that subject and second, too commonly known a topic to write on (like writing a book on qwerty key board), but writing success stories of checklist seems to add some meaning to it.
    Right now I am reading two books, The last Lecture and The fabric of cosmos; may be you would like to try both of them…
    One thing that caught attention was – “Traditional methods to solving complex problems”…. I have something to think on this lines….

    • I have “The Last Lecture.” I am not sure when I will be able to read it, though. What is the fabric of cosmos about?

      It is not entirely success stories but it is more like an evolution of checklist in the surgical world mainly. Whenever he mentioned other industries, the checklists already seemed to be in place and used well there.

      On the other hand, because it is too common a topic, that is why a book highlighting best-practices is important. We all write checklists but we rarely use them (I know I rarely do). This book explains what we can do to make sure we use them often and have fun doing it.

      • Zoy

        Now that seems to be interesting…. I will pick it up the next time I visit a book store.
        Fabric of Cosmos is about evaluation of Science and understanding of mankind. At points it turns philosophical too but not for long… It is a must read for any one who wonders how theories of science explain the same thing and even at times contradicts… as I read it I feel science is no less than spirituality… never conclusive but obviously directs to the conclusion that we perceive.

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