Book Notes – The Checklist Manifesto – Atul Gawande

Book Notes – The Checklist Manifesto – Atul Gawande

NOTES

  • Know-how and sophistication have increased remarkably across almost all our realms of endeavor, and as a result so has our struggle to deliver on them
  • Our failures remain frequent. They persist despite remarkable individual ability.
  • The volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us.
  • Multiple fields, in other words, have become too much airplane for one person to fly. Yet it is far from obvious that something as simple as a checklist could be of substantial help.
  • People can lull themselves into skipping steps even when they remember them.
  • The researchers found that simply having the doctors and nurses in the ICU create their own checklists for what they thought should be done each day improved the consistency of care to the point that the average length of patient stay in intensive care dropped by half.
  • Checklists seem able to defend anyone, even the experienced, against failure in many more tasks than we realized. They provide a kind of cognitive net.
  • Simple problems, they [Zimmerman, Glauberman] note, are ones like baking a cake from a mix. There is a recipe. Sometimes there are a few basic techniques to learn. But once these are mastered, following the recipe brings a high likelihood of success.
  • Complicated problems are ones like sending a rocket to the moon. They can sometimes be broken down into a series of simple problems. But there is no straightforward recipe.
  • Complex problems are ones like raising a child. Once you learn how to send a rocket to the moon, you can repeat the process with other rockets and perfect it. One rocket is like another rocket. But not so with raising a child, the professors point out.
  • [In life] we are besieged by simple problems.
  • Checklists can provide protection against such elementary errors.
  • The assumption was that anything could go wrong, anything could get missed. What? Who knows? That’s the nature of complexity.
  • [Hurricane Katrina] had been an “ultra-catastrophe,” a “perfect storm” that “exceeded the foresight of the planners, and maybe anybody’s foresight.” But that’s not an explanation. It’s simply the definition of a complex situation.
  • No, the real lesson is that under conditions of true complexity—where the knowledge required exceeds that of any individual and unpredictability reigns—efforts to dictate every step from the center will fail. People need room to act and adapt.
  • Under conditions of complexity, not only are checklists a help, they are required for success. There must always be room for judgment, but judgment aided—and even enhanced—by procedure.
  • There seemed no field or profession where checklists might not help.
  • Question your seniors: The more familiar and widely dangerous issue is a kind of silent disengagement, the consequence of specialized technicians sticking narrowly to their domains. “That’s not my problem” is possibly the worst thing people can think, whether they are starting an operation, taxiing an airplane full of passengers down a runway, or building a thousand-foot-tall skyscraper.
  • Because we’d worked as a single unit, not as separate technicians, the man survived. We were done with the operation in little more than two hours.
  • Bad checklists are vague and imprecise. They are too long; they are hard to use; they are impractical. They are made by desk jockeys with no awareness of the situations in which they are to be deployed. They treat the people using the tools as dumb.
  • They turn people’s brains off rather than turn them on.
  • Good checklists, on the other hand, are precise. They are efficient, to the point, and easy to use even in the most difficult situations. They do not try to spell out everything—a checklist cannot fly a plane. Instead, they provide reminders of only the most critical and important steps—the ones that even the highly skilled professionals using them could miss. Good checklists are, above all, practical.
  • The wording should be simple and exact, Boorman went on, and use the familiar language of the profession. Even the look of the checklist matters. Ideally, it should fit on one page. It should be free of clutter and unnecessary colors. It should use both uppercase and lowercase text for ease of reading. (He went so far as to recommend using a sans serif type like Helvetica.)
  • But first think about what happens in most lines of professional work when a major failure occurs. To begin with, we rarely investigate our failures.
  • [Anonymous investor] enumerated the errors known to occur at any point in the investment process. He then designed detailed checklists to avoid the errors, complete with clearly identified pause points at which he and his investment team would run through the items.
  • The checklist doesn’t tell him what to do, he explained. It is not a formula. But the checklist helps him be as smart as possible every step of the way, ensuring that he’s got the critical information he needs when he needs it, that he’s systematic about decision making, that he’s talked to everyone he should.
  • Benefits of (good) checklists:
    • They improve outcomes with no increase in skill.
    • The process is more thorough but also faster.
  • It somehow feels beneath us to use a checklist, an embarrassment.
  • A checklist is only an aid. If it doesn’t aid, it’s not right.

The book is a bit pop-psych and not necessarily a game-changer, but it is an easy insightful read for everyone performing complex tasks on the daily. If you liked these notes, you can support my blog by purchasing the full book on either:
Bol.com: The Checklist Manifesto on Bol.com
Amazon: The Checklist Manifesto on Amazon
Check out this book on Goodreads. I rated it 4 out of 5.

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