The Checklist Manifesto: How to Get Things Right

Dr. Gawande acknowledges that this book grew out of his December 10, 2007 New Yorker article, "The Checklist". I suspect that, for many readers, it would be a better use of their time and money to read the article (which is available online) rather than the book. Although the book, like Dr. Gawande's previous books, is well-written, the author's essential conclusions could easily be summarized in one page (and have been in several reviews).

I have to admit that I approached this book with a level of skepticism. Sometimes authors tout a simple solution that isn't as easy to implement as they suggest. I've transformed from a skeptic to an advocate of this book, and here's why: Like his colleague at the New Yorker, Malcolm Gladwell, Gawande has the ability to write about material that could easily be boring (in the hands of a less gifted author) in a way that is clear, engaging, and thought-provoking, without ever being condescending. This serves him well in this book, whose general topic is that most professions (his is medicine) have been overwhelmed by complexity. We have trouble getting things right, because the volume of knowledge we've created has overwhelmed our ability as individuals to follow through. And we've seen ideas like "use a checklist" as a sign of weakness. Gawande points to the year 1935, when aviation reached a level of complexity that safety could not be obtained without the use of checklists. What's more, Gawande shares a host of enthralling stories that take us from Austria, where an emergency checklist saved a drowning victim who had been underwater for more than half an hour, to Michigan, where a cleanliness checklist used by hospital intensive care eliminated a troublesome and deadly form of infection. Gawande shows how checklists create immediate improvements in the workplace, and he illustrates the utility of checklists in environments beyond healthcare (disaster response, investment banking, skyscraper construction, and on and on). At minimum, this book will make you reconsider the use of checklists, and, if you're like me, you'll see immediate applications for checklists in your own work (and profession!). Emotional Intelligence 2.0 is another book that has been really helpful in my work of late. It has a wonderful process for increasing your EQ, and improving communication between coworkers.

I looked over the other reviews of this interesting book, and there are many of them that you will find very useful—so I'll just try to list some highlights. As Dr. Gawande points out, a checklist can't be too long (people won't use it), yet it must succinctly cover the most essential considerations of the situation at hand. Although what follows isn't a checklist, I'll try to focus on the most essential characteristics of Dr. Gawande's book: First, this is an easy-to-read, engaging book. I'll bet that you will find it hard to put down. It is interesting enough to make you want to read the book and serious enough to deliver important messages. Second, the value of using checklists springs directly from the complexity of modern life, whether we're talking about surgery (the author is a surgeon), flying an airplane or building a skyscraper. By the way, in reading this book I have developed a newfound appreciation of how complex the construction business can be. Third, checklists are not just for simple, straightforward tasks. Checklists help people communicate and work together better, especially when the unexpected occurs. Fourth, checklists are important regardless of the time available. Indeed, when the cockpit crew of US Airways flight 1549 lost both engines over New York City, they had only three minutes of airtime remaining. The first thing they did was to get out their checklists. (You can read Captain Sully Sullenberger's excellent book for more details.) Fifth, checklist usage has saved numerous lives, including one of Dr. Gawande's patients. His candor in discussing that episode is laudable. Sixth, humans being human, mistakes will inevitably occur. Checklist usage is important when the potential cost of human mistakes is great. Seventh, the mere act of creating a checklist focuses the mind on the most important characteristics of our tasks. Eighth, like anything else, it takes practice to produce and use checklists effectively. Ninth, practice comes from commitment and personal discipline. Indeed, one of the most important things Sully Sullenberger did was to maintain his composure and discipline, even while the gravity of his situation must have been racing through his mind. Tenth, as I read this book, my mind frequently reflected on how a checklist approach could be applied in some of the business and academic practices that I am familiar with. That's the real beauty of this book—it gets the reader thinking about ways to improve life.

The Checklist Manifesto is a good book if you require convincing that checklists are a good thing. Or if you like to read a quasi-novel on how checklists can be useful. If you already believe in checklists then you may be bored with 193 pages espousing their virtue. You will not find anything at all on how to construct a checklist, or methods to keep them current amid ever-changing procedures and technological advances. Well written, but not particularly practical.

I'm a huge fan of Dr. Atul Gawande ever since meeting him at a patient safety conference in 2005, and then subsequently reading his books and following his New Yorker articles. Perhaps because I've been following his works closely or maybe because I'm a practicing doctor diligently making the healthcare system better is why I didn't find his latest work the most compelling. Dr. Gawande makes two points, checklists and clear communications among teams, are absolutely required to decrease errors and problems and increase the chances of absolutely the best outcome, whether in constructing buildings, flying airplanes, and performing surgery. We aren't perfect. Systematic approaches make us better. Only the last two chapters, "The Hero in the Age of Checklists" and "The Save", which highlight the "Miracle on the Hudson" landing of US Airways flight 1549 by Captain Sullenberger and his crew and Dr. Gawande's experience in the operating room of adverting a near catastrophe respectively, were the most gripping. Ultimately, despite his points the irony will be that the healthcare system will not adopt these ideas, which are accepted as expectations in the aviation industry, because doctors still feel that we are somehow smarter or above checklists or teamwork. This failure to do what we are truly capable of is disheartening. As a result, individual patients will be the ones responsible in taking care of their health and asking questions. A good easy to read book or "checklist" in ensuring you get the right care every time is at Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America's Healthcare System. Although I wasn't bowled over like his other works, nevertheless, I have my own checklist and that is to continue reading and learning from Dr. Gawande and many others who toil in making healthcare better and safer.

As a professional nurse, I realize that life has become so complicated, that I want to give the best care possible, and that I need some help. Atul Gawande, is not the first person to come to the realization that checklists are the way to go. He has, however, written about his experiences brilliantly. I have been involved in many health care improvement projects. This has all led to the realization that the way I practice my craft has changed enormously. One of the most important of these realizations is that we need to include the patient in every aspect of care. After all, is that not why we are here, for our patients? Who better to give us expertise from their advantage point. Dr Gawande has gone a step further and has looked at other professions and how they have overcome the complexities of their profession. The airlines, he discovered use checklists. Now, checklists can be cumbersome, you need to be able to make a checklist that is concise, does not take much time and will be used. Nurses understand that change with physicians can be a black hole. Often, each physician thinks their way of 'doing things' is the best. To corral them into using a checklist takes expertise and good outcomes. What Dr Gawande gives us is that by using a simple checklist for surgeons, outcomes for patients improved 46%. Unbelievable results. However, Dr Gawande has also told us that there has not been one day since he started using checklists that he realized he and his team might have overlooked a step. Certainly, not every step would have avoided a death, but each step will give better outcomes. Such a simple thing, really, checklists. Busy people, caught in the complexities of life can change their ways and can produce better outcomes by using a simple checklist. Don't we make checklists when we go to market? Realizing, of course, we can't remember everything we need. Ah ha! A moment of recognition- it could work for any aspect of our life. Saving lives is Dr Gawande's method, but making our lives simpler and more productive is just as important. An ah ha moment in reality! Highly Recommended. prisrob 01-06-10 Better: A Surgeon's Notes on Performance Complications: A Surgeon's Notes on an Imperfect Science

Unfortunately sporting one of the least promising covers ever, don't be deceived — "The Checklist Manifesto" isn't a desktop publishing project by a high school student, it's real Atul Gawande being his normal, brilliant self. The book flows seamlessly and weaves medicine and other professions together in a story tapestry that will leave you shaking your head with blinding flashes of the obvious. A vital read for anyone managing complexity.

As in all of his work, Dr. Gawande latest book brilliantly reminds us all of the huge value of getting the human interaction side right to accompany the advancements in science and technology that his (and other's) field of work has witnessed. It highlights the inadequacy of technical expertise when not joined by an equal (maybe greater) emphasis on strengthening our relationships with those we work with and care about. Though the medical narrative is gripping, I challenge you to not be moved by so many of the other stories of people under complex pressure trying to get things right. The beautifully written examples of Wal-Mart and Katrina and of Mr. Hagerman are worth far more than the price of the book just on their own.

Amazon's December Book of the Month summary describes the author's mission of revolutionizing the "to-do list…without programmatic steps or tables to help reshuffle daily tasks." One may infer from this recap that this is a how-to-self-improvement book for making one more productive, more efficient and less stressed - this couldn't be farther from the core message of this book. The author's key message is that the volume and complexity of knowledge today has exceeded any single individual's ability to manage it consistently without error despite material advances in technology, boatloads of more training and super-specialization of functions and responsibilities. Yet, despite demonstrating that checklists produce results, there is resistance to their use because of the (1) Master of Universe mentality (Rock Star; Fighter Pilot; Hero), (2) our jobs are too complex to reduce to a checklist, (3) checklists are too rigid and don't force us to look up and see and think ahead of what's in front of us. Yet, in a complex environment, he states that experts are up against 2 difficulties - the fallibility of human memory when it comes to mundane, routine matters that are easily overlooked under the strain of more pressing events and secondly, people can lull themselves into skipping steps even when they remember them - after all certain steps don't always matter…until one day they do. Gawande makes a persuasive case in his book as to why you should develop and implement a process checklist for critical processes/decisions. * Whether you are from the medical field or not, you will benefit from the inspiring thinking and insights. * This book is game changing - a call-to-action for generating better results despite the pull to run with intuition or gut instinct. If you are implementing via intuition rather than a systematic process, this book's message will force you to pause in your tracks to seek a more disciplined approach. * The author uses a wide range of industries to make his case using an engaging blend of anecdotes, storytelling and research - from healthcare to aviation (US Airways 1549 landing in Hudson River) - - to high-end award winning restaurants - - to building massive office skyscrapers and shopping centers - -to setting up a Van Halen rock concert - - to FEMA's response to Hurricane Katrina in New Orleans - - to money managers making investment selections. * Can be read in 1-2 sittings. Page Turner. Fully engaging and riveting until the last page is turned. * Author's determination, authenticity, inspired thinking, modesty and willingness to disclose personal mistakes makes this an inspirational book. Both brilliantly written and a pleasure to read. My favorite excerpts: "Despite showing (hospital) staff members of the benefits of using the checklist, 20% resisted stating that it was not easy to use, it took too long and felt it had not improved the safety of care. Yet, when asked an additional question - would you want the checklist to be used if you were having an operation - a full 93% said yes." "In a world in which success now requires large enterprises, teams of clinicians, high-risk technologies, and knowledge that outstrips any one person's abilities, individual autonomy hardly seems the ideal we should aim for. ..what is needed, however is discipline…discipline is hard - harder than trustworthiness and skill and perhaps even than selflessness. We are by nature flawed and inconstant creatures. We can't even keep from snacking between meals. We are built for novelty and excitement, not for careful attention to detail. Discipline is something we have to work at." "We don't study routine failures…when we look closely, we recognize the same balls being dropped over and over, even by those of great ability and determination. We know the patterns. We see the costs. It's time to try something else. Try a checklist." "We're obsessed in medicine with having great components, the best drugs, the best devices, the best specialists - but pay little attention to how to make them fit together well"" "It somehow feels beneath us to use a checklist, an embarrassment. It runs counter to deeply held beliefs about how the truly great among us - those we aspire to be - handle situations of high stakes and complexity. The truly great are daring. They improvise. They do not have protocols and checklists. Maybe our idea of heroism needs updating."