“The Checklist Manifesto”—Book review

I use my packing checklist religiously. And my grocery store checklist. And, yes, my Bible reading checklist, too. (Contrary to popular opinion, it’s really not sacrilegious to “check the box” after you read 3 chapters.)

Do you use checklists?

Checklists simplify the complexity of having to remember a set order or repeat the same details from memory over and over.

The Checklist Manifesto by Atul Gawande If you’ve had surgery lately, you probably saw checklists in action. You were asked things like: What surgery are you having done today? Check. Who is your surgeon? Check. Do you have someone here to drive you home? Check.

The Checklist Manifesto will reinforce (or begin) your belief in checklists.

Written by an endocrine surgeon in Boston, it is a most interesting and easy-to-read book on Atul Gawande’s experiment with creating and implementing a checklist for surgery.

(He also includes examples explaining David Lee Roth’s quirk about no brown M&M’s before a show, and why Walmart’s response to Hurricane Katrina was so effective.)

For surgery, Gawande’s own checklist included items like these:

  • Have we introduced ourselves to the others on the team by name and function?
  • Has the patient received any necessary antibiotics?
  • How long do we anticipate this surgery to last?

Could that make a difference? He was surprised to discover not only YES, but definitely yes! And not always for obvious reasons.

When nurses were given a chance to say their names and mention concerns at the beginning of a case, they were more likely to note problems and offer solutions. The researchers called it an “activation phenomenon.” Giving a people a chance to say something at the start seemed to activate their sense of participation and responsibility and their willingness to speak up. page 108

The number of decisions, large and small, that have to be made in even the most routine of surgeries is astounding. Not all of them need to be on a checklist, obviously, (the preferred number is 5-9, the limits of working memory), but by putting key ones on a list, Gawande reported 1/3 lower complications and deaths for those using a no-tech, no-cost 90-second checklist compared to hospitals that did not use a list.

They found that the average [ICU] patient required 178 individual actions per day, ranging from administering a drug to suctioning the lungs, and every one of them posed risks. Remarkably, the nurses and doctors were observed to make an error in just 1 percent of these actions—but that still amounted to an average of two errors a day with every patient. page 24

The airline industry has known for years that checklists work. (One major problem when airlines merge is deciding whose checklists will be used; they get attached.) Being able to properly use a checklist had big payoffs for Capt. Chesley “Sully” Sullenberger and his crew and passengers on US Airways Flight 1549 in January 2009, their “Miracle on the Hudson.”

Four generations after the first aviation checklists went into use, a lesson is emerging: 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. They catch mental flaws inherent in all of us—flaws of memory and attention and thoroughness.   page 48

The construction industry also relies heavily on checklists. The more complicated a process is, the more room for error there is. And something as simple as a checklist can make a difference? Apparently so.

For me, I probably would forget to pack an extension cord if not for my packing checklist. While it’s never a life or death situation if my blowdryer cord won’t reach the outlet in the hotel room without the extension, it sure is nice to have the luxury of one.

So if I weren’t totally sold on checklists before, I definitely am now. It’s hard not to be after reading this book.

* * *I Read It at 5 Minutes for Books

I read this book at the recommendation of Tim Challies when he was reviewing all the bestsellers on his blog 10 Million Words. I hope he’ll be able to restart the blog someday. It was wonderful!

For more books read after a recommendation, check out the links at “I Read It.”

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