The checklist manifesto : how to get things right

by Atul Gawande

Hardcover, 2010




New York, N.Y. : Metropolitan Books, 2010.


Reveals the surprising power of the ordinary checklist now being used in medicine, aviation, the armed services, homeland security, investment banking, skyscraper construction, and businesses of all kinds.

Media reviews

I already know that "The Checklist Manifesto" will be on my list of best books this year. Gawande writes with gusto, humor and clarity. He features his mistakes -- always a good sign in a reporter -- including the one that ends the book.
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Read this book and you might find yourself making checklists for the most mundane tasks—and be better off for it.
But that narrative gift doesn't transfer automatically to accounts of in-flight safety checks and structural engineering near-misses. Gawande's style is always clear, with the crispy lilt that is a trademark of the New Yorker, where he is also a staff writer. But there's no escaping the fact that this is a book about, well, checklists. Hemingway would struggle to make it gripping. Gawande does well to pull off engaging.
Gawande, a professor of surgery at Harvard Medical School and a staff writer at The New Yorker, makes the case that checklists can help us manage the extreme complexity of the modern world. In medicine, he writes, the problem is “making sure we apply the knowledge we have consistently and correctly.” Failure, he argues, results not so much from ignorance (not knowing enough about what works) as from ineptitude (not properly applying what we know works).
Dr. Gawande is right to note that checklists are indispensable in situations where a small mistake can lead to tragic consequences, as in surgery. But his call for a broad checklist regime would be counterproductive—fraught with all the dangers of bureaucracy and excessive law.
The most intriguing chapters are those in which Gawande hangs out with skyscraper builders, sous chefs and airline safety officers to understand why other professions have far outpaced medicine in breaking down complex processes to deliver reliable results.
Thoughtfully written and soundly defended, this book calls for medical professionals to improve patient care by adopting a basic, common-sense approach.
Maybe there’s a case to be made for why checklists help in enterprises as diverse as finance and government, but Dr. Gawande doesn’t really make it convincingly. Nor does he need to. Few medical writers working today can transmit the gore-drenched terror of an operation that suddenly goes wrong — a terror that has a special resonance when it is Dr. Gawande himself who makes the initial horrifying mistake.
This is a brilliant book about an idea so simple it sounds dumb until you hear the case for it. Atul Gawande presents an argument so strong that I challenge anyone to go away from this book unconvinced.

User reviews

LibraryThing member horacewimsey
Good initiative, execution a bit overlong. The basic idea is this: Creating good checklists and following them religiously is shown to catch mistakes before it's too late. The book made this point but used too many anecdotes along the way.
LibraryThing member chellerystick
At first glance the story of the creation of pre-surgical checklists to avoid frequent complications, surgeon and writer Gawande persuades us that one way to cope with complexity and specialization is to create the expert checklist. This idea of the checklist is not the exhaustive list of someone who is just learning or who has a poor memory. No, this idea is that we need more spare, whittled down lists, and that they should be weighted towards the few simple but high-impact things that we might be liable to forget among all our specialized tasks, plus items to get us to work better together: to meet our teammates and to share our specialized and context-specific knowledge. As always, Gawande gives a quick and pleasurable read.… (more)
LibraryThing member alphaorder
Although Gawande uses his experiences as a surgeon to highlight the importance of checklists, his findings can be translated into any type of work.

One of my favorite quotes:
"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."

He suggests that checklists encourage both teamwork and discipline.

Another interesting takeaway: "We don't look for the patterns of our recurrent mistakes or devise and refine potential solutions for them." He suggests that if we do so and incorporate our solutions into our checklists, we will reduce errors and increase efficiency, no matter what our profession.

Gawande's final example of how the checklist possibly changed an outcome is the safe landing of the flight in the Hudson in January 2009. The details are fascinating.

I enjoyed this short, readable book. By developing my own checklists, I am sure that it will have impact.
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LibraryThing member ldmarquet
The Checklist Manifesto
In 1936 when Boeing introduced a new bomber, labeled the Model 299 it crashed on its competitive test flight by an experienced test-pilot. See, this new plane with 4 engines was significantly more complicated than any that preceded it and relying on pilots’ memory for operations would no longer work. The response – a checklist. The result was successful operation by thousands of pilots and the contribution of the B-17 to winning the war.
This is one of the many compelling stories that Atul Gawande tells to get his message across that checklists are the answer to complexity and that modern medicine is incredibly complex. The implication is that modern medical teams are essentially at the point where aviation was in 1936.
Fundamentally, Gawande is right as anyone who has operated a nuclear powered submarine knows. There is a parallel between what Gawande is advocating and the broader leadership theme that procedures trump personality that limits the current models of leadership.
The case is overdone however. You’d think no one ever used a checklist in a hospital until Gawande educated them. Further, the B-17 didn’t crash because of the complexity of the engines – it crashed because the flight surfaces were never unlocked and tested – something that could happen on an airplane with only one engine.
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LibraryThing member phildec
Very good book. Interesting insights on surgeons' work, pilots, building constructors ... all sharing the same general issues related to critical steps to accomplish. The book explains that carefully well-thought specialized but simple checklists have been proven to reduce errors dramatically in some critical jobs. The author shares with the reader his own mental progress that lead him to apply checklists in his work as a surgeon and eventually write this book - and for me just following such scientific but accessible reasoning is real pleasure.… (more)
LibraryThing member Sean191
This book was lent to me by a coworker. Since my career deals with information in the medical field, I thought it might prove to be educational and useful. After reading it, I'm not sure if it was really much of either, but that doesn't mean I regret reading it.

The book is a quick easy read. Dr. Gawande's writing style is very conversational and enjoyable. He doesn't often go into much technical detail that would be outside the average person's knowledge-base, but even when he does, he takes a step back to explain. There are no checklists actually offered in the book and there's again, a more conversational tone on offering advice on creating a checklist. If I could equate it to something, it would be like reading the journal of an adventurer - it's not offering so much "how to," instead, it's largely anecdotal and basically a reinforcing of the idea that it can be done and done successfully. I did find a lot of what he wrote to be interesting, but to me, it seemed to be only educational in the extent of adding to my trivia knowledge - which I like anyway.

At the conclusion of my reading, one feeling I did have was envy. I'm envious that Dr. Gawande can be a successful surgeon and an engaging writer. I'd settle for one of those!
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LibraryThing member mfagan
my notes/lessons from the book:
* the value of checklists
* even intelligent and experienced people forget small obvious things sometimes (naturally); checklists can prevent this and allow you to focus in the things that require more thinking
* the importance of decenralizing power when tasks are complex
* what makes a good list; i.e. not including everything
* reminder that most knowledge and experience exists, just isn't known or utilized
* systems thinking is often missed... as only a systems thinker would think to think of it (others are specialized/boxed)
* a checklist can be a good place to include verifications that contingency solutions are available
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LibraryThing member rivkat
Short, engaging book about the use of checklists to enhance, focus and guide expertise and protect against common errors that even the best-trained doctors, pilots, etc. make. There’s something very interesting here about routinization and class/prestige; doctors have been able to resist scripts in ways that CSRs, for example, haven’t been. Gawande does not discuss checklists as used by people without years of specialized education and training, perhaps because he assumes that naturally checklists are appropriate for certain types of jobs. And because doctors share that assumption, checklists are hard for them to accept, as if they involve deskilling. The book doesn’t get into sources of resistance—Gawande, perhaps for what I’d call political reasons, treats resistance like a bad habit rather than an issue of comparing oneself to a lower-prestige worker. Anyway, with medicine and aviation as his main examples, Gawande makes a convincing case for checklists in complicated situations.… (more)
LibraryThing member LeighHorte
Lots of detail on why checklists are useful, how to create checklists, common pitfalls, and checklist types: READ-DO and DO_CONFIRM (p123). The activation phenomenon (p108) is interesting: giving people a chance to say something at the start to activate their sense of participation, responsibility, and willingness to speak up. Pause points (p111) are a great process addition and project management tool. Root cause analysis and information overload are key concepts (p132-133) in checklist development and overall performance. There's even a bit on cognitive theory (pp163-164) to support checklist use and psychology to explain some of the usage barriers (pp161,173,183). Plus I learned there are over 13,000 ways the body can fail. Great anecdotal writing. Lacks (and needs) an index.… (more)
LibraryThing member kaelirenee
I’m the kind of person who used to always write a shopping list, then forget it on my kitchen table, and come home without milk. I started devoting a section of my planner to post it notes with reminders and I don’t go into a store without my shopping list. In Checklist Manifesto, Atul Gawande presents the benefits to professionals for using short lists to keep them from metaphorically forgetting the milk. This book is part memoir, part research review. Gawande is a prominent surgeon who worked with the World Health Organization to come up with low-cost methods to improve surgery outcomes. Through research in other fields, especially aviation, they composed a short, two minute checklist.
He focuses on the need for checklists, the uses for checklists, the composition of lists, and the psychology behind the people using these lists. Of all the issues confronted, the psychology of using checklists is the most problematic. Professionals are trained and smart and don’t want to be reminded of every little detail. They are above the menial tasks listed in a checklist. But the important message I took from this book was that, by freeing up the mind from all the menial details, you can focus on the unexpected. His examples are primarily from his own field, surgery. For instance, by telling people in the operating room how much blood he expects to be lost and what problems he can foresee, nurses were able to have packed blood on hand, just in case. There are also numerous examples from the field that pioneered these checklists, aviation. The key example from this field is the “Miracle on the Hudson” from January 2009, in which a flight crew managed to make an emergency landing in the Hudson River after a double bird strike took out the engines.
Gawande admits his own failures and shortcomings, a trait that I admire from a renowned surgeon. He presents his mistakes with a candor that acknowledges room for improvement that all humans have. I know that if I were going into surgery, I would want my surgical team to use his checklist (and apparently, so did 93% of the surgeons in this study). I can also imagine that all of these saved lives and avoided postoperative problems save quite a bit of money, so I’m shocked more insurance companies haven’t incentivized their use.
I would like to see this study expanded to more professions, too. But first, we must admit where we’ve made mistakes and which are the easiest to avoid. Like forgetting the milk.
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LibraryThing member wbc3
Gawande makes a great case for why checklists can enhance almost any business activity. He uses his surgical experience to show how even experts (like surgeons) would do well (save lives) by using checklists. However, he does not do as good a job of showing how you might implement them yourself. The book is well worth reading, but like many of its kind, it would be better as a meaty magazine article than as a book.… (more)
LibraryThing member sandyreader
What do airline pilots, good operating hospitals, builders of sky
scrapers, and rocker David Lee Roth have in common? It's a checklist.
When surgeon Atul Gawande presented the idea of this checklist to
hospitals his ideas, at first, were brushed aside as more work, but
as time went on and with astonishing results, he was vindicated and
more and more hospitals have added this to their surgery theaters.

In this excellent book, he ties all this together in an interesting
way. I'm not a fan of books on hospitals, but there is so much more
of interest that most everyone will learn and be entertained by
The Checklist Manifesto.
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LibraryThing member ACQwoods
This book was recommended on the Freakonomics blog (I think) so I decided to check it out. The author, a surgeon, explores how simple checklists at critical points can have dramatic effects on the outcome of complex processes. Although it dragged at times, overall I found it fascinating. All my pilot friends will definitely enjoy the discussion of how aviation embraced checklists and how new ones are developed and tested.… (more)
LibraryThing member dougcornelius
As a former transactional attorney, I was trained to use checklists. The transactions were too complicated to keep track of everything in my head. I also needed to communicate with the rest of the transaction team. In The Checklist Manifesto, Atul Gawande approaches checklists from the perspective of a surgeon.

I had put off reading this book because I’m already a fan of checklists. I didn’t need to be sold on their effectiveness. But I was still floored by the effectiveness Gawande reported in his studies.

In using a checklist for placing a central line, the ten-day infection rate was reduced from 11% to zero. He cites many other examples and studies that show that checklists can improve the performance of highly-trained workers.

“In a complex environment, experts are up against two main difficulties. The first is the fallibility of human memory and attention, especially when it comes to mundane, routine matters that are easily overlooked under the strain of more pressing events…. A further difficulty, just as insidious, is that people can lull themselves into skipping steps even when they remember them. In complex processes, after all, certain steps don’t always matter.”

I was particularly happy to see Gawande cite the correct story about Van Halen’s use of M&M’s as a compliance checklist tool. (See my prior post: Compliance Van Halen and Brown M&M’s.)

If you haven’t already read The Checklist Manifesto you should add it to your reading list.
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LibraryThing member Paapere
Can the checklist manifesto be applied to the education sector in a way that supports the education of underachievers in High School? I think so and am about to start an action research project that will help me find out. Can teachers be caused to operate with more urgency to provide the outcomes for their "patients" or "passengers" the High School students so that crashing into the side of the learning hill or dying on the operating table of education is eliminated or at least greatly reduced.

Great book for clarifying the types of lists and their usefulness. I have begun to reassess my own checklists. Are they transformative or lists that help me as a teacher simply keep students happy busy and good but not necessarily learning. Are they lists that make my job easier rather that helping learning become more interesting for students? If so I'm chucking them out and experimenting with new one's.
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LibraryThing member mattparfitt
This is an engaging and inspiring book. In essence, Gawande argues that the medical profession, and certain other professions, adopt the use of checklists, as is the norm in aviation and construction. But Gawande, who writes regularly for The New Yorker, is a great story-teller, and it's hard to put this book down.

The term "checklist" is just slightly misleading - or oversimplifying. The checklist is merely the instrument that ensures that critical procedures are identified and are properly followed. So this book is as much about procedures as it is about checklists, and in that way it is powerful in a great many contexts.

I'm a big fan of David Allen's Getting Things Done (or "GTD") approach to task management. Gawande's ideas do not cover quite the same ground, but it's a similar kind of strategy: why try to keep a ton of things in your head when the right system allows you simply to focus on the task at hand, knowing that everything else is taken care of? Gawande declares that the age of the "Master Builder" -- the solitary genius, the inspired artiste -- is over, and that the complexity of almost any task today requires a different approach -- usually a team of experts working together. He makes a strong case for checklists -- and the whole systematic approach to managing complexity that they represent -- as the tool that's needed in today's world.
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LibraryThing member longword
I agree with some of the lukewarm reviews. I found the perfect description in another review: "gladwellian". a bit disappointed with its (lack of) depth.
LibraryThing member dono421846
Book-length treatment of article-length idea: to make sure you don't overlook important steps, follow a recipe. He shows how this simple idea can have dramatic impact on health outcomes in surgery rooms.
LibraryThing member Sandydog1
Gawande describes the necessity of simple, clear checklists to complete complex tasks with few errors. Examples come from surger, construction, airlines, and investments. He also provides eloquent explanation of the resistence to checklists. They are percieved as denigrating, mundane and obvious.
LibraryThing member stephmo
A really quick read, Atul Gawande manages to weave a compelling narrative around his call for widespread implementation of checklist development and usage in the medical field after experiencing astonishing success through a WHO project seeking to lower medical incidents during and following surgery. Before one immediately thinks, "not only do I abhor checklists, but I'm not even in the medical field!" you really need to hear what Gawande has to say. Because the checklists he cribs don't come from the medical field. They're culled heavily from pilot checklists, but also are liberally peppered with bits and pieces of checklists (theory and practice) from areas as diverse as construction, restaurants, rock and roll and venture capital. This isn't about the need to cookie-cutter every single process one does, but rather to ensure that the mundane basics are not skipped over in a mad rush to get to the sexier, more important stuff. If you're involved in an organization of any kind that deals with some sort of process, you will find some insight in this slim volume.… (more)
LibraryThing member jorgearanda
An accessible (but somewhat fluffy) advocacy for simple, standardized practices.
LibraryThing member verka6811
Hundreds of thousands of people die every year from surgeries gone wrong. While surgeries are never truly “routine” and unexpected things do happen, some errors are very preventable.

A surgeon by profession, Atul Gawande was part of the team assembled by the World Health Organization (WHO) to look at the prevalence of surgery errors. They heard accounts from other surgeons – those that operated in high-tech hospitals of the developed countries and others from the developing countries that lacked adequate resources, training, personnel, and so on.

What they found was that errors happened everywhere, and no amount of technology or pharmaceuticals could prevent them. In fact, errors happened most often due to human error, due to routine tasks that were forgotten while focusing on the more complicated problems at hand. This conclusion led to the development of a simple checklist that was then tested at participating hospitals around the world. The results were quite surprising, even to Gawande.

Checklist Manifesto is Gawande’s account of the development of the surgical checklist, but it’s also so much more. He discusses and compares checklists used by a variety of professionals, from pilots who heavily rely on checklists, to financiers who use checklists to make calculated investment decisions. More importantly, Gawande makes a convincing argument in favor of checklists. Our world is complicated and our skills are getting more and more specialized, causing seemingly unimportant and routine tasks to fall through the cracks. That is where checklists come in.

Checklist Manifesto has been a true inspiration, and I have since made checklists for the routine tasks in my life: packing for travel, making professional Power Point presentations, preparing for holidays, etc.
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LibraryThing member ErasmusBee
This book is an interesting collection of anecdotes about how the humble checklist is essential for maintaining professionalism in a world where the sheer wealth of information and knowledge far exceeds what any one person can learn and implement on their own. As the division of labour has lead to ever more specialists, the success of any given project, from building a skyscraper to performing a surgical operation, relies on the consistant implementation of one's own specialist knowledge but also on good teamwork and effective communication.

When I started reading this book I was expecting more practical advice. I found the chapter about how a skyscaper is built, and built so that they never fall down, fascinating. It also showed that devising an effective checklist itself requires expertise, teamwork and trial and error. Atul Gawande effectively demonstrates the importance of communication and discipline in getting things right.

One of the most interesting parts of the book was when Atul Gawande discussed the emergency landing of the US Airways flight 1549 into the Hudson river. It was a good example of humanity's need for hero worship and I had accepted without question the news reports that the passengers were simply lucky to have a pilot who used to fly for the Air Force. The fact that no-one died is still incredible, it's just that the reason for this had little to do with Sullenberger's military history (as he himself kept saying) and much to do with the discipline of all the staff who followed procedures correctly (with help from checklists), computer assisted landing, training and experience from both pilots who communicated with each other and the cabin crew; and of course a little luck.
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LibraryThing member splinfo
An analyzing of work and decision making in the most complex layered environments and the need to guarantee success inspite of those difficulties. I found it fascinating to think about who "checks off" when a skyscraper is built or in a surgical suite. We no longer have a master builder but more is built than ever! Particularly of interest to someone who does heavy lifting in a large organization.… (more)
LibraryThing member Milda-TX
I just love reading Gawande. He's so enthusiastic and makes his stories so accessible and interesting. I'm a checklist girl, too. So: liked the book a lot.



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