The Checklist Manifesto

Sorry, this blogging every few days is a decent amount of work. This is a good book and I am still learning from it. (Unfortunately, I have misplaced it and I read it about 10 months ago.) Some of my facts may be wrong. (mental note: I need a checklist.)

This is a book written by Atul Gawande and was published in 2009. When you read him, he sounds like a friend telling you an adventure or story one afternoon in your living room. He is also a surgeon, I think in the Boston area. Busy guy, stupid successful and interesting.

When I put it on one of my lists, I thought this was more of a productivity type of book. It is not about that. It was a difficult project that he took on for the World Health organization. They asked him to find a way to improve the results of surgery, not necessarily make the surgeries better, just make the catastrophic failures happen less. I believe he wanted to focus this solution on third world countries, but his brain and wisdom told him it would have to work for him too. (The fancy doctor in Boston.)

He came to realize that people in general didn’t recognize the complexities of this world and especially in places like an operating room. Oh, and the solution to more complexity is more specialization which sort of defeats the point of a checklists value. It is valuable when it is concise and simple and helps the memory and steps. It also engages the other members of the team. In this case the surgical team.

At the very beginning of the book, he gives these examples of medical emergencies that were handled very well. I don’t remember them in detail, just suffice it to say that they were amazing. He found that the people involved worked a list or a checklist and they were a team, in the truest sense. They asked questions of each other. They worked to resolve the issue or in other words, build a project or complete a set of action items.

Now, the success stories were really unusual and there were lots of failures that were just accepted as “the cost of doing business” and you can imagine the issues in third world countries and how hard that would be to do successful surgery in difficult situations. (Mildly, I would say.)

Yet, the issues tended to be similar. (Something missed, something forgotten, arrogance? From a surgeon? No. )

I have a cousin in America, who works in the construction industry. So when he brought up the construction schedule as a giant check list. I called my cousin and asked him. He doesn’t read non-fiction. He says I read enough specifications and plans to sink a damn ship, so he won’t read non-fiction. (This is unusual for a chap.) Anyway, after a lot of bluster and noise about Arsenal. (I am a proud Spurs fan.) He told me that he could see it as a giant check list and that some of the points of this list were critical. Dr. Gawande referenced pause points. These are important times in a project or whatever that are on the list to be checked twice or thrice!

Going from the schedule as a checklist, he became bogged down in something. The construction schedule was too long and took too much time. He needed something quicker because in the operating room. (Theater?? Odd word for medicine.) This lead him to the people who invented the checklist. Airline pilots.He went to Boeing and went to a guy that was a pilot and researched and built checklists at the checklist factory.

Why checklists? They are basic and can be done in a variety of ways. (written and verbal for example) and they are really really cheap. Now they have to be done well, they can’t be vague or a chore that means nothing. You can’t make people do it.

He did do a good job of tracking the results at the 4 hospitals he tested his checklists in. And the results were dramatic. Like 40% less deaths and 30% less complications.

He also talks about the lack of a need for a hero when you have good checklists. In fact, Sullie, the airplane pilot didn’t feel like a hero. He followed his training and that training is all about checklists.

Read the book. It shows how a simple idea can change the world…ugh cliche’. And help save lives yuk more cliche.

Just read it.

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