A best-selling nonfiction book by author, surgeon, professor, and all-round smartypants Atul Gawande, The Checklist Manifesto is a quick read at under 200 pages. It is filled with compelling anecdotes about medicine, high-rise building construction, and air safety, all of which support the book's central thesis: that making and using brief checklists can improve the reliability of even the most complex human endeavors.

Gawande gets the reader fired up about the power of well-constructed checklists. He demonstrates how the rigorously constructed checklist binders in aircraft help the pilots focus in emergencies. He shows how checklists coordinate the highly complex process of skyscraper construction so that structural failures are almost unheard-of. He draws from his own experience in public health to prove how a specific checklist for surgery saves both lives and millions of dollars by preventing errors and reducing post-operative infections. He explains how checklists need to be carefully tested, refined, and optimized to include a small number of critical steps, particularly those that might otherwise be overlooked. By focusing on real-world examples in these high stakes professions, Gawande draws along, and effectively proselytizes, the reader.

In a secondary way, Gawande also shows how checklists are a team activity, and that the act of using the checklist promotes inter-team communication in a way that helps to ensure the desired outcome. While this aspect of the book is relatively undersold, I think it's a key element of the checklist's success. The WHO Surgical Safety Checklist that Gawande helped to produce features 13 checklist items, but also three 'pause points' for the surgical team to discuss the next steps. I think that Gawande knows full well that this is the key element, but undersells it on purpose. He needed to convince surgeons, many of whom are noted prima donnas, to follow his checklist. Promoting the team element might not have worked, so that gets the soft sell. However it echoes other successful practices such as Agile software development in making ongoing small-scale communication a central pillar of process.

Where the book disappoints is that after firing you up about checklists, it's not at all prescriptive about how to create and use them. I suspect the book grew out of Gawande's efforts to promote the Surgical Safety Checklist, which had already been developed and refined. He didn't need to tell his target audience how to make a checklist, he had that in hand. He just needed to get buy-in, and the book excels at that. But if you're convinced by his argument and ready to go, but you need help building a checklist for yourself, you won't find the help here, and that's a shame.

If nothing else, though, the compelling vignettes of medical drama and emergencies in the sky will reward a reader for the relatively small investment in time that this book requires.


See also: The New England Journal of Medicine article about the WHO Surgical Safety Checklist, or here in PDF form. If you're looking to do your own surgeries, refer to Table 1 in the PDF. (See also the Everything2 medical disclaimer, and remember to count the sponges before you close up.)

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