Book Review The Checklist Manifesto: How to Get Things Right

What makes a good checklist versus a bad checklist?  What are the limits in the power of a checklist?  Sure, checklists work for the weekly run to the grocery store or packing before we go on vacation but can they work to reduce errors in surgery?

The answers to these questions and more can be found in the fascinating book, The Checklist Manifesto by acclaimed writer and surgeon Atul Gawande.  This book is filled with a series of stories from hospital settings to piloting airplanes that makes a compelling argument that using well developed checklists can produce a significant impact on performance success and eliminate errors.  Facing ever-growing complexity in our lives and workplaces along with pressures to get things right the first time, checklists may prove to be a simple yet valuable tool in our error-proofing approach.

The final results of a World Health Organization initiative which is the core study described in this book “showed that the rate of major complications for surgical patients in all eight hospitals fell by 36 percent after the introduction of the checklist.  Deaths fell 47 percent. Overall, in this group of nearly 4,000 patients, 435 would have been expected to develop serious complications based on our earlier observation data. But instead just 277 did.  Using the checklist had spared more than 150 people from harm-and 27 of them from death.”   These results are exciting and hopeful in the quest for improved patient outcomes but it should be clearly understood that the use of checklists is not described as the complete solution to the problem.  It is just a simple one that appears to make a significant impact.

 The Checklist Manifesto is extremely well written that draws the reader along the journey of the author in exploring the power of checklists.  I found the stories interesting and hopeful that the simple checklist might work surprisingly well which the evidence seems to support in this book.

 This book is not a “How-to-do-it” type book however it provides some helpful suggestions in creating useful checklists.  For example, good checklist are designed to only provide critical reminders, practical, precise, easy to use and short and most of all, ones that are used consistently.  In addition, it will take some experimentation and collaboration with the users to develop a good checklist so expect to try out several variations until you create a checklist that works well.

 For more details on building a better checklist, read the chapter The Checklist Factory in which Atul learns about how to create a great checklist from his field trip to Boeing’s “Checklist Factory” under the guidance of uberchecklist master, Daniel Boorman.  I found it fascinating and it opened my eyes to just how difficult it is to create a really good checklist.

 The most significant and insightful observation in this book is the use of checklist as a team activity to enhance communication as a team, to simply talk to each other and coordinate our activities at critical points in the process. Dr. Atul Gawande writes:

 “But like builders, we tried to encompass the simple to the complex, with several narrowly specified checks to ensure stupid stuff isn’t missed (antibiotics, allergies the wrong patient) and a few communication checks to ensure people work as a team to recognize the many other potential traps and subtleties.”

And finally, as we know from our lean and six sigma work, it is not easy to influence culture change, promote new behaviors and sustain improvements, just as the author found in trying to influence surgeons to use checklists. Dr. Atul Gawande writes:

"...using the checklist involved a major cultural change, as well - a shift in authority, responsibility and expectations about care"

As organizations, are we ready and able for a shift in authority, responsibility and expectations for success?  Do we still cling to the illusion of superior lone superstar status or are we ready to humbly work as a member of a well coordinated and trained team?

I enthusiastically recommend this book to all!  This book is easy to read, short and a fascinating story of battling complexity with a simple checklist. The Checklist Manifesto is a must read for anybody working on continuous improvement and reducing errors in any process.