The Checklist Manifesto

Your Personal Safety Net

Under conditions of complexity, not only are checklists a help, they are required for success.

Introducing The Checklist Manifesto

The Checklist Manifesto is the latest book by surgeon, researcher and writer Atul Gawande and is based on his medical experiences.

The wider relevance of this book is how Gawande addresses a problem that is endemic in modern life.

As technology develops and areas of specialist expertise become increasingly niche this creates an environment of ever increasing complexity.

Dealing with complexity

The challenge is how professionals in any sphere of expertise cope with this complexity and specifically how they avoid making avoidable mistakes and errors of judgement.

Gawande illustrates his thesis with a series of medical examples showing how the routine procedures of surgeons are now so complex and inter-dependent on other supporting specialisations that mistakes are almost inevitable leading to an otherwise competent doctor missing a step in the real time stress and pressure of the moment.

His researches led him to specialists in other high-risk fields such as airline pilots and constructors of high rise buildings and large scale civil-engineering projects.

His solution is checklists that walk these specialists through the key steps of any complex procedure.

Wider applications

The message of the checklist manifesto has wider applications than the rarefied environment of the highly skilled professionals.

In a recent article on how not to be stupid we looked at the seven causes of everyday stupidity, and we noted that whilst we will never fully eliminate stupidity from our own behaviour, we can reduce the likelihood of it occurring and take practical steps to mitigate its effects when it does, and I shared an example of how I use checklists.

The checklist manifesto offers a simple and effective antidote to the avoidable mistakes and stupidities caused by human failing and weakness.

As Gawande says:

“Whether running to the store to buy ingredients for a cake, preparing an airplane for takeoff, or evaluating a sick person in the hospital, if you miss just one key thing, you might as well not have made the effort at all.”

The Characteristics Of An Effective Checklist

Checklists:

• Are not detailed manuals but brief and convenient tools built to improve performance and avoid unnecessary errors
• Are effective and easy to use even in the most complicated circumstances
• Are concise and coherent and only include the most significant and crucial actions
• Are unambiguous and accurate
• Fit on one page.
• Consist of only five to nine steps [this is the memory limit]
• Should not take more than 60-90 secs to read
• Can be for the DO-CONFIRM or a READ-DO format
• Ensure that important items are not missed
• Ensure that people speak, organize, and embrace accountability
• Maintain the capacity to handle unpredictability

The Checklist Manifesto - in his own words:

“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.”

“Checklists seem to provide protection against such failures. They remind us of the minimum necessary steps and make them explicit. They not only offer the possibility of verification but also instill a kind of discipline of higher performance.”

“Under conditions of complexity, not only are checklists a help, they are required for success. There must always be room for judgment, but judgment aided—and even enhanced—by procedure.”

Further Reading:

Atul Gawande - Profile

The Checklist Manifesto - Book Summary

The Checklist Manifesto - Reviews

Next Article: How Not To Be Stupid - 4 Key Tips

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