The Checklist Manifesto by Atul Gawande


6667514We live in a world of great and increasing complexity, where even the most expert professionals struggle to master the tasks they face. Longer training, ever more advanced technologies‚neither seems to prevent grievous errors. But in a hopeful turn, acclaimed surgeon and writer Atul Gawande finds a remedy in the humblest and simplest of techniques: the checklist.

First introduced decades ago by the U.S. Air Force, checklists have enabled pilots to fly aircraft of mind-boggling sophistication. Now innovative checklists are being adopted in hospitals around the world, helping doctors and nurses respond to everything from flu epidemics to avalanches. Even in the immensely complex world of surgery, a simple ninety-second variant has cut the rate of fatalities by more than a third.

In riveting stories, Gawande takes us from Austria, where an emergency checklist saved a drowning victim who had spent half an hour underwater, to Michigan, where a cleanliness checklist in intensive care units virtually eliminated a type of deadly hospital infection. He explains how checklists actually work to prompt striking and immediate improvements. And he follows the checklist revolution into fields well beyond medicine, from homeland security to investment banking, skyscraper construction, and businesses of all kinds.


It’s easy to see why this book and the paper at its core started a medical revolution. Gawande makes a compelling case for smart, short checklists for procedures as small as inserting a central line and as large as crash trauma surgery. A well thought out checklist, he argues, will cut down on complications, foster teamwork, and save lives.

The facts in the paper are striking and medical professionals took them to heart. Standard questions were (and still are) being asked in operating rooms all over the world – are we operating on the correct person? Have we given antibiotics? Have we anticipated potential problems? Do we all know each other’s names and roles? These simple questions, adding a mere two minutes to a surgery, have prevented thousands upon thousands upon thousands of complications and deaths since the study came out.

At first some doctors scoffed at the idea. “I spend my time doctoring, not ticking boxes.” They often became fans after a checklist saved their patient from a nasty drug interaction… or worse. Ironically, now some doctors are complaining of too many checklists. “I spend so much time ticking boxes that I can’t doctor properly.” The issue is more complex than that, of course, but it shows you the amazing reach of Gawande’s research.

I’m really glad I read this book. It put the checklist I observed during a routine surgery into context. (Not on me – I was the interpreter.) I also learned about “do-confirm” and “read-do” checklists and how they are best implemented. Most examples are from aviation as flying a plane mimics surgery’s urgent and potentially disastrous nature, but building engineering and disaster relief are touched on as well.

It’s worth mentioning that I devoured this in a single day as an audiobook. It’s the first time I’ve turned up the playback speed and I was able to get to 1.6x by the time I finished. Glorious. Not sure I could blast through fiction that quickly but it kept my mind very happy as I worked on other (non-language!) things.

The Checklist Manifesto‘s place as a classic of modern medical literature is well deserved, and it’s a must read for anyone getting into the field.