Checklist Manifesto, The (R/J)

Good one, covering practices across industries. If followed properly, life changing book.

I am not a big fan of self-help books, but I made an exception for “The Checklist Manifesto” for a couple of reasons: (1) I consider one of Gawande's later books, “Being Mortal,” the best non-fiction book I have ever read, and (2) I expected interesting anecdotes about the history of checklists, written in Gawande’s breezy, engaging style. While well-written and easy to read, this book is no "Being Mortal." Although it encourages readers to use checklists more consciously in their daily lives, it discusses a subject that most of us intuitively understand and does not seem very insightful or groundbreaking. Gawande's logic is sound and compelling. He argues that the increase in available knowledge has both saved and burdened us. The instances of fallibility due to ignorance have been overtaken by those due to the complexity of modern systems and processes. Checklists, he suggests, are the straightforward solution to prevent mistakes that arise from this complexity. The book is quite short at about 190 pages in the Kindle version, making it a quick and accessible read. Gawande covers the use of checklists in various industries such as aviation, construction, investments (an industry I am somewhat familiar with, and his examples seemed somewhat manufactured and less convincing), music, and restaurants. However, most of his narrative focuses on hospitals and the medical field, making it somewhat repetitive despite its short length. Despite its shortcomings, the book is probably worth a read, especially given its brevity. As Gawande points out, using a checklist can often feel beneath us and even embarrassing, but this book might make you rethink that notion and appreciate the simplicity and effectiveness of checklists in achieving efficiency and preventing errors. A fun fact to highlight (according to Gawande): when airlines merge, one of the fiercest battles is between pilots over whose checklist will be adopted and used going forward. This underscores the importance and impact of checklists in critical operations. Pros: Gawande’s typical breezy and engaging style, brevity making it a quick read Cons: Lack of significant insights or new revelations, somewhat repetitive narrative

The author writes about how an effective checklist can save lives, solve problems. Checklists can be used in several areas including surgery, business, and personal life. Taking referrals from how a 3-year-old child, drowned in an icy pond in Austria, with her heart-stopping for almost 2 & half hours, to how the 1935 Flying Fortress (Boeing model 299) airplane crash was solved & going into the construction industry & others - checklist proves to be an effective method of solving & overcoming errors which may turn fatal & catastrophic. The author also talks about the type of checklists and how effective checklists are to be made. A compelling read, Atul Gawande is a Surgeon & writes very well keeping us absorbed in his writing style. A must read.

THE CHECKLIST MANIFESTO – How to get things right – Atul Gawande It is a difficult proposition classifying Dr Atul Gawande, the Boston based surgeon who writes really profound books into any genre. Is he a doctor writing on medicine or is he a philosopher discussing issues of life and death or do his books fall into the now popular category called ‘self-help’ or can one think out of the box and refer to him as a Management Educator. I think he is all of them. My introduction to Dr Gawande’s writings was thru ‘Being Mortal’ which I rated 6/5 last year and also listed it as the best book that I read in 2014. I followed this up with one of his earlier books ‘Complications’ which also was thoroughly readable and insightful. CHECKLIST MANIFESTO is one of his earlier books. While the world was simple and not overwhelmed with as much of science and technology, it was easy to do things…simple straightforward steps…mastered over a period of time…and the masters did it right. Unfortunately the world did not stay that way….from simple…it went into complex…..with multiple rules / algorithms / procedures….so how do you ensure that everything is done the way it should be done…so that nothing gets missed out…and we get results right ? Burrowing thru his experience as a Surgeon and also from real life examples, Dr Gawande finally comes to the conclusion that ‘check lists’ is the best way of ensuring that everything is done the right way…when multiple work together and any complex job almost becomes an orchestra playing a symphony….if you want to get all the notes right…..let us be clear who does what, when before we embark onto a complex job…whether it is removing a tumor from a patient’s brain or serving customers in a Michelin starred restaurant. While the stories from the world of medicine come naturally to him, what is really admirable is Dr Gawande picking up real life stories from industries as diverse as haute cuisine and aviation. His description of the miraculous landing of a packed to capacity jet liner into Hudson without any casualty is riveting. As I said earlier this is not medicine or philosophy or self-help or management education. It is all of them rolled into one…and an eminently readable book. The deftness of his writing is like a surgeon’s scalpel. One of the best books that I have read in the last 6 months.

The book takes off gruelingly, but picks up the pace and reads like an exciting quest in search of holy check list. The book has inspired me to introduce check lists in some routine tasks i perform at work.

I’ve had the checklist manifesto in my “to-read” list for about 5 years now. It’s a book I’ve had reccomended to me many times and, in a nutshell, it’s a manifesto for the use of checklists. Atul Gawande who wrote it is a surgeon who has a history of process improvement projects. The checklist manifesto is his attempt to convince people that checklists, simple as they are, can massively improve the output quality and consistency of tasks that we repeat frequently. What is more surprising though, is that his research uncovers that even in areas where there are complex problems for which we can’t cheklist – checklists can help significantly in resolving complex and unforeseen problems. The thesis is simple. Checklists raise output quality and consistency. The reason they do this is simple – we overestimate our ability to routinely perform series of tasks dramatically. In scenarios where there is stress or complication, the rate at which we overestimate our ability rises dramatically. Gawande examines three key scenarios – flight checklists, large scale construction projects and his own home – the operating theater. IN each scenario, he tackles simple, routine problems and also complicated and complex problems. What emerges is a surprisingly strong case for checklists as a tool to ensure consistency, and to change behavior, and also as a tool to aid resolution in complex and unforeseen circumstances. The bottom line is that we are inadequate repeaters of routine tasks, people routinely skip steps for one of two reasons – either they just forget through distraction or inattention, or they don’t know about, or don’t believe in the efficacy of a step – so they skip it. In each of these cases, checklists function as a kind of spot audit – telling people that they didn’t perform a step, and ensuring that they do. In many cases, authority was granted to people responsible for overseeing the checklist to stop a process if people didn’t perform it as written. What followed in each case, was a dramatic improvement in performance – in one case, a US hospital system had 1500 fewer yearly deaths after introducing checklists to key procedures. Routine tasks aside, complex tasks were also found to benefit. IN routine simple and complicated tasks, the series of steps required to be carried out were documented in order so that they could be directly followed. In Complex tasks however, this wasn’t possible because what was required to be done was typically an emergent phenomenon like an accident or disaster and needed to be analysed and dearth with on the fly. While task based checklists were not capable of operating in this environment, what was shown to produce results was checklists describing mandating communication among team members and the best results were found in cases that included delegation of authority to act away from a central organisation. The book contains excellent tips on how to make checklists work. It boils down to keep them short, precise, and practical. They don’t over-describe – they provide reminders of only the most critical and important steps. The point of invocation of the checklist needs to be clear for it to be useful. Checklists also come in two distinct types – Do-confirm and read-do. One is about an audit of what you carried out, the other provides steps to follow – which you do in order and tick off. Checklists should also be a maximum of 5 to 9 items – which is cognitively about all we can handle. There is also some very specific advice on formatting – right down to fonts and typeset. One interesting point made repeatedly was that there were substantial improvements in the ability to cope with crises by teams that came together at the start of a surgery to work through the checklist. Checklists are the simplest way to protect you, and others, from you – and the systematic mistakes you make by believing that you’re systematic – when you’re not. They’re also the simplest way to get an advantage without being smarter or first, you can be more thorough – EVERY time

Greta book that help me with getting the things right!

I measure a great book by how often I'm reading sections to my long-suffering wife/listener. Another indicator: I read the book slowly, tasty morsel by tasty morsel. Lastly, there's serious emotion when I turn the last page--somehow hoping it could go on and on. This book scores 10s on all counts. Really? A book about checklists is that good? Yes. If you enjoyed Malcolm Gladwell's Outliers: The Story of Success , you'll love this one. [x] 1. Atul Gawande, a surgeon and staff writer for The New Yorker, leads the World Health Organization's Safe Surgery Saves Lives program. If you didn't believe in checklists before, you'll be a born-again checklist-maker after Chapter 1. [x] 2. He quotes a 1970s study on "necessary fallibility." It cites two reasons we fail at stuff: a) ignorance and b) ineptitude. In the latter, "...the knowledge exists, yet we fail to apply it correctly." [x] 3. Caution! If you're having surgery soon, or have friends or family facing the knife, you may want to skip this book--or ask your surgeon's views on operating room checklists. (In a recent global experiment, a two-minute pre-surgery team review of a standard checklist has dropped infection rates, death rates and complication rates by a staggering amount.) [x] 4. Pilots have long been the checklist gurus--but the art and science of well-crafted checklists have not found favor in other professions or industries...yet. The Captain Sully story, though expected, still caused my heart to beat fast. You'll appreciate how checklists saved the day for the "Miracle on the Hudson." [x] 5. The chapter, "The End of the Master Builder," takes you into the elite world of checklists created under the hardhats of McNamara/Salvia, a Boston high rise construction firm. The dingy construction trailer is long gone. In its place, "...on the walls around a big white oval table, hung sheets of butcher-block-size printouts of what were, to my surprise, checklists." [x] 6. Checklists are "ridiculously simple." What seems obvious, isn't. Checklists enhance teamwork--even among virtuoso surgeons. "There's a reason much of the world uses the phrase, operating theater." [x] 7. Boeing's checklist expert uses "pause points" when building checklists for pilots in crisis. Within each pause point, he limits the checklist to between five and nine items. I had no idea that there were checklist connoisseurs. [x] 8. For crisis lists, decide whether you want a DO-CONFIRM checklist (do what your gut tells you, then go back and confirm you did it) or a READ-DO checklist (more like a recipe). [x] 9. Gawande interviewed the managing partner of a California investment firm who is a checklist zealot. He cited the "cocaine brain" that researchers often experience when investigating company financial reports. Without a thorough checklist (honed over years of experience), a greed mode kicks in and wipes out thoughtful discernment. They use a "Day Three Checklist" to avoid disasters. "Forty-nine times out of fifty, he said, there's nothing to be found. `But then there is.'" [x] 10. "Fly the airplane," amazingly, is the first item on a checklist for engine failure on a single-engine Cessna airplane. "Because pilots sometimes become so desperate trying to restart their engine, so crushed by the cognitive overload of thinking through what could have gone wrong, they forget this most basic task. FLY THE AIRPLANE." In one study of 250 staff members (surgeons, anesthesiologists, nurses and others), 80 percent reported that the new checklist had improved the safety of care and 78 percent "actually observed the checklist to have prevented an error in the operating room." Yet, 20 percent gave it a thumbs down. Then Gawande asked one more question, "If you were having an operation, would you want the checklist to be used?" A full 93 percent said yes!

It is not like a guidline for utilising checklist, but have so many stories around the importance of checklist with many examples from many industries.