The Checklist Manifesto

I just finished reading "The Checklist Manifesto" by Atul Gawande, a very interesting book.

Gawande, a surgeon, essentially makes the following point. Given the incredible amount of knowledge we have accumulated in some professions, the complexity of certain tasks could be incredibly overwhelming to professionals (e.g., surgeons, airline pilots). Since in many situations these professionals work under pressure, they often forget some very simple yet important steps that later create unforseen problems (e.g., making sure the antibiotics are applied at a particular time before the incision is made into the patient).

Hence, he argues for simple checklists that teams should go through to ensure that important details are not glossed over. In the airline industry, checklists are used religiously. At every step of the flight, or whenever anything goes wrong, there is a checklist for the flight crew to follow. Gawande's main argument is that this principle should be applied in other professions as well, and in particular, in medicine. He describes his experiences launching such a checklist program with the World Health Organization and the impact that it had on reducing complications following surgery.

There are two main challenges this strategy. First, the checklist needs to be short as to not to completely slow down work. Hence, choosing and phrasing the items on the checklist requires significant thought. The second challenge is putting ego aside. For example, surgeons are used to being the kings of the operating room, and do not lightly take comments from nurses or other staff. Well, pilots have gotten over it, and they're not slackers in the ego department.

Gawande also gives examples from the construction industry and from restaurants, where constructing a high-rise or making sure that everything comes together at the right time on a customer's plate can be rather challenging. One main observation he makes from all of these examples is the importance of communication among the team members, in addition to the checklist. It is crucial for members of the team to communicate well with each other and building communication into the workflow is key. In that way, it's less likely that things fall between the cracks leading to additional problems.

To me the book was interesting because it points out that even if we build a huge body of knowledge in a particular domain, applying this knowledge in practice can be equally challenging.