The Checklist Manifesto – Book Review
I started reading “The Checklist Manifesto: How To Get Things Right” by Atul Gawande as the book was suggested by Jack Dorsey (CEO Square/Twitter). When I finished reading, I understood why he had suggested this book.
The renowned surgeon, Dr. Atul Gawande took very ‘simple’ material called checklist and glorified to the point that it saved Boeing from going bankrupt.
At a high level, the notion of a checklist looks trivial, but once you start reading the book, you will fall in love with the checklist. They can be implemented in every walks of life as simple as tracking daily progress to as complex as flying aircraft, performing surgery and finalising investment.
The heart of the book lies in the way, the conclusion is drawn by giving real-life account and interpreting beautifully back to the checklist even before you know the author is driving you to the goal. A must-read.
The Checklist Manifesto : How to Get Things Right
Deep Dive for more details
The Checklist Manifesto- Book Summary
On October 30, 1935, at Wright Air Field in Dayton, Ohio, the U.S. Army Air Corps held a flight competition for aeroplane manufacturers vying to build the military’s next-generation long-range bomber.
Two major competitors were
- Boeing’s plane (with 4 engines), that could carry five times as many bombs as the Army had requested; it could fly faster than previous bombers and almost twice as far.
- Very humble designs of Martin and Douglas with 2 engines
A Seattle newspaperman who had glimpsed the Boeing’s plane on a test flight over his city called it the “flying fortress,”
The Checklist Manifesto.
On paper there was no competition, it was dubbed as mere formalities. However, on D day, Boeing’s Plane crashed killing two of five crew members. Martin won the contract of 65 planes and Boeing nearly went bankrupt.
The Boeing model was deemed, as a newspaper put it, “too much aeroplane for one man to fly.”
The Checklist Manifesto.
Wait…. After few years, Army bought 13000 same aircraft from Boeing that gave the army a decisive air advantage in the Second World War, enabling its devastating bombing campaign across Nazi Germany. During this period there was just one enhancement in the aircraft. New aircraft were equipped with “Pilot’s Checklist”. You may need to read the book to understand completely, how this indigenous checklist enabled the flying the behemoth.
“Pilots Checklist” saved Boeing from getting bankrupt
The Checklist Manifesto.
What is so great about the checklist?
According to philosophers Samuel Gorovitz and Alasdair MacIntyre, there are two major reasons for failure
- Necessary Fallibility—some things which are simply beyond our capacity even with enhanced technology. Our physical and mental powers are limited.
- Something which is under our control but
- Have Partial knowledge of the subject (ignorance)
- Have full knowledge but unable to apply them correctly (Philiospher terms it as ineptitude, general people call it negligence)
Having a checklist handy, reduces the occurrence of negligence to a great extent.
Okay, can you give one example of a checklist
Yes. Let’s take the healthcare sector. Typical checklist of hospital comprised of four physiological data points—
- body temperature,
- pulse,
- blood pressure, and
- respiratory rate
These 4 readings give health professionals a basic picture of how sick a person is. Missing one of these measures can be dangerous. Maybe three of them seem normal—the patient looks good, actually—and you’re inclined to say, “Eh, she’s fine, send her home.” But perhaps the fourth reveals a fever or low blood pressure or a galloping heart rate and skipping it could cost a person her life. Even as simple as this checklist, if implemented well, can save many lives.
So, the checklist works even in complex scenarios?
Yes, 100%. How did you wonder how those skyscrapers are built? Let me rephrase, how the different teams from architect to a builder to the electrician to a plumber to host of other teams coordinate while the building is coming up. The set-up is complex and full of uncertainties. Still, less than a fraction of skyscraper is rendered useless after it is built. How is it possible?
There is just one component that stitches all of them together – Power of communication guided by Checklist. They didn’t believe in the wisdom of the single individual, or even an experienced engineer. They believed in the wisdom of the group, the wisdom of making sure that multiple pairs of eyes were on a problem guided by the checklist and then letting the watchers decide what to do. And Skyscrapers follows
Man is fallible, but maybe men are less so.
The Checklist Manifesto.
What if the process is long? People will forget the points of the checklist.
Yes, that’s why Power of pause is used.
During surgery, three “pause points,” are observed. As they are called in aviation—three points at which the team must stop to run through a set of checks before proceeding.
They are
- right before the patient is given anaesthesia,
- one after the patient is anaesthetized but before the incision is made, and
- one at the end of the operation, before the patient is wheeled out of the operating room.
Another good example of pause points are from the investment world
- during the research phase,
- during decision making,
- during the execution of the decision, and
- even in the period after making an investment when one should be monitoring for problems.
Warren Buffet uses a ‘mental checklist’ process” when looking at potential investments
The Checklist Manifesto.
But sometimes, checklists are worthless? How to know if a checklist is fit for implementation?
You are right, there are Good checklist and bad Checklist
Bad checklists are
- Vague and imprecise.
- Too long
- Hard to use
- Impractical.
- Made by desk jockeys with no awareness of the situations in which they are to be deployed
- Treat the people using the tools as dumb and try to spell out every single step.
- Turn people’s brains off rather than turning them on.
On the other hand, Good checklists are
- Precise.
- Efficient,
- To the point
- Easy to use even in the most difficult situations.
- They do not try to spell out everything—a checklist cannot fly a plane. Instead, they provide reminders of only the most critical and important steps—the ones that even the highly skilled professionals using them could miss.
- Good checklists are, above all, practical.
In addition to this, there are two types of checklist
DO-CONFIRM checklist, – team members perform their jobs from memory and experience, often separately. But then they stop. They pause to run the checklist and confirm that everything that was supposed to be done was done.
READ-DO checklist, – people carry out the tasks as they check them off—it’s more like a recipe. So for any new checklist created from scratch, you have to pick the type that makes the most sense for the situation. The checklist cannot be lengthy. A rule of thumb some use is to keep it to between five and nine items, which is the limit of working memory. Boorman didn’t think one had to be religious on this point. “It all depends on the context,
What should be the duration to run the checklist?
“In some situations, you have only twenty seconds. In others, you may have several minutes.” But after about sixty to ninety seconds at a given pause point, the checklist often becomes a distraction from other things. People start “shortcutting.” Steps get missed. So you want to keep the list short by focusing on what he called “the killer items”—the steps that are most dangerous to skip and sometimes overlooked nonetheless.
Are there any guidelines on the wording of the checklist?
The wording should be simple and exact, use the familiar language of the profession. Even the look of the checklist matters. Ideally, it should fit on one page. It should be free of clutter and unnecessary colours. It should use both uppercase and lowercase text for ease of reading. Use a sans serif type like Helvetica.
Interesting, How to implement the checklist?
- Training – People must realize that their memory and judgment are unreliable
- Checklists have proved their worth—they work.
No doubt, there will be push back from the people but with consistent training and good checklist will convince people to use them.
Then, why do we not like the checklist
It’s because they can be painstaking. They’re not much fun. But I don’t think the issue here is mere laziness. There’s something deeper. It somehow feels beneath us to use a checklist, an embarrassment. It runs counter to deeply held beliefs about how the truly great among us—those we aspire to be—handle situations of high stakes and complexity. The truly great are daring. They improvise. They do not like to have protocols and checklists.
It’s not cool to use the checklist you know.
If we don’t follow the checklist, the mistakes happen as our cocaine brain takes over
The Checklist Manifesto.
Based on the book- Gawande, Atul. The Checklist Manifesto. Penguin Random House India Private Limited. Kindle Edition. Disclaimer: I am under amazon affiliate. I earn some bucks for qualified sale without adding any cost to buyer.
