Dr. Gawande is an excellent author. Anytime I can learn from a Harvard graduate then I will spend the time on it. Checklist Manifest shows us the power of using checklists to breakdown sophisticated tasks into manageable and auditable sections. Thus we can automate the redundant tasks and focus on the relevant 20% to garner 80% of the results. The checklist covers us so we don’t miss a small thing and create a big mistake. Checklists have been instrumental in reducing catastrophic surgical failures. Imagine having a surgery on your leg and it was the other leg that had the problem. Checklists are the solution to eliminate or at least significantly reduce these errors.
Why is this important to me? The power of asking questions and digging in is critical in any endeavor you pursue. If you look at complex health care systems or flying a 747, these tasks are broken down into checklists because one simple, stupid mistake means the difference between life and death. The core problem breaks down to two types of failures that can occur.
1. Ignorance – We may not have the knowledge yet to provide a solution. Every growing industry evolves and ignorance is overcome only to be ignorant of the next problem. This is like a never ending ladder.
2. Ineptitude – In these instances the knowledge exists, yet we fail to apply it correctly. This is where the checklist can have huge benefits.
Dr. Gawande dives into great detail on the power of checklists and the data before and after controlled use of the tool. For the sake of time, I will profile 3 success stories that resulted from implementing checklists.
First, let’s examine the power of checklists. Checklists seem to provide protection against failures. They remind us of the minimum necessary steps and make them explicit. The goal of the checklist is to make sure you get the stupid stuff right.
1. John’s Hopkins: There is a 5 step process that doctors are supposed to follow in the ICU. These docs were watched for a week and steps were skipped. They did a 10 day checklist test where nurses were tasked to stop the doctors to make sure they follow all 5 steps of the checklist. This simple 5 step check list had huge results. The 10 day line-infection rate went from 11% to zero. Implementing this in the hospital prevented 43 infections and eight deaths and saved two million dollars in costs. Checklists established a higher standard of baseline performance.
2. US Airways Flight 1549: Humans are designed for emotion, intelligence and fun and NOT for nitty-gritty details. Captain Sullenberger and his staff used the checklists to save the lives of all the passengers on the plane. When interviewed he credited the training, staff and the checklist to saving lives.
3. Human Condition: Think about a couple things for a moment – World class pilots, surgeons, investors and engineers have benefited from checklists. The problem with implementation is ego and communication. These are complex tasks that their trained for and to be reminded by staff to adhere to the checklist takes behavior change and permission from the top. The biggest obstacle of getting checklists implemented is the communication gap but as this book points out, the results are staggering when they are implemented.
Dr. Gawande profiles Mohnish Pabrai who is a managing partner for an investment fund. Mr. Pabrai has developed a checklist based on knowledge to evaluate investments. His check list was a study of good and bad investments made by the top dogs in the industry. He paid $650,000 for lunch with Warren Buffett and found out that Warren uses a mental checklist. Mr. Parbai’s goal was to automate a yes/no decision to spend time on deals. The checklist doesn’t tell him what to do but helps him be as smart as possible ensuring he has all the critical information needed so he can make a systematic decision.
I hope you have found this short summary useful. The key to any new idea is to work it into your daily routine until it becomes habit. Habits form in as little as 21 days.
One thing you can take away from this book is use a checklist to fix a particular problem. If you run a business then there are several systems that can be improved when using checklists so take a small piece and try it. Another example of a simple checklist in your personal life is the stop doing list. Use this list to eliminate nonessential tasks to improve your effectiveness.
Free Book Summary - The Checklist Manifesto - How to Get Things Right - Written by Atul Gawande
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