Book Review: The Checklist Manifesto

How does one take an incident every American journalist seems to have written about and put a new spin on it?  How does one make an instruction list the center piece of the 'Miracle on the Hudson'?  How does one dare to take the superhero cape away from Captain 'Sully' Sullenberger?

Readers of Brick and Rope doubtless know my boundless admiration for Atul Gawande.  The surgeon with the scalpel-sharp writing has charmed me with everything he has written.  Complications was a stunningly good book that was an obvious choice for my list of Best Books of 2008.  Better was his next book where he started making a transition from the high ground ethical questions raised in Complications to more prosaic themes - like how surgeons can save thousands of lives a year by the simple expedient of washing their hands more thoroughly.  That transition continues with The Checklist Manifesto.

Warren Buffett often says something to the effect that "I don't have particularly better ideas than other people.  I just avoid making dumb mistakes."  The Checklist Manifesto is about avoiding dumb mistakes.  You will never become the best at anything just by following a set of written instructions and following them to the T.  But by making a checklist and sticking with it, your mind will be free of the distractions of the mundane, and can concentrate on the things that are truly differentiated.  In other words, checklists won't make you great, but by creating and following checklists, your mind will be let free to pursue greatness. 

Gawande leads the World Health Organization's Safe Surgery Saves Lives program.  As part of this, he and his team led a worldwide test to administer checklists as part of standard procedure in operating rooms across eight different hospitals in dramatically different parts of the world.  They created a two-minute, nineteen step surgery checklist that they piloted across these hospitals.  After running this pilot for some months, they found results that would have been stunning to the level of unbelievability had they been caused by a new drug in the market - Surgery complications reduced by 36% in these hospitals, deaths reduced by 47%.  The checklist turned out to be a hero bigger than the superstar surgeons operating in the OT.

Is there something special about surgery that makes it amenable to checklists?  Hardly.  If anything, it seems like a much more complicated sphere of activity, more prone to surprises and curveballs than endeavors you and I are likely to be engaged in every day.  So if checklists work there, wonder where else they might work.  Gawande introduces us to the use of checklists in investment strategies (make sure you are running through a list of must-do checks before investing in a security), in building construction, and of course, with the Sully Sullenberger example, in aviation.

We don't like checklists.  They can be painstaking.  They're not much fun.  But I don't think the issue here is mere laziness.  There's something deeper, more visceral going on when people walk away not only from saving lives but from making money.  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 have protocols and checklists.

Maybe our idea of heroism needs updating.

Gawande's books are always thought provoking.  I have a feeling that this one, while the most mundane of his three so far, is likely going to be the most behavior altering for me.  Just today, I found myself advocating checklists for two very different activities performed repeatedly at work.  And I found myself referring to Gawande and his experiments with the surgery checklist.

Particularly useful to me was Gawande's exploration of what makes a good checklist.  The Boeing guys, so he informs us, are masters of checklist making, having made thousands of them over time for aircraft maintenance, piloting, and special situations (like multiple birds hitting a plane simultaneously).  Citing examples from there, Gawande offers some simple principles on what makes an effective checklist and what makes a bad one.

With such a prosaic topic for a book, there is scarcely a chance for Gawande to write the soaring prose he employed in his previous books, particularly Complications.  There isn't room to soar in The Checklist Manifesto.  For all the twists and turns in the operating room stories, the book tends to be a bit dry.  Gawande tries gamely to make his exploration of checklists in professions outside medicine as interesting as his medicine stories.  But it isn't clear to me that he succeeds.  There is a different level of energy, a whole other level of tautness in his tales the moment the doors to the OT close.  The construction stories, the investment stories - they aren't quite the same thing.

The Checklist Manifesto isn't exactly racy reading.  But learn from it, and it will probably pay you back many, many times over.  Once again, Atul Gawande has written a book that will leave the reader a better person for having read it. 

Read the book.  Better still, use it.