Checklist Manifesto - Gawande

 

Use a checklist.  This is the major takeaway from Atul Gawande’s latest, “The Checklist Manifesto: How to Get Things Right”.  Although it’s a short book, just less than 200 pages, but for me it was a difficult book to get through.  I don’t know if that is because I’ve spent my entire career in and around checklists and believe in their value already (I don’t have to be convinced) or because Gawande is reaching too far with his message.  Doing a complex job correctly demands following a checklist.  He suggests that better team cooperation, communication, and discipline are the components of getting things right that emerge from the use of a checklist.  No kidding ?  He uses as his fundamental example the growth and now ubiquitous use of checklists in aviation.  And for sure checklists designed to operate something as complex as a large multi-engine aircraft demand such instructions…they also require team skills, communication, disciple, and a lot of experience…which he points out.  He applies his analogy to surgery and how a checklist used during a surgical procedures could help eliminate the most common mistakes made in the operating room…introducing infection, unexpected blood loss, operating on the wrong side of the body, etc.

This, of course is rather frightening because I’ve always viewed the modern operating room as a place where they have already reduced the procedure to its simplicities thereby allowing the surgeon to concentrate on the task at hand.  Perhaps I’ve been watching too much television where the doctors and nurses are so familiar with their scripts they work as a team.  The truth according to Gawande is a bit different.    It is normal in a large modern hospital for a surgeon to show up for an operation with a team he has never worked with before…this is particularly troublesome when we now realize they don’t have a script or the most rudimentary of  checklists to follow.  How could that be?  No wonder mal-practice insurance is so high!  It’s incredibly ironic that we pay more for a medical procedure so the highly skilled doctor can afford mal-practice insurance so when he is in the operating room he can wing it with a team of stand-ins.  For the love of God…..other expletives deleted.

Don’t we all use checklists several times a day?  Checklists are everywhere.  ”Read this First” stickers, warning labels, recipes, instructions, trouble-shooting guides, home improvement tips, and even Google maps.  And we have all not used checklists.  We bake bad cookies, we break things, and we get lost.  Those of us with complex jobs undoubtedly have checklists, standard operating procedures and directions at work which we don’t tend to ignore like the ones we do at home.  I am dumbfounded by the lack of checklists as reported by Gawande in the medical industry.  Dumbfound isn’t the correct word… appall is closer to my true feelings.

Because of this disconnect I’ve got a considerable amount of criticism for this book and I’ve been struggling between giving it one star because there is not a single original thought when it comes to large scale, complex program management and the utility of checklists…but then Gawande isn’t a program manager and is therefore way out of his element.  And this book is not like his other books where he is an undisputed master of the domain within which he writes.  On the other hand, five stars definitely seem appropriate since he points out this magnificent oversight of the medical community.  And if the medical community is his audience then he has done a decent enough introduction to the subject.

I’m going to settle on four stars simply based on the potential value this book could have within the medical community.  I will highly recommend it to medical professionals.  But anyone else, particularly those with a lick of common sense can avoid reading this book and just read the warning labels first.