Book of the Week: "The Checklist Manifesto" by Atul Gawande
Graphic, compelling story-telling format of the “The Checklist Manifesto” will make you pause and reflect on how you can use the power of checklists in your business and professional life. At least, that is the effect this book had on me: examine and pause.
Given Atul Gawande, the author of “The Checklist Manifesto,” is a surgeon, I should have been better prepared for some of the medical “war stories” that he covers in his book. His stories involving patients whose hearts have stopped will leave you a little breathless (and for me, squeamish), unless you are not affected by graphic operating room stories.
(Pictured below: Dr. Atul Gawande; Photo by: Fred Field).
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However, this vivid and compelling story-telling format makes the reader stand-up and think about the point of “The Checklist Manifesto,” which for me is this, the use of checklists can improve patient survivability rates, improve business performance, airplane safety, and even improve outcomes in legal matters. For example the statistics related to medical issues are quite dramatic, he states that in 2006 it was less than a 50 percent chance that heart attack patients would receive the appropriate testing, diagnosis and medical plan within 90 minutes of arriving at the hospital (a timeframe that would increase the survivability of such patients). He also states that “Studies have found that at least 30 percent of patients with stroke receive incomplete or inappropriate care from their doctors, as do 45 percent of patients with pneumonia. Getting the steps right is proving brutally hard even if you know them.” He believes—and implementation has proved—that checklists provide shortcuts to solve complex problems (and in the realm of air travel safety—emergency problems) in an abbreviated time frame.
One of the industries that has long used checklists and continues to use checklists as an everyday practice is air travel. In the book, he discusses the inaugural flight of the B-17 Bomber (in 1935) that was flown by one of the best pilots of that time period. The flight was tragic in that shortly after lift-off, as the plane approached 300 feet in the air, an engine stalled and the plane turned on its side and crashed. The plane was the most complex for its time period. The investigation showed that the accident was caused because of one “pilot error”; one simple step had been skipped among many actions a pilot had to do before and during the take-off. The fix was to use a checklist, and since then, the airplane pilots have a checklist for almost every possible scenario and routine checklists play a role in every single flight. I told the story about the B-17 bomber to a client (he was a pilot) and he was pretty shocked that I heard of it as he thought of it as an industry specific one, and he only met pilots that knew about that story.
Gawande gives additional examples of modern-day checklists in flight safety with the famous “Miracle on the Hudson” landing by Sully and how pilots deal with fuel icing that causes engines to stall (an accident just in the past few years that allowed the creation of yet another checklist).
Another industry that uses checklists to solve complex problems is the building industry, for example in the building of skyscrapers—a process that involves all sorts of complicated building processes that have to work together in a coordinated effort, even when there are numerous "change orders."
Throughout the book he goes back to his native profession of surgery and how checklists improve the performance within the medical industry. He provides a strong argument that checklists can be useful in almost any field or industry where there are complex problems with numerous steps, and where the misstep of a single simple step can have dire consequences.
I would have to think that anyone can benefit from reading this book. After reading the book, one would be well advised to begin dissecting their own tasks, or business protocols to see how checklists can create better outcomes and provide efficiency in one’s daily routines—or to be used when a random problem comes at you, and you need a systematic way to solve it.
