Feb 17 2010

The Checklist Manifesto: How to Get Things Right

Malcom Gladwell on The Checklist Manifesto: How to Get Things Right by Atul Gawande:

Gawande begins by making a distinction between errors of ignorance (mistakes we make because we don't know enough), and errors of ineptitude (mistakes we made because we don’t make proper use of what we know). Failure in the modern world, he writes, is really about the second of these errors, and he walks us through a series of examples from medicine showing how the routine tasks of surgeons have now become so incredibly complicated that mistakes of one kind or another are virtually inevitable: it's just too easy for an otherwise competent doctor to miss a step, or forget to ask a key question or, in the stress and pressure of the moment, to fail to plan properly for every eventuality. Gawande then visits with pilots and the people who build skyscrapers and comes back with a solution. Experts need checklists–literally–written guides that walk them through the key steps in any complex procedure. In the last section of the book, Gawande shows how his research team has taken this idea, developed a safe surgery checklist, and applied it around the world, with staggering success.

Some quotes from the book:

"Despite showing (hospital) staff members of the benefits of using the checklist, 20% resisted stating that it was not easy to use, it took too long and felt it had not improved the safety of care. Yet, when asked an additional question – would you want the checklist to be used if you were having an operation – a full 93% said yes."

"In a world in which success now requires large enterprises, teams of clinicians, high-risk technologies, and knowledge that outstrips any one person's abilities, individual autonomy hardly seems the ideal we should aim for. ..what is needed, however is discipline…discipline is hard – harder than trustworthiness and skill and perhaps even than selflessness. We are by nature flawed and inconstant creatures. We can't even keep from snacking between meals. We are built for novelty and excitement, not for careful attention to detail. Discipline is something we have to work at."

"We don't study routine failures…when we look closely, we recognize the same balls being dropped over and over, even by those of great ability and determination. We know the patterns. We see the costs. It's

"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."

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