Book Review: The Checklist Manifesto

Every once in a while, you run across a book that makes you think, “Why aren’t we doing this? Or why aren’t we doing this more?” The Checklist Manifesto: How to Get Things Right* by Atul Gawande is such a book. Gawande is a doctor on a mission. He wants to save lives. Gawande is looking for a solution to prevent simple mistakes and manage complexity. He advocates for the use of checklists as an organization and pre-planning tool. He suggests working out the issues before emergencies demand their use. However, as Gawande points out, checklists are not only for medical emergency situations but also for routine tasks. Systems and processes have become complex enough that it is difficult for one person to keep track of all the steps in memory.

How Checklists Help Manage Complexity

In 1935, Boeing was building a bomber aircraft that had crashed upon take-off. The crew failed to release the elevator lock. As a result, engineers developed a checklist for this new B-17 aircraft, enabling pilots to fly the B-17 Flying Fortress 1.8 million miles without an accident. Gawande recognized that checklists are used by pilots throughout the world and helped Captain Sullenberger land an airliner in the Hudson River. The pilots used checklists to fly the aircraft to safety. Gawande implemented checklists in hospitals for routine tasks and operating rooms. Gawande noted that consistent use of checklists in one ICU improved care and reduced the average hospital stay by 50%. “In the Keystone Initiative’s first eighteen months, the hospitals saved an estimated $175 million in costs and more than fifteen hundred lives” (Gawande, location 614-627).

What Makes an Effective Checklist?

Gawande offers suggestions for developing checklists. First, checklists should be efficient, precise, and easy to use. Checklists should be concise, e.g., 5-9 items. These 5-9 items fit in working memory and should be the most essential items. Checklists should be one page and easy to read with no distractions. You should create a checklist based on real-world experience. Checklists should serve as memory aids to prevent missed steps, not as comprehensive instruction manuals.

Pilots use checklists because:

1. They undergo training and must do so.
2. Checklists work.

Teaching Teams to Use Checklists

Gawande did not simply hand out checklists and expect them to work. He and his team provided PowerPoint slides, YouTube videos, and checklists to teach others how to use the checklists. They gathered the results, performed the analysis, and communicated the successes.

Throughout the book, Gawande illustrates numerous instances where checklists succeeded and highlights the issues that arose when people did not use them. Most of these examples focus on the medical field. However, he provides examples related to aviation, finance, and construction.

Applying Checklists to Your Own Work

While in the Air Force, I used checklists extensively, and I understand how successful they are. It was nice to have a reminder of their importance, and I have developed checklists to support my operations and checklists to support extension staff and educators.

For my extension friends, I would recommend looking at checklists to see how you can support your clients. I also recommend reading The Checklist Manifesto: How to Get Things Right*.

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Reference

Gawande, A. (2011). The checklist manifesto: How to get things right(1st ed.) [Kindle DX version]. New York: Picador.

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