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 as well as handle complexity. He advocates for the use of checklists as an organization and pre-planning tool. It is better to work out the issues before they are needed in an emergency. 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.

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, a checklist was developed for this new B-17 aircraft, and pilots were able 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 reduce 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).

Gawande offers suggestions for developing checklists. First of all, 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, thus no distractions. A checklist should be forged through the flames of the real world. Checklists should not be comprehensive instruction manuals, rather, they should be memory ticklers so steps are not missed.

Pilots use checklists because:

  1. They are trained and required to do so.
  2. Checklists work.

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. The results were also collected, analysis, and the successes were shared.

Throughout the book, Gawande provides countless examples of the success of checklists and the problems when they were not used. Most of these examples focus on the medical field; however, he does provide examples related to aviation, finance, and construction.

While in the Air Force, I used checklists extensively, and I understand how successfully they are. It was nice to have a reminder of their importance, and I have begun to start developing checklists to support my operations as well as 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*.


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

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