Thoughts on “The Checklist Manifesto”

A book I checked out from the library is The Checklist Manifesto by Atul Gawande.

I first heard about the magic of relying on checklists when I read an article in the Chicago Tribune titled “United leans on go-to guys” (archive here), about ramp workers that United Airlines sends on special assignments, including charter flights to transport troops and equipment for the military. Here is the money quote: The group’s methods for developing checklists and centralizing information have had so much success that Elk Grove Township-based United has begun introducing their approaches to solving problems into other areas of the airline’s operation, standardizing operations whenever possible.

I heard about the power of checklists again on a technology podcast, and one of the hosts mentioned that he was taking flying lessons. He said that pilots use checklists for everything. Even how to deal with engine failure. He said that he started using checklists for his software projects and other areas of his life and that it helped him get things done more efficiently and with fewer errors.

Gawande goes over how using checklists have reduced medical errors at hospitals. He also covers the use of checklists in architecture/engineering/construction. In construction, when there is an unanticipated issue, the group he looked at would go off the checklist. People from different groups would come together and make a decision.

His thoughts on when to stay on-list (usually during routine activity) and when to go off-list (during emergencies) led to a discussion of Hurricane Katrina. Many people like to contrast the federal government with WalMart to show that the private sector can handle things better. He said the real issue is a large organization should know there are times to stay on script and times to decentralize decision-making. WalMart let its branches do what they felt was best, while the federal government would not delegate authority. He gave examples of private companies that did not delegate and thus did poorly, while some local government agencies let their people improvise. When life goes off-script, you should go off-script. [Note 1]

Gawande profiles an investment manager who uses a checklist when looking at investments to decide whether or not to invest in a company. He said it helped improve his returns. This manager said he has studied Warren Buffett (but then again who has not?). This manager said that Buffett has made some bad investments (which Buffett himself has admitted), and this manager has said that there are mistakes that Buffett has made more than once. He has inferred from this that Buffett is not using a checklist when he looks at companies. Saying you are better than Buffett is a pretty bold claim.

Gawande wrote about how checklists have helped him in surgery. One of the things that he does is he has the whole team (surgeons, nurses, anaesthesiologists, etc) introduce themselves to each other. I think someone else suggested this step, and Gawande thought this was silly. Until he cut into a patient’s artery and the patient nearly died. Gawande thought that the one minute that people spend introducing themselves can engender more trust on the team that can increase the chance of success, especially in an emergency.

He spent a lot of time writing about the checklists that airline pilots use. He said that the steps should be short and clear.

He wrote that many people resist the idea of checklists because they are afraid it will squash their creativity and individuality. But he said that it frees you from having to worry about details and allows you to focus on the bigger picture. Plus, you can always change and improve the checklist.

He is part of the Safe Surgery 2015 movement, which runs Project Check. It includes a checklist for developing checklists. [Note 2]

Note 1: Update 2022-01-02_02.33.27: Just a reminder that during Hurricane Katrina, the federal government was run by conservatives who had a negative view of government before they were in it. Some Republicans used the federal response to Katrina as justification for cutting funding to federal agencies. Perhaps the ineptness was intentional. Something to keep in mind when conservatives say that government cannot get anything right.

Note 2: Update 2022-01-02_02.38.36: To all the Apple-fanboi hipster web designers: One of the items on the checklist for making checklists is that the font is dark on a light background. It’s good for paper, and good for screens too.