Tomas Vik

Atul Gawande - The Checklist Manifesto

cover Goodreads

My rating: ★★★★☆ (75%)

This book answers the age-old question: Can you write a whole book about something as trivial as checklists?

As it turns out, you can, and to my surprise, it was a fun read.

I got this book recommendation from a YouTube video Find Business Ideas Customers ACTUALLY Want 💡 Josh Kaufman.

I use checklists extensively and I’ve read about them in Charles T. Munger, Peter D. Kaufman - Poor Charlie’s Almanack. So I was eager to find out if there’s anything I can add to my checklists to make them more useful.

The story

The book describes how planes in the 30s became so complex to fly that pilots had to introduce checklists to prevent crashes. Gawande argues that all industries have reached this level of complexity, necessitating the use of checklists to manage intricate processes and prevent errors.

Multiple fields, in other words, have become too much airplane for one person to fly.

The main storyline follows Gawande and his colleagues as they successfully introduce a checklist to be used before and after surgeries. This significantly reduces preventable mistakes, such as forgetting to administer antibiotics to patients. An interesting insight is the widespread resistance of professionals to follow a checklist, despite its proven benefits.

But we believe our jobs are too complicated to reduce to a checklist.

The useful info

Checklists for planes can be of two kinds: do-read and read-do. For a quick double-check after performing an action, you would use do-read. For example, after completing a pre-flight inspection, pilots might use a do-read checklist to ensure they haven’t missed any critical steps. When you want to follow a more complex process (e.g., emergency water landing), you will use read-do to ensure you do all the steps in the right order. This type of checklist guides the user through each step of the process as they perform it.

Most of the checklists in the book capture important steps in a complex process (e.g., surgery) that repeat very often. However, there are exceptions like checks for plane emergencies that pilots almost never use in real life. The difference between these “probably never needed” checklists and the common checklists is that aviation companies have whole departments dedicated to crafting and testing checklists.

When designing a checklist, you can have multiple pause points. For example: before the taxi, before takeoff, and after takeoff.

Read chapter 2 if you plan on introducing checklists to your company and you have team leads that should follow them (e.g., surgeons).

Designing a good checklist

To create an effective checklist, consider the following guidelines:

Content:

  • Include only steps you might forget to do; if you do the step every time without fail, don’t put it in the checklist.
  • Assume domain knowledge and don’t explain terms/processes everybody knows.

Length and timing:

  • The author recommends that you time your checklist and make sure that each pause-point takes only 60 seconds. (This may vary depending on the context)
  • The checklist should have between five and nine items. (This guideline may also vary based on the complexity of the task)

Practicality:

Good checklists, on the other hand, are precise. They are efficient, to the point, and easy to use even in the most difficult situations. They do not try to spell out everything—a checklist cannot fly a plane. Instead, they provide reminders of only the most critical and important steps—the ones that even the highly skilled professionals using them could miss. Good checklists are, above all, practical.

Meta checklist

I devised this checklist after reading the book. Apply it to your checklists:

  • Contains tasks that I would often forget, not the tasks I do every time
  • The checklist feels like a net-benefit, not net-loss - it regularly catches mistakes/omissions I’d make
  • There are no items that are significantly less important than the others
  • Can be completed in a reasonable timeframe for the context (e.g. 60 seconds for quick checks, longer for complex decisions)
  • Addresses common failure points or recurrent mistakes in the process
  • Is visually clear and easy to read quickly

Meta (sidenote)

At one point in the book, the author works for the World Health Organization (WHO) to develop a program for surgeons worldwide to reduce surgery complications. The author goes on to do something clever:

He studies previous successful WHO health projects to see what they had in common. This is something that’s hard to do but has massive ROI, take a step back and inspect your task on a meta level.

Applications in different fields

Throughout the book, Gawande explores the use of checklists in various industries:

Aviation

The aviation industry pioneered the use of checklists, developing both routine and emergency checklists to ensure safety.

Medicine

Gawande’s work in implementing surgical checklists led to significant reductions in complications and deaths. The World Health Organization (WHO) adopted a similar approach for a global surgery safety program.

Construction

The author draws parallels between the complexity of modern construction projects and the need for effective communication and coordination, which can be facilitated by checklists.

“The biggest cause of serious error in [construction] is a failure of communication,”

Investing

Gawande mentions how investors use checklists to ensure they consider all critical factors before making investment decisions. For example, ensuring that board members are not selling their stock too much.

Conclusion

Checklists, when designed and implemented correctly, can be powerful tools for managing complexity, reducing errors, and improving performance. As our world becomes increasingly complex, checklists can help manage some of the complexity.

I personally use checklists every day in my notes. My “pause points” are:

  • starting a project
  • finishing a project
  • encountering a difficult task
  • implementing new feature

When reading the book, I felt a bit envious of more mature engineering disciplines like civil engineering. The level of coordination and communication that happens during construction seems miles ahead of what I experience daily as a software engineer.

The book is repetitive and basic at times, but it’s enjoyable to read thanks to Gawande’s healthcare stories.