Business at a certain level is about bringing clarity to complexity. You hear about organizations struggling to provide clarity all the time. Ford, for example, found an executive, Alan Mullaly, who could best manage its manufacturing and development complexity. Who better to run a company that produces vehicles made of thousands of parts than one who had managed Boeing, a company that built planes containing millions of parts?
A similar search is the foundation for The Checklist Manifesto: How to Get Things Right by Atul Gawande. Gawande, a surgeon and associate professor at Harvard Medical School, sought the best method to minimize physician care error. I had heard Gawande’s interview on Harvard Business Review podcast in which he explained his journey and associated study, and I wanted to read more.
With More Understanding Comes Less Understanding
Gawande’s book is about the need to better manage required steps in patient safety in a surgery setting. The end result was a search for the best checklist that could cover all the bases. The search took the author to various locations and even various industries. With an casual style, The Checklist Manifesto brings the reader to a doctor’s level. But like many true innovators, Gawande incorporates other views to explain perspective from within his profession. The result for the reader is a well-written book that conveys the challenges without using excessive jargon or watering down information.
For example, he explains how people fail due to ignorance, “because science has given partial understanding of the world and how it works,” and ineptitude (we know, but fail to apply the knowledge). Gawande uses the example of our knowledge about heart attacks:
“Even as recently as 1950 we had little idea on how to prevent or treat them….Today, by contrast we have at least a dozen effective ways to reduce your likelihood of having a heart attack…”
Gawande next explains the challenge in getting the right knowledge applied:
“…just making the right treatment choice among the many options for a heart attack patient can be difficult, even for expert clinicians.”
Then he mentions recent medical studies on caring for stroke victims to reinforce the challenge physicians face:
“Studies have found that at least 30 percent of the patients with stroke receive incomplete or inappropriate care from their doctors as do 45 percent of patients with asthma and 60 percent of patients with pneumonia. Getting the steps right is proving brutally hard, even if you know them.”
The ability to prevent the errors that can result from the complexity of choice is at the heart of his journey - “Knowledge has both saved us and burdened us.”
The middle chapters showcase Gawande’s journey in developing a checklist solution, starting with his work with the World Health Organization. Gawande looked at professions that involved multiple tasks, skill requirements and dire consequences if proper steps are not followed. His journey offers great “a-ha” reminders of how the world works, and is simply fun to follow.
The journey leads Gawande to Daniel Goodman, a Boeing aviation checklist expert who develops lists to avert human error during flight. Goodman explains the idea behind good checklists:
“Good checklists are precise. They are efficient, to the point, and easy to use in the most difficult situations. They do not try to spell everything – A checklist cannot fly a plane. Instead they provide reminders of only the most critical and important steps – The ones that even highly skilled professionals could miss.”
The brief explanation of a READ-DO and a DO-CONFIRM checklist are enlightening and excellent.
Why This Manifesto Works So Well
The Checklist Manifesto is a solid book for a few reasons:
- The risks at stake in the anecdotal examples are easily understood. Poor surgery procedures can lead to patient deaths. Poor preflight procedures can lead to a crash. Thus the impact of checklist benefits can be easily taught to your employees, contractors or project teammates.
- The idea of risk management is introduced simply, so readers with no experience with statistics will not be intimidated.
- Gawande shows the ubiquity of the need for checklists in critical projects as well as the usefulness the checklist provides in its simplicity.
- By investigating how several industries tackle the same problem, Gawande showcases how innovation comes from assimilating processes from other industries.
Who Will Enjoy The Checklist Manifesto?
If you are a business owner addressing complexity, this book will win you over. There are no charts or research notes, but the manifesto for better upfront decision-making is very clear thanks to the story that this book weaves.
With The Checklist Manifesto, you and your team will be inspired to make a checklist and, like Larry The Cable Guy says, “Git ‘er done!”