The Checklist Manifesto: How to Get Things Right

Read in May 2016
Book by Atul Gawande published in 2009

I try my best to write a short summary/review of the books I read, and this is one of them. I typically publish them on Goodreads, but also sync them to here.

This is a good book about the impact of checklists and importance of being humble to your discipline. The challenge in modern fields is that the volume of knowledge has outgrown our ability to execute it correctly. Even with super-specialization, the standard reaction to the volume problem, endemic to medicine and other complex fields—it's still too much for one person to keep in their head. Mistakes are easy to make.

The book cycles through case and case again of people it's saved when applied to medicine and aviation. The book makes a valuable distinction between the simple, complicated and complex. The simple is what can be performed with a simple recipe, like baking a cake. The complicated is when many recipes come together, and identifying the recipes may not be easy, but they are present—like computers. Complex is when giving the same input doesn't always give the same output, meaning simple or complicated recipes don't work. Checklists work well for simple and complicated, but even in the complex cases can aid substantially. Checklists are a great means to enforce communication for complex projects.

There are two types of checklists: read-do, and do-confirm. In the first, you read and do each task as you read them. In do-confirm, you do, and then confirm you didn't miss any. Both are valuable for different scenarios. Checklists scale new knowledge and discoveries. The aviation's antifragile nature of RCAs that propagate information to the rest of the world, is largely due to checklists. Every crash causes changes to checklists that are distributed to all similar airplanes in the world. This is how an industry as a whole gets better, rather than the individual actors within it. The latter being true in especially software.

What I liked, was that the book took a pragmatic approach to checklists. It discusses in practise how you implement it into disciplines where people may feel offended by being presented with a simple piece of paper that should tell them what to do. The issues of the nurse dictating surgery by being in charge of the checklists. As well as the practical implications of having checklist overload. Some checks are too complicated for the probability of it going wrong in the first place.

Humans are not build for discipline, but for novelty and excitement. Checklists are built for discipline and attention to detail. We need to get better at studying the tools, not just the new drugs and technology. We can get better at applying what we already have.