Peter Zhang

Checklist Manifesto

Review

Atul Gawande’s Checklist Manifesto reviews the surprising utility of a simple checklist. While his personal background is in medicine, Gawande explores the triumphs of checklists in contexts ranging from mid-flight disasters to investment decisions.

Here’s the paperback and audiobook.

Utility: ★★★✰✰ (3/5)

Writing: ★★★★✰ (4/5)

I love the content. It aligns with everything I know about psychology and my personal experience. No proselytizing necessary; I’m sold. I also genuinely enjoy the stories, many of which are animated by first-person narration.

My one qualm with the book is that there’s just not enough information to justify its length. While the personal anecdotes and historical examples are interesting, they suffer from diminishing marginal utility. Whole lotta reading for not a lotta notes.

Notes

Value-Add

Surgical mistakes cause thousands of deaths a year, many of them preventable. Operating teams often forget a crucial step in the midst of operation, even when each member is specialized in their jobs. Professionals in fields from piloting to civil engineering face similar levels of complexity. It leads to error in three ways:

  1. Most people lack the knowledge and skills to keep up.
  2. In the midst of an emergency, we may become absent-minded or lose focus.[^1]
  3. We may become complacent and start to skip steps.

You can be really good at your job, but the sheer amount of information guarantees occasional mistakes. A checklist can prevent these oversights.

Good Checklists

  • …are planned. They have an objective, a pause point (when to start the checklist), and someone responsible.
  • …are either Do-Confirm or Read-Do. The former gives you the freedom to operate from memory and confirm ex post facto. The latter is more like a set of instructions, guiding you to completion.
  • …are short. People have limited time spans and patience. Long checklists will quickly become a chore and lose compliance. Shoot for one page with 5 to 9 items.
  • …aren’t obvious. Some steps are obvious. If I’m making a checklist for safe driving, “enter the vehicle” can probably stay off the list. Focus on “killer” items.
  • …are revised. Regularly seek feedback and update the list.

Examples

  • Piloting airplanes. Pilots have both “normal” checklist for common events like takeoff, as well as “non-normal” checklists for emergency events, such as a cargo door unlatching.
  • Surgery, especially ICUs. The introduction of checklists cut the average length of stay by half.
  • Making investments. A simple due diligence checklist can catch any red flags and also speed up the process.
  • Modern construction projects. They employ hundreds of employees and thousands of moving parts, requiring delicate coordination and, of course, daily checklists.
  • The hotel industry. Employees follow checklists for checking in guests and serving food to standardized quality.

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