Book Review: The Checklist Manifesto


Gawande, Atul. The Checklist Manifesto: How to Get Things Right. New York: Metropolitan Books, 2009. 209 p.

I picked up this book after completing Being Mortal by the same author. My motivation was 60% enjoyment of Gawande’s writing and 40% interest in the topic. I was not disappointed on either front.

Gawande tells the story of how checklists—a systematic way of accomplishing complicated tasks—influence safety and success, and how we are resistant to embracing them. He traces their birth and development in aviation from the B-29 bomber through US Airways Flight 1549 “Miracle on the Hudson” in 2009. He also looks at how the concept allows us to build skyscrapers and stadiums, how some financiers have started using them, and how they can benefit surgical patients.

Gawande became involved in a World Health Organization initiative to reduce surgical complications and fatalities in 2007. The scope was world-wide and the budget minimal. As his small group pondered what could be done, more training and better equipment were the two standard answers to most modern shortcomings, but both required huge budgets.

What if they could develop a checklist to address common, but serious, issues in surgery? So they did just that. They eventually crafted a 19-question checklist that reduced complications and fatalities significantly in some of the most modern hospitals in the world as well as in some third-country hospitals.

Interestingly, there remains significant resistance to checklists in medicine, which Gawande admits himself. He started using one because he didn’t want to be hypocritical, but he didn’t think it would make any significant difference in his cases. He soon discovered, however, that it did, and he credits at least one patient’s life to the discipline and teamwork that a good checklist engenders.

All of this has me pondering what applicability there might be to me and my profession. I don’t perform surgery, build skyscrapers, or broker multimillion dollar financial investments. I do fly, but only as a passenger. Nevertheless, I can still see at least some initial applications.

First, I run some fairly complex programs on occasion. I just held a retreat for about 45 couples hours away from where I or any of them live. I had to work on both the presentations and the administration. A week before the event, I called the resort event coordinator because I had thought of something that was vague and could be interpreted by her in a way that would be disastrous for the retreat. A 2-minute phone call cleared up the ambiguity and she said that she had planned to call me for the same reason.

The phone call would not have been necessary, however, if I had had a good checklist for the event. Instead, I used the “think through everything that we may have forgotten or could go wrong” technique, which is not as efficient and is much more time consuming than using a solid checklist.

Second, I do use a checklist on a regular basis in the Daily Offices of the church. They help me maintain a balanced prayer life. I’m not just responding to what is on my mind as I pray, but am able to focus on a wide set of concerns and needs. I have found it to be very effective and to have reduced one of my biggest hindrances to prayer: my wandering mind.

I’m going to keep my eye out for other areas where checklists might help increase efficiency or effectiveness. It is a simple concept and I don’t want to overlook it for its simplicity. Sometimes the simple things are the most significant.


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