The Checklist Manifesto - Atul Gawande

I read this based on a recommendation from work. Handling alert pages involves doing the best you can under time pressure, and this is pretty much what this book is about.

More specifically, the book is really about the author's attempt to reproduce aeroplane pilot culture in surgery. The thesis is that flying a modern aeroplane is basically too much for a person to do reliably unaided. They need to work effectively as part of a team, and assisted by reminders. The checklists accomplish both of these things - they give people reminders of what to do in both regular and extraordinary situations, but also the checklist routines give a mechanism by which people who've never worked together become a team, and are thus better prepared for those emergency situations. Moreover, standardised checklists provide a way of spreading best practices across the industry, to raise the bar globally.

Surgery has not traditionally had this mindset. The surgeon is an expert and can, based on this expertise, decide what's best. Checklists blunt this vital spirit, necessary for handling complications, etc. Except when the author got surgeons (including himself) to use checklists, they regularly spotted things they missed. Hospitals picked up new best practices. And, when things got tough and sudden complications arose, the surgical team actually worked much better as a well-prepared team, more than just a collection of people in a room.

It's not clear how many of these benefits transfer to other situations. A different form of checklisting is used to manage the construction of immensely complicated building projects. Some outperforming investors use checklists to overcome greed and fear. At my workplace, the default checklist is "automate it and take the human out of the loop".

Towards the end of the book, the point is made that the reason that pilots survive difficult situations is discipline under pressure. This is the core of their culture, and what checklists help propagate.

This is quite a long review of a short book, and the development and roll-out of the surgical checklists is an interesting story in itself, let alone everything else in there. If you care about getting tricky things done quickly, read this book.

Posted 2016-11-02.