David's Reviews > The Checklist Manifesto: How to Get Things Right

The Checklist Manifesto by Atul Gawande
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Jan 24, 10

bookshelves: read-in-2010, unexpectedly-terrific
Read in January, 2010

You have to feel sorry for Atul Gawande's siblings. No matter how brilliant their accomplishments, at any family gathering, we know who is going to be center stage. He's not just your average doctor, he's a surgeon. Specializing in endocrine cancer. This astonishingly good book isn't his first - he's written two others, "Better" and "Complications". Of course he's a Harvard professor. Oh yes, he does a little magazine writing. For the freaking "New Yorker", for crying out loud. His essay in the June 1st 2009 edition analyzing the cost of healthcare
Annals of Medicine is considered to have been most influential in the legislative debate Sidney awards . He heads up the WHO's "Safe Surgery Saves Lives" program. Did I mention the MacArthur "genius" award? The kind of brother any sibling would be justified in resenting.

I have no idea what kind of a surgeon Dr Gawande might be (though a reasonable guess would be that he is a very good one). I can say that, based on his New Yorker articles, and on this book, that he is an excellent writer. Like his colleague, Malcolm Gladwell, he has the ability to write about material that could easily be boring in the hands of a less gifted author in a way that is clear, engaging, and thought-provoking, without ever being condescending. This serves him well in this book, whose general topic is achieving success in areas of endeavor that are intrinsically complex, where success requires a high level of interdisciplinary cooperation, and where the consequences of failure are catastrophic.

In 2006, Gawande was approached by the WHO to help develop a global program to reduce avoidable deaths and harm from surgery. His initial (quite sensible) reaction was to have nothing to do with it, but he eventually agreed to help. What followed from that request is one of the fascinating stories that make up this book, and the author does an excellent job of telling it. That story on its own makes the book worth reading. But Gawande takes things a step further, arguing that the kinds of challenges that make surgery a risky and complicated business are characteristic of many modern endeavors. Launching a manned space shuttle, building skyscrapers that don't collapse, discovering, testing and manufacturing a novel cancer drug, flying a commercial jet -- these are all examples of activities whose successful execution requires the coordinated efforts of experts spanning a huge range of expertise, and for which the consequences of failure are serious, possibly catastrophic. As the author points out, advances in technology have led to systems that are so technically complex that no one person is capable of understanding the entire system - we live in an age of hyper-specialization. Yet we have faith that such systems will work every time we enter high-rise office building, board a plane, or are admitted to hospital. How can we be sure that our trust is warranted?

Gawande explores three cases in great depth - airline safety, building construction, and hospital safety (with separate discussion of critical care procedures and surgical interventions). By examining the ways complexity is addressed in the first two cases (both of which have excellent track records), he identifies general principles that should carry over generally. I won't give them away here, except to say that he makes his case in a way that is both articulate and convincing.

Shorter vignettes are included to support his arguments, and they make for fascinating reading. His comparison of Walmart's and FEMA's relief efforts after Hurricane Katrina was particularly interesting, as was the explanation for David Lee Roth's notorious "no brown M & Ms" contract rider.

This is a terrific book - well-written, interesting, and thought-provoking. I read it in just two sittings.

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Preeti Great review of a terrific book! I, too, liked the first part about Gawande's siblings!

Your review reminds me that I need to go check out his other books soon!


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