Phút Dừng Lại Của Người Thông Minh

by Atul Gawande, Khánh Trang (Biên dịch), Nguyễn Nghệ (Biên dịch)

Thế giới hiện đại đã và đang mang lại cho chúng ta nhiều bí quyết thần kỳ. Nhưng những sai sót có thể tránh được lại tiếp tục quấy nhiễu chúng ta trong lĩnh vực y tế, hoạt động chính phủ, luật pháp, ngành tài chính – gần như là trong mọi lĩnh vực, các hoạt động và tổ chức. Và lý do thật đơn giản: khối lượng kiến thức và mức độ phức tạp của nó đang vượt quá khả năng kiểm soát của chúng ta, đe dọa khả năng của chúng ta trong việc truyền đạt thông tin đến mọi người xung quanh một cách hoàn hảo, nhất quán, chính xác và an toàn. Chúng ta được đào tạo lâu hơn, chuyên môn hóa hơn, sử dụng các công nghệ hiện đại hơn, nhưng chúng ta vẫn cứ thất bại.
Giờ đây, tác giả nổi tiếng, bác sĩ phẫu thuật Atul Gawande đưa ra một lý lẽ hết sức thuyết phục rằng chúng ta có thể làm tốt hơn và tìm ra cách giải quyết vấn đề bằng giải pháp bình thường nhất: một danh mục kiểm tra tầm thường. Ông giải thích làm thế nào các danh mục kiểm tra lại biến những điều khó khăn nhất thành có thể – từ điều khiển máy bay đến xây dựng các tòa cao ốc phức tạp. Và với kinh nghiệm của chính mình, ông cho mọi người thấy nhờ vào đâu mà việc áp dụng ý tưởng này vào lĩnh vực phẫu thuật vốn vô cùng phức tạp lại tạo ra được một danh mục kiểm tra mà việc thực hiện chỉ mất 90 giây, nhưng lại giúp giảm hơn một phần ba tỷ lệ tử vong và biến chứng tại tám bệnh viện trên thế giới – mà hầu như không cần thêm khoản chi phí nào và có thể áp dụng cho hầu hết các loại hình phẫu thuật.
Qua những câu chuyện kể hấp dẫn, Gawande dẫn dắt chúng ta đi từ nước Áo, nơi danh mục kiểm tra trong cấp cứu đã cứu sống một nạn nhân suýt chết đuối vì đã chìm dưới nước nửa giờ đồng hồ; đến Michigan, nơi danh mục kiểm tra vệ sinh ở các khu săn sóc đặc biệt gần như đã giúp loại trừ một kiểu nhiễm trùng gây chết người; và đến cả danh mục kiểm tra cho buồng điều khiển của chiếc máy bay đang gặp nạn. Xuyên suốt các câu chuyện, ông tiết lộ cho chúng ta điều gì danh mục kiểm tra có thể làm được, điều gì không, và chúng đã tạo ra những tiến bộ thần kỳ như thế nào trong cuộc sống này.
Được bình chọn là cuốn sách bán chạy nhất tháng 12 năm 2009 của Amazon, Phút Dừng Lại Của Người Thông Minh (tên tiếng Anh: The Checklist Manifesto) là một khám phá thú vị về bản chất phức tạp trong đời sống chúng ta và là cuốn sách dành cho bất cứ ai đang khao khát tìm cách giảm thiểu tối đa các sai lầm.

Genres: Nonfiction, Business, Productivity, Self Help, Medicine, Science, Medical

295 pages, Unknown Binding

First published December 22, 2009

About the author

Atul Atmaram Gawande is an American surgeon, writer, and public health researcher. He practices general and endocrine surgery at Brigham and Women's Hospital in Boston, Massachusetts. He is a professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health and the Samuel O. Thier Professor of Surgery at Harvard Medical School. In public health, he was the chairman of Ariadne Labs, a joint center for health systems innovation, and chairman of Lifebox, a nonprofit that works on reducing deaths in surgery globally. On June 20, 2018, Gawande was named the CEO of healthcare venture Haven, owned by Amazon, Berkshire Hathaway, and JP Morgan Chase and stepped down as CEO in May 2020, remaining as executive chairman while the organization sought a new CEO.
He is the author of the books Complications: A Surgeon's Notes on an Imperfect Science; Better: A Surgeon's Notes on Performance; The Checklist Manifesto; and Being Mortal: Medicine and What Matters in the End.
On November 9, 2020, he was named a member of President-elect Joe Biden's COVID-19 Advisory Board. On December 17, 2021, he was confirmed as the Assistant Administrator of the United States Agency for International Development, and he was sworn in on January 4, 2022.

Reviews

[Peter Derk · Rating 3 out of 5]

We all have those books that sit on a nightstand, half-finished for weeks, right? Months? Maybe a year?

*cough*

Well, at some point you have to look at them and say, "I may not be finishing that one."

Or, alternatively, you can look at it and say, "Man, fuck this book."

It's not like there was anything terribly wrong with the book or anything. I just...I feel like I got the idea pretty early on.

Premise:
Humans are to the point where we've uncovered so much knowledge that human minds can't hold all of it. AND processes have become not only long, but very complex in some cases. Rather than count on simplification or drilling in knowledge, a checklist can be a really great solution.

The best example related to flying bombers in the 30's. Basically, the new planes were complicated enough that they kept crashing until a pre-flight checklist was instituted, and then everything was rad.

In my personal life, the closest thing I have to flying a bomber is passengering on a commercial flight. Going without a checklist, I've shown up at destinations missing everything from toothbrushes (replaceable), to any sort of reasonable footwear (more a problem), to swim trunks (which is actually on purpose because swimming is for suckers).

The problem I have with checklists is that I'm really awesome at using them to replace ACTUALLY DOING THE THING for which the checklist was created. If I'm going to do some serious cleaning, I might get it in my head to do a checklist first so that I don't waste any time. Why clean the spiders out of the curtains before cleaning the beetles out of the kitchen? Might as well do beetles first, then spiders, right? And centipedes....well, we always get rid of centipedes immediately. I don't know which dimension they escaped from, but I do know that it's a dark place that I would like to avoid.

Anyway, by the time I get the cleaning checklist and necessary bug taxonomy notes wrapped up and bound by a plastic spiral at Kinko's, I feel like I've already done a lot of work. Which makes it hard to rally and do the actual work.

Gawande's other books, Complications and Better, also had really simple messages explained in a way even us dum-dums could understand. But the message of this one, though important, was easy even for me, Archduke of Dum-Dums, to understand, and it might not have required a whole book.

Now, I didn't get to be Archduke by making great choices, so it's entirely possible that there is some great stuff later in the book that I didn't get to. So if someone tells you this is a really great book and you have nagging doubts, just remember that those doubts were planted by a guy who uses a spatula for a scepter to punctuate the royal addresses he makes aloud to absolutely no one in his insect-filled kitchen.

[Petra X · Rating 5 out of 5]

The Checklist Manifesto is not as helpful as Gawande's previous books - especially Better: A Surgeon's Notes on Performance which improved my business quite a bit with the injunction to 'count something' (so we did, everything, and saw the patterns. You should see my spreadsheets now! (Just as an aside, as an artist I am good at statistics I can see the patterns. Can't do maths though, never even got to GCSE level on that).

Where this book really made a difference is in operating theatres. They are now run like airplanes. First there is a very short briefing where any of the team can say anything without regard to status, and then there are the checklists to make sure that all eventualities, equipment and item retrieval - swabs put into your body are supposed to be counted and then accounted for at the end.

Gawande is so easy to read because he mixes his advice with proof and anecdotes, some of them personal. These sort of books, regardless of the subject are almost a genre in themselves. Think: Oliver Sacks for neurology and Jon Ronson for somewhat scandalous pop culture, but there are many more. Very enjoyable, light, non-fiction.

Recommended for people who are allergic to self-help books (me) but work in a complex industry and would like some advice that doesn't look like it because as Oscar Wilde said, "The only thing to do with good advice is to pass it on. It is never of any use to oneself."

Read March 3, 2011. Review rewritten Dec. 15th, 2015

[Maggie Stiefvater · Rating 5 out of 5]

A splendid little thing by a surgeon who extrapolates general problem-solving solutions from a variety of specific, technical examples.

[LG · Rating 4 out of 5]

Before starting, I read quite a few reviews that described it as an extended magazine entry. And I went in skeptical; I was curious how much one could say about checklists. I see lists as a great way to get things done. As long as they are simple and directed, they can focus my attention and keep me on task. So I went in a list enthusiast, but still skeptical.

This book argues checklists help us be more effective with complex tasks, by focusing us on what needs to be done and is often overlooked in emergency situations. Gawande recognizes that lists should not create bureaucratic nightmares. They are there to increase accuracy and prevent errors. Efforts should be made to test and refine them. What are things people are likely to remember (don't add them to the list) and what are things people are not likely to remember (put them on the list). This process means experts in the field need to make the checklists. By creating a space for everyone to check in with the process, the checklist can empower all team members and allow them to speak up when things are not working. This empowerment is the true value of the book.

While complex tasks (medicine and architecture) used to be handle by a single master, this book argues that our modern world is too complex for a single master. Instead, a checklist guides the decision making process of a team. If a step can not be accomplished, people need a space to speak up or be authorized to make the best decision. (Example of authorizing people to make decisions - Walmart's decision to let staff do whatever needed to be done during Hurricane Katrine) When possible, the team should discuss events that are not accomplished as planned. However such discussion is not always possible.

He acknowledges some tasks lend themselves to check lists (surgery preparation, airplane takeoffs, building buildings) and some do not (raising children). He argues - quite rightly - that children are unique. You can't create a checklist to deal with all children.

Basically Gawande believes what Einstein said about simplicity - everything should be made as simple as possible, but not simpler. And I think there is a strong satisfaction to finding a simple solution.

I liked the different examples. Because I felt it helped open the possibility of checklists, while also maintaining perspective on the challenges. The exploration of different checklists will either appeal to you as a reader or you will feel it is going over the same information. I liked it...

**Follow Up Thoughts**
When I read the book, I realized that you can't raise kids with a checklist. But you could help kids manage their time and responsibilities with checklists. I think some kids would be very drawn to the routine of a daily checklist. So a checklist could be a positive teaching tool.

[Matt · Rating 3 out of 5]

My having read - and enjoyed - a 200-page book about using checklists suggests that I'm a cocktail party nightmare, but I found this to be very much a worthy read. At the heart of it, this is really a book about management and efficiency. It's got a lot more "manifesto" in it than "how-to" though, which makes it both easy to plow through and easier for mass consumption. I actually wish it were more scientific and systematic than it turned out to be, but even as it rambles, it's thoughtful and interesting, with many good anecdotes.

I really do think this guy is onto something. A 200-page book about checklists will really get you to think about checklists. What makes it interesting is that it's not quite like you're reading "The Hammer Manifesto", where everything improves if it's pounded by a hammer. The devil is in the details, and improperly specified checklists are more a hindrance than a benefit. A checklist can't be too cumbersome, or you'll lose efficiency. It also mustn't be authoritarian. Gawande's idea of effective checklists are those that free decision-makers up to use their expertise and will make for a more "democratic" decision-making procedure.

The basic puzzle Gawande wants to solve is that in his field of medicine, as medical knowledge has advanced, the field has become so complex that no single individual is likely to both possess all the cutting-edge knowledge and expertise required for every contingency as well as be mentally prepared to take the right action all the time. Errors in communication and inconsistencies in preparation are proportionally more responsible for more fatalities these days than in the past. He compares being a physician to two jobs that rely heavily on checklists and procedure, airline pilot and building engineer.

For example: "Determining whether a structure … is built to code and fit for occupancy involves more knowledge and complexity than any one inspector could possibly have. So although inspectors do what they can to oversee a building's construction, mostly they make certain the builders have the proper checks in place and then have them sign affidavits attesting that they themselves have ensured that the structure is up to code. Inspectors disperse the power and the responsibility."

This is not necessarily what I expected when I picked up the book. "That routine requires a balancing a number of virtues: freedom and discipline, craft and protocol, specialized ability and group collaboration. And for checklists to help achieve that balance, they have to take almost opposing forms. They supply a set of checks to ensure the stupid but critical stuff is not overlooked and they supply another set of checks to ensure people talk and coordinate and accept responsibility while nonetheless being left the power to manage the nuances and unpredictabilities the best they know how."

Not being a doctor or pilot, this stuff was a bit beyond useful for me, but still fascinating. Speaking more generally about the details of checklist-writing, he advocates certain principles. "Bad checklists are vague and imprecise. They are too long; they are hard to use; they are impractical. They are made by desk jockeys with no awareness of the situations in which they are to be deployed. They treat the people using the tools as dumb and try to spell out every single step. They turn people's brains off rather than turn them on. Good checklists, on the other hand, are precise. They are efficient, to the point, and easy to use even in the most difficult situations. They do not try to spell out everything -- a checklist cannot fly a plane. Instead, they provide reminders of only the most critical and important steps -- the ones that even the highly skilled professionals using them could miss."

If I have any specific complaint, it's that after reading 200 pages about checklists I still feel like I've only grasped the tip of the iceberg, although I'm not likely to run out and clamor for the footnoted version just yet. Still, I'd have loved to see an appendix with a few good checklists in there.

Yep, I'm pretty much a cocktail party nightmare.

[Shane · Rating 2 out of 5]

How is this book a bestseller? It's not what I'd been hoping for. I expected a grand revelation in this book about a new way to approach making and using checklists to accomplish more, faster. What I got was a bunch of anecdotes about people using checklists successfully, many of them having already done so prior to the author exposing them to the technique.

The author, a surgeon, essentially had just discovered the power of checklists himself and was on a mission to get their usage established as a norm in operating rooms worldwide, in hopes of drastically reducing the number of (sometimes fatal) errors made by hospital staff in patient care.

What we get in this book is the story of that quest, including the dozen or so stories about others using checklists that gradually brought our author to his realization. Again, like many of these “self-help” books, it really does tend to go on ad infinitum about the same thing: checklists are helpful tools to ensure success. Anybody with a mother or a wife could have told him that.

I can’t tell you how many times my wife has told me, “Write it down!” when I need to remember something important. Heck, three years into our marriage we finally figured out the ideal, most efficient and fool-proof way to decorate our Christmas tree each year so that it looks beautiful, the lights are evenly and aesthetically spaced, and takedown is a breeze. Know what we did? We wrote it step-by-step on the inside flap of the box (beginning with “HEY, DUMB ASS!”) in order to get it right year after year from then on.

I’ve had a tiny slip of paper from a Chinese takeout fortune cookie taped to the front of my monitor for more than a year. It says, A short pencil is usually better than a long memory any day. Know what that means? Write it down! Checklists are good!

Here’s a summary of Dr. Gawande’s book:

Intro – Bad stuff happens when people make mistakes, especially in operating rooms. Failures are of two types: Necessary fallibility, which means we simply aren’t equipped to do everything in this world; and ineptitude, which means we have the knowledge and skill but fail to apply it properly. As our knowledge increases in this information age, more and more failures are coming from examples of ineptitude and lack of organization.

Chapter 1 – Organization and communication are important in a hospital. They can and do save lives.

Chapter 2 – Checklists are important and effective in aviation and emergency medicine.

Chapter 3 – There are three types of problems: simple (can be solved like following a recipe); complicated (solution requires multiple people, teams or specialists); and complex (each problem is unique and never the same twice). Oh, and checklists are important in construction too.

Chapter 4 – Organization and communication is important. Walmart saved lives faster after Hurricane Katrina than any government agency did. Checklists are also important in rock & roll as well as in the restaurant business.

Chapter 5 – Soap works better with step-by-step instruction. Checklists are still important in hospitals.

Chapter 6 – Checklists are still important in aviation. They save lives in critical situations at 30,000 feet. Investigate your failures so that you can make future improvements.

Chapter 7 – The assertion that checklists are important in hospitals is dramatically tested and further enforced. Yep, they’re important and definitely save lives, even through seemingly mundane steps.

Chapter 8 – Checklists are important for financial investors. In the operating room, it’s about more than the checklist itself; it’s about the culture of teamwork and discipline that the checklist instills.

Chapter 9 – Once again, checklists are important in an operating room. Our author finds out firsthand when a checklist helps his own OR save a life that he himself almost accidentally terminates through a mistake during a surgical procedure.

All in all, CHECKLISTS ARE IMPORTANT. WRITE IT DOWN.

Duh.

My biggest takeaway? David Lee Roth is not an egomaniacal control freak after all. Well, at least not when it comes to the famous bowl of M&Ms that was in the Van Halen touring contract rider in the ‘80s. The “no brown M&Ms” clause was apparently buried deep in the rider checklist which was mainly full of safety concerns, etc. If DLR came into the dressing room and that bowl of M&Ms was not there, or it still had the browns in it, then they knew they had to walk that checklist item-by-item to see what else had been skipped over or had the corners cut off it.

Recommended reading? Not sure. It was OK, and it had some points that will stay with me, but it seemed to be a lot of repetition. Once again, as many of these books seem to be, it was twice as long as necessary to get the point across.

[Peter · Rating 5 out of 5]

Checklist
The Checklist Manifesto introduces a groundbreaking transformation framework in ensuring the most critical of tasks are religiously followed, because it is a matter of life and death. In healthcare making a mistake may cost someone their life or leave them permanently damaged. Driving down avoidable errors should be one of the most crucial objectives in healthcare.

I have worked with the wider healthcare sector for over 30 years, and recognised the levels of authority, the egos, and intransigence of senior professionals (especially in relation to their juniors) and the difficultly in speaking out on potential mistakes being made by senior members. The unspoken reality is that senior healthcare professionals do not take recommendations well from personnel at a lower grade, and they maintain the belief that medicine is somewhat of a gifted and cerebral profession that only they can understand. The truth is that the third largest killer in the Western world is medical errors.

The challenge has been, to instil something so obvious and relatively easy to implement that has buy-in from the top to bottom in the chain of authority. Proposed by Gawande is the adoption of checklists in medical procedures and treatments. He presents compelling evidence that checklists can have a dramatic positive impact on the quality of care and healthcare outcomes. He has shown that this is repeatable around the world in all types of healthcare systems, where they have poor systems, state of the art systems, state-run healthcare systems, insurance-based healthcare systems or private healthcare systems.

This is a very compelling approach and the book lays it out perfectly. I have recommended this book to so many healthcare professionals and became part of a Crisis Checklist Consortium to help encourage the identification of areas of concern and adoption of these processes in hospitals throughout Europe. For those that oppose the idea for fear of losing control - Suck it up buttercup!

[Trevor · Rating 4 out of 5]

Over the last couple of years I’ve been studying and some of the subjects I have done have presented me with an assessment rubric. This is a kind of checklist which sums up everything that is good and bad about checklists to me. The first is that a checklist only really makes sense for highly repeatable behaviours. There is a really good reason why they work so well when landing planes and performing surgery. Things can go catastrophically wrong in either of these, but mostly they go wrong in somewhat predictable ways. No, that’s not quite right. It is like when I represented people in the trade union – people are infinitely inventive in getting themselves into trouble, but getting them out of trouble again generally follows a very predictable path. Jet engines can stop in all manner of ways, but really, whether they have stopped because of ice or geese, in the end you are still going to want to land the damn plane.

The big lesson here is that checklists can very easily become self-defeating. Checklists aren’t recipes, they are not meant to tell you all of the steps necessary to do any particular thing – if they did that they would be so long as to be completely useless. Instead, the point of an effective checklist is to ensure that you have done all of the things that really must be done – that, if they haven’t been done, then all hell will break loose.

There is an interesting discussion here about fires in operating theatres, for example. They decided not to include a checklist for this in a group of checklists they were working on, not because fires don’t happen or that they are not terrifying, but because they occur too infrequently and a good checklist looks for low-hanging fruit.

Checklists should also start from the assumption that the person using them is an expert. This is why they are not really recipes. The point is not to teach a surgeon how to take out your appendix, it is to make sure they go through the kinds of checks that have been shown surgeons tend to miss ‘some of the time’ and that cause problems when missed ‘most of the time’.

In a sense, and this is a point that is made really well in the book, we all tend to think that checklists are important for other people to follow. We know that we don’t make mistakes – obviously, that goes without saying – but other people are infinitely stupid and so it is a really good idea that they are forced to make doubly sure. If the price we must pay to make sure stupid people don’t make mistakes is for us to have to follow a checklist too, well, so be it. The fact we are deluded about our own abilities should be our primary assumption, but never seems to be…

Checklists need to be comprehensive in the sense that they should be evidence based – what normally goes wrong – and culturally implemented – how do you trip people to make them check before they do what needs to be done? You see, we humans are really terrible at following procedures. We get bored. A computer, on the other hand, is really good at following procedures. In fact, that is pretty much all a computer ever does. This is the reason why we tend to forget the milk we were supposed to pick up on the way home from work – even though we might have reminded ourselves just as we were leaving. We are victims of habit to the extent that something new tends to be forgotten. Unfortunately, we aren’t even all that good at habit and so even things we do over and over again, we tend to mess up now and again as our minds wonder.

The advice here, then, is that checklists can make a huge difference, but that checklists, like poems, are very hard to write. And that is true for much the same reason. In a good checklist you have to leave out what isn’t necessary, but make sure you put in what is. There is an inverse relationship operating here – the easier it sounds to write a checklist that ‘just has important things’ the harder it actually is to do. I believe the best people to write checklists are those who admits to making mistakes – but then, I think people who admit to making mistakes are the best people anyway. They tend to be grossly mistreated (‘she admits to making mistakes, what a loser!’), are infinitely rare – but invariably worth their weight in gold.

If writing a checklist is a remarkably difficult task, following one can be just as hard. As I said, I’ve had to hand in assignments that have required following assessment rubrics. In theory these should be easy – make sure you have answered all of the questions and you win! But what is really called for is a change in culture. You need to remember to go back and check through the checklist before handing in the essay, and really check it, not just glance over it. This is a very hard thing to do once you have convinced yourself you have done ‘everything’ that needs to be done already. On one assignment this year I did not address an entire assessment criteria – it turned out I was not the only one to leave this particular criteria out. It was not in the least surprising to me that this was the criteria that asked me to detail how I would change what had occurred. This was the question that was asking me to be creative – and being creative is the hardest thing and therefore the most likely thing to be left to the end (based on those most the dangerous words, ‘I’ll just come back to that later’). But without having some procedural ‘cultural’ trigger to actually go through the checklist one last time before handing in the assignment, many of us completely missed this question and lost what ought to have been fairly easy marks.

The problem is that checklist are:

Hard to write
Hard to follow
Easy to convince ourselves we’ve followed when we haven’t
Only good for more or less predictable outcomes and processes.

Given these limitations this book does make it clear that they do make substantial improvements to performance if they are well constructed, easy to use and effectively used.

My main problem, though, is that checklists come at the problem from the wrong end of the telescope. Checklists should be used as a ‘when everything else fails’ solution. The first solution we should be looking for is not, how do we restrict the options available by writing more or less optional procedures, we should be redesigning out dangers. Procedures lead to cultures of blame, and as I’ve said, humans aren’t terribly good at following procedures. So a checklist is a kind of time bomb waiting to go off in the face of the overworked and overly stressed person who misses one of its line-items. If you really want to improve things, don’t start by writing lists, start by redesigning hazards out of situations. For example, if you are using a guillotine you can have a checklist that says, ‘make sure your hands are not under the blade before operating’ or you can construct the guillotine so that it is impossible for either hand to be under the blade when it cuts. It is infinitely better to make it impossible for the worker to lose their hands, than it is to smugly tell them they don’t have hands because they didn’t properly follow a checklist.

But, with that said, I think this is a very interesting book and also know that if I was the sort of person who made more lists I would probably be happier and more successful. Just because this book is a clear victory for the anally retentive, doesn’t make it any less worthwhile.

[Vaishali · Rating 1 out of 5]

Really, really boring. Save time by reading David Allen's "Getting Things Done", the book that ushered in the GTD wave. Since Allen trumps this field, Gawande’s book would have been more useful with sample checklists of groundbreakers… Who wouldn't want to see one from Dr. Jane Goodall or Lebron James? What do they end up crossing off, and why? Instead, drawn-out tales from hospitals and airports come across like the author publicly congratulating himself for becoming a famous surgeon. Clearly this was not his intention, but it is what was achieved. Not one sample checklist on any page either … a bit like flipping through a cookbook with zero recipes :) :) :)

[David · Rating 5 out of 5]

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.

[Glenn Sumi · Rating 4 out of 5]

Surgeon and New Yorker writer Atul Gawande explores how using a humble checklist can reduce simple human errors, saving lives, money and time.

Curious about how checklists might limit post-surgical complications, Gawande examines how they have worked in the fields of construction and aviation, where errors could potentially kill hundreds or even thousands.

His results, written in lively and clear prose, are eye-opening, with fascinating glimpses into operating rooms around the world as well as busy construction sites, crowded cockpits and testosterone-fuelled investment firms.

Don't miss the story about David Lee Roth's "no brown M&Ms clause" in Van Halen's dressing room rider contract. Yes, that detail too has to do with checklists and troubleshooting in a complex world.

[Darwin8u · Rating 4 out of 5]

“One essential characteristic of modern life is that we all depend on systems—on assemblages of people or technologies or both—and among our most profound difficulties is making them work.”
― Atul Gawande, The Checklist Manifesto



"Checklists seem to provide a protection against such failures. They remind us of the minimum necessary steps and make them explicit. They not only offer the possibility of verification, but also instill a kind of discipline of higher performance."
― Atul Gawande, The Checklist Manifesto

Atul Gawande is a bit intimidating. Anytime you have a guy that does surgery, public health, and has written four bestselling books, it is only fair to acknowledge the guy has both brains and hustle. Unlike Malcolm Gladwell, Gawande has a tremendous talent for distilling scientific and academic ideas into a glossy, easily digestible 8.5" x 6" science-lite book. Gladwell does it with other people's ideas. His books involved several varied stories that come together into a lose federation of themes. Gawande usually starts with the idea: "Hand washing" in Better: A Surgeon's Notes on Performance) or "Checklists" (The Checklist Manifesto: How to Get Things Right) and creates a book around them.

Like Dr. Gawande the person, I find his books to be interesting, compelling, admirable, and straightforward. I admire his work and his vision. His books are almost always solid, just never once yet great. Dr. Gawande is clever. He writes books that are essentially entry-level business/leadership books that are disguised as surveys of medicine. He uses his experiences as a doctor and public health researcher to tackle broader social and cultural issues that intersect with medicine and health. He isn't super subtle, but most of those who are reading Gawande aren't looking for poetry or subtly. They want an idea to click. They want to feel inspired. The want to get better and avoid mistakes. He seems focused on presenting simple processes (soap, checklists) that may help.

[David Rubenstein · Rating 4 out of 5]

I really enjoyed Atul Gawande's earlier book Being Mortal: Medicine and What Matters in the End, and also an anthology that he edited, The Best American Science Writing 2006. So, I eagerly started this very short book, about checklists. Dr. Gawande ran a program sponsored by the World Health Organization. He proposed that hospitals institute checklists in the operating room, that would do two things. First, the checklists would help catch mistakes that can easily happen, as surgeries can be simple, difficult, or complex. Second, the checklists help bring the people in the operating room into a real team. The checklist helps to bring the timid people out, to give them the confidence to say things that are wrong, when otherwise they might simply defer to the chief surgeon.

Dr. Gawande was astounded by the success of his program. It was tested in four first-world hospitals, and also in four third-world hospitals. The checklists helped improve surgical outcomes in all of the hospitals, regardless of economic zone. Now, some of the surgeons reacted very well to the checklists, while others rebelled. But it didn't matter; in all cases, mistakes were noticed before harm was done, infections were thwarted, and the surgical teams were better prepared for the inevitable surprises and emergencies that occur.

The book also mentions several other areas. Everybody knows about the checklists that airplane pilots use. But most people don't realize that there isn't a single checklist; rather there is an entire hierarchy of checklists for all sorts of situations and emergencies. And, surprisingly, the book describes the checklists used by a few of the best investment companies; the checklists help save time, prevent mistakes, and improve profitability.

The title of the book seems so banal; I expected a rather trite description of the benefits of checklists. I was happily surprised; the book is not at all what I expected, and was even entertaining at times.

[Jim · Rating 5 out of 5]

It never ceases to amaze me how systems can get lost in their own complexity as they grow. Something starts out simple, but as time goes by complexity creeps in incrementally. What used to work so well isn't really cutting it any more. Worse, the attitudes & aptitudes that were once mandatory must also be changed. Gawande does a great job of showing exactly this when it comes to medicine.

The doctor that delivered me & cured my childhood colds also did my hernia operation, sewed up our wounds, & set our bones. He even made house calls occasionally, but that was the very end of that era - the early 1960s. Medicine had evolved beyond the black bag & home setting. He was very well respected, a solitary king of his domain, & had an ego to match. He needed that ego to control everything, too. In the past 50 years, technology has changed the profession immensely. In 1900, doctors needed a high school diploma & a year or two of medical school. Today most doctors can't get out on their own until they are in their mid thirties, an additional 15 years of study. There's that much more to learn & even so they have to specialize. Gawande jokes about left & right ear surgeons, but says it's not that big of a stretch.

Doctors are no longer solitary kings, now they're part of a team, one more cog in the machine, but their egos & past mystique still cling to them. They are well practiced & immensely educated, so the idea that a simple check list can help them seems ludicrous, but it does. He provides numerous, real world examples & some are plain scary. Medical mistakes are, though. Gawande outlines a number of studies that show exactly that & he goes on to show why through examples both in & out of his industry from a simple medical procedure, flying a plane, building a skyscraper, finance, & all the way to the boondoogle that surrounded New Orleans when Katrina hit in 2005. He uses the aviation industry a lot since they originated/codified the process & prove it out continuously.

The simple check list defines the goal, participants, & makes certain each step happens no matter what other distractions occur. It also defines the order, who is responsible & needs to make what decisions at what point. It fosters communication between the participants - even those not directly involved. His example of proper soap & dressings not being available due to lack of administrative involvement really brought the point home, something he does time & again. He addresses the ego problems very well & respectfully. Real world problems & solutions.

He says there are basically 2 types: DO-CONFIRM & READ-DO. The first lets you do several tasks, then stop to confirm them. The second is more like a recipe - do one at a time & check it off. In both cases, there is a tendency to put in too many items, but they should be simple enough to always be used. Precision of meaning is also key. They're not how-to instructions or even outlines, they're only there to confirm the critical & overlooked items.

This book really hit home. I'm the entire IT department for a small manufacturing company, a very complex field. (I often joke that I should get a degree in computer psychiatry when duplicate machines have different, intermittent issues.) I've been playing with computers for several decades now, the top tech for companies for more than half that time, can just about build a computer in my sleep. Still, I made a build check list years ago since I was forgetting things due to distractions or simply time between steps. After reading this, I went through my check lists, updated most. I made & deleted a couple more thanks to ideas that he sparked.

I highly recommend this book to one & all. Not only does it make medicine more understandable, but it has a lot of practical value in our increasingly complex lives.

[Hamad · Rating 2 out of 5]

~DNF@ 66%~

Every resident in my department is known for their thing and I happen to be known as the checklist resident. So, when I found out there is a book about checklists that is written by a doctor, I immediately wanted to read it. Unfortunately, it did not meet my expectations!

I have read Being Mortal by Gawnade and really enjoyed it. It is one of the non-fiction books that changed something -however small it is- in me and I think those are the best kind of books. I read this book despite already being a fan of checklists because I thought it would add something to my approach, but it did not.

This is one of those books that you can get the essence of in a blog post or a 5 mins video but the author somehow succeeded in expanding it to almost 300 pages! It may be a good book to convince you to start doing lists if you don't do that but, in my case, it was just insufferable at one point.

I made it to around two thirds in the book and then the author mentioned checklists again and I was like damn it, I can't go on with this. I decided to DNF it and look for something else.

[Z. Aroosha Dehghan · Rating 2 out of 5]

کل کتاب:
چک لیست چیز خوبیست.
چک لیست داشته باشید.

[Bkwmlee · Rating 4 out of 5]

Looking through my reading log the past couple weeks, I realize that I’ve been a bit behind with my reading the past couple weeks. This was due mainly to a few projects that I had to be involved with at work, which ended up requiring a bigger time commitment than I originally anticipated. Luckily, those projects will be completed by next month, so I will be able to get back on track very soon!

With that said, one of the books I was able to squeeze in during this time period was Atul Gawande’s nonfiction bestseller The Checklist Manifesto . Though this book came out 12 years ago, I actually only heard about it recently, when it was discussed on one of the book podcasts I listen to. I will admit that, going into this book, I was expecting it to be a “how-to” manual of sorts on designing checklists, so I was anticipating a long and arduous read (as most nonfiction books in the “self-help” category usually are for me). To my surprise though, this book proved to be the complete opposite of what I thought it would be. The “how-to” piece was actually less than 10% of the book; majority of the book was filled with fascinating anecdotes about several industries (primarily medicine and aviation) and how checklists contributed to various successes in those industries. It was obvious to me that Gawande is a passionate advocate for the use of checklists and while most of his focus here is of course on his profession (he is a renowned surgeon) and how checklists helped him in his line of work, I still found quite a bit of relevance in what he wrote. I think that anyone who works in a highly complex field (or has tasks that require a fair amount of complexity) can definitely benefit from incorporating checklists in the way that Gawande describes. In fact, before I even got to the end of the book, I already started thinking about possible ways to incorporate checklists to a few of my own tasks at work.

One of the things I appreciate most about this book is how well-written it is. Medicine and aviation are two fields that I would normally find boring to read about in such painstaking detail, but Gawande managed to make the subject matter interesting to the point that I wanted to keep turning the pages to see how things would turn out. I actually ended up finishing this book in one sitting, which usually never happens with me when reading nonfiction books! I think what also helped is that Gawande writes in an honest, down-to-earth manner with a good amount of self-deprecating humor sprinkled throughout, which is very different from the “preachiness” of many “self-help” books out there (especially the business-related ones, most of which tend to have a condescending tone that usually turns me off the getgo).

While definitely not perfect by any means, there is a lot of good insight here — to me, this is a useful book that is well worth a read-through regardless of what profession you are in. Though with that said, Gawande does describe some of the medical situations he encounters in explicit detail, so just a word of warning, in case stuff like that makes you queasy (I personally read through these scenes quickly and in a few cases, skipped some of the descriptions altogether). Overall, this book was both helpful and entertaining (plus, at about 200 pages, it’s relatively short), so definitely a recommended read!

[Rossdavidh · Rating 5 out of 5]

Apparently, after reading this years ago, I handed the copy to my wife and thus did not get around to reviewing it on GR. Suffice to say that it is excellent, and the one advantage of a delay is that I can say, with empirical data, that this is a book which can stay with you for years. I quite often think of the stories and lessons and principles in this book. I drew on it when helping my daughter learn to organize her schoolwork so that everything gets done on time. It is short, readable, and enormously useful.

[JJ Khodadadi · Rating 2 out of 5]

همونطور که از نام کتاب مشخص هست، راهنمای کامل انجام درست کارها با استفاده از چک لیست را در این کتاب خواهید آموخت
البته کل این کتاب رو میشد توی یک صفحه نوشت!

[Ms. Smartarse · Rating 3 out of 5]

In my experience, telling people that I like to read is a risky endeavor. There are of course a select few bookworms, who would respectfully respond by asking about my taste in books. Most people's reaction however, tends to fall into one of the following extremes.

1) Utter bewilderment that anyone would STILL be spending time to read books... and for pleasure, no less.

2) Great, let me recommend this absolutely amazing book called--

The first ones I can deal with easily enough: they feed my need for supercilious smirking wonderfully. The second ones however, are much harder to rebuff. Though it might seem easy to just give them a polite smile and make non-committal vaguely agreeing sounds, they like to follow up on my reading progress... and that's how this book ended up on my reading list.



To be fair, I should admit that the book has a decent starting point. I certainly feel better being able to push the blame for my failure onto someone/something else. We're most probably all fairly good professionals, but being pushed into a context where interruptions are stalking us at every corner, succeeding is almost impossible.

Even so, there are cases where the end result doesn't make things any more pleasant. Just imagine telling a grieving family, that their beloved son/father/brother/uncle did not necessarily have to die, but everyone just had so many things to look after, that they naturally missed a basic - but ultimately critical - step, when preparing for surgery. If only there were something to prevent this...



Obviously the author doesn't try to convince anyone that coming up with checklists was his sole invention. Nor does he claim to have the ultimate checklist that will solve every one of our problems... ever. But he does present several examples, and a fairly comprehensive case study to make his point.

Too bad it had to be surgery related. I'm squeamish enough as it is about blood in general, and you now make me read detailed descriptions of complex surgical procedures?! Sadist!



So far so good, right? Well... not quite. See I love lists of any kind: to-do lists, checklists, reading lists, inventory lists... ugh list lists, you name it, I'm probably a fan. Heck, the first thing I do when I get to work is to jot down a quick list of tasks that I want to take care of... which will already be forgotten by noon. But still, I write stuff down!

My biggest and most prominent problem however, is not addressed: how do you get back to the list, after an interruption? Because I totally forget all about the list once someone has an emergency that needs my attention asap.

Score: 3/5 stars

A decent effort, and an excellent anecdote to end things with. Still, the next person to recommend YET ANOTHER self-help book will be glaredpouted at mercilessly pitifully... *STARES*

[نیما اکبرخانی · Rating 4 out of 5]

یک انتخاب خوب دیگر بر اساس پادکست دوست داشتنی بی پلاس.
قبلا از آقای اتول گوانده هم خوانده بودم. میرایی یا آنطور که در ایران نام گرفت "مرگ با تشریفات پزشکی" خوب باید عرض کنم این یکی هم خوب بود البته نه مثل آن اولی.
کتاب دقیقا به مساله ای اشاره دارد که همواره من یکی را در زندگی آزار داده است. اینکه در انجام اموری که تا کنون بارها و بارها انجام داده ام ممکن است بر اثر مشغولیت ذهنی اشتباهی کنم و همه چیز را به فنا بدهم.
مثلا برای خودم همواره خروج های بلند مدت از منزل برای 10 روز یا یک ماه بسیار استرس زا بوده است. همیشه نگرانم گاز روشن مانده باشد، برقی وصل مانده یا آب را باز رها کرده باشم و ... همه ی این ها را هم نه در زمان آرامش و تمرکز که در حالی باید کنترل کنم که وسایل را در خودرو می‌گذارم و با پسرم سر و کله می‌زنم و به وضع آب و هوا در جاده فکر می‌کنم و ترافیک را در نظر دارم و .... خلاصه صادقانه امکان گند زدن بالاست.
اما بعد از اینکه این مشکل را کتاب برای شما تبیین می‌کند راه کارش را هم ارائه می‌دهد و مثال های بسیار فراوانی از تشکیلات ها و مجموعه های صنعتی و خدماتی می آورد که چطور با ابزاری ساده این مشکل را حل کرده اند.
کتاب قطعا در زندگی خود من به درد خورد و به شما هم توصیه می کنم بخوانید علی الخصوص اگر از این جنس نگرانی های من دارید.
مثال در کتاب به نظرم زیادی زیاد بود دیگر ، من را کمی خسته کرد اما این را هم بگویم اگر بعضی مثال ها برایتان جذاب نبود می توانید جهش کنید و یقینا چیزی از دست نمی دهید.
پی نوشت: شرح بهتر از آنچه من نوشته ام قطعا پادکست بی پلاس است.

[Emily · Rating 4 out of 5]

I am a list person. I have daily and weekly to-do lists and lists of projects I want to do, lists of projects for my husband to do and lists of ideas for summer activities for my boys, lists of books I want to read and places I want to visit. When I can see everything that needs to be done, even if it's an enormous amount, I feel like it's at least possible to get my arms around it and begin.

When I was the credentialing coordinator for a multi-specialty medical clinic, I used checklists all the time to make sure I didn't miss any important details that would mean a disastrous delay in a physician getting licensed or covered by malpractice insurance. And checklists are a powerful tool for me as a business consultant, helping clients define, track, and evaluate their processes.

All this to say that Dr. Gawande was preaching to the choir with this book; I'm already a believer. And even I was blown away by the data he shared demonstrating the incredible efficacy of this simple tool.

Using examples across several professional fields, including construction, aviation, investment funds, restaurants, and of course, medicine, Dr. Gawande illustrates again and again the power of checklists to serve as a defense against complacency and arrogance. They help insure quality and consistency and yes, save lives.

Dr. Gawande includes some specifics about using checklists optimally: keep them short, include items that are often skipped or missed rather than every single step, easy to read. But most interesting to me was his focus on using checklists to create the sense of teamwork and collegiality. The checklists are very useful, but they are a means to an end: aiding appropriate communication to ensure the best result.

And it's always nice to have scientific backing of your natural inclinations. :)

For more book reviews, come visit my blog, Build Enough Bookshelves.

[Jack · Rating 5 out of 5]

It is easy to hate Atul Gawande. The boyish good looks in a wunderkind surgeon with an extraordinary gift for prose. The first two books were lovely, reading about the experiences I had had and sometimes thoughts I had thought, but far more beautifully expressed than I ever could. It's just not fair.

And then he goes and writes this book. It's really good.

In particular, it is a shamelessly persuasive manifesto for a remarkably simple idea: smart people should focus their smart energy on doing things only smart people can do. And he uses several very nice examples to build the case that doctors, the smart people he is most interested in, are currently often idiots. In particular, these idiots insist on trying to remember everything all the time, rather than using simple back-ups (he calls them check-lists) to insure they haven't forgotten a silly detail. This, he suggests, means they frequently forget silly (but life-saving) details, AND they have to spend an enormous amount of time and energy trying to remember all those details, instead of doing real problem solving. He is right, and he explores this and explicates in such a powerful and subtle way that it's remarkable. It frankly changed my thinking.

[Satar Mahmoudi · Rating 3 out of 5]

سهیل خرسند یک شیاد گودریدزی است که با نوشتن ریویوهای بلند، دامی پهن می‌کند برای فروش کتاب و گرفتن پول از افرادی چون من. او پس از دریافت پول، فرد را بلاک کرده و از دسترس خارج می‌شود، مراقب او و امثال او باشید. تمام ریویو های امسالم را با معرفی این دزد شروع می‌کنم.
از طریق پادکست بی‌پلاس با این کتاب آشنا شدم و باید بگویم که یا در ترجمه اتفاق بدی رخ داده یا اینکه علی بندری با آن روایت جذابش توقع من را از اصل کتاب بالا برده است.
کتاب در آن حدی که فکر می‌کردم نبود ایده کتاب و فصل چهارم با عنوان ایده خوب بودند
اما در مجموع من بجای خواندن اصل کتاب، شنیدن اپیزود مربوطه را در پادکست بی‌پلاس پیشنهاد می‌دهم.

[Peter Tillman · Rating 5 out of 5]

Start by reading the publisher's summary. Then read Petra's 5-star review, the best I saw here:
https://www.goodreads.com/review/show...

I can only hope that the use of checklists has since become widespread in the medical industry. Dr. Gawande's study of them for the WHO clearly demonstrated how well they work, how many surgical errors they prevent (Gawande is himself a surgeon), and how they promote teamwork in the surgical team. Dr. Gawande did a thorough review of the use of checklists elsewhere. They were invented by pilots of the then-new B-17 bomber, which crashed during flight-testimg -- it was too complex an aircraft for the pilots of the time to handle without assistance. Fortunately, with checklists to help, pilots could fly the B-17s safely, and they went on to become a workhorse bomber for the USAAF and many other countries in the early days of WW2.

Next, Dr. Gawande looked into the construction industry, finding that the Master Builder era was long over there -- just as he suspected that the era of the Master Surgeon was ending in his profession. This was a truly interesting and unsuspected (by me) area where checklists came to be essential, democratizing the ability of workers to be heard, and assuring that tall buildings don't fall down!

Finally, Dr. Gawande relates his own experience in using checklists in his own practice. He was pleasantly surprised how helpful they were, how many errors and miss-steps they prevent -- and how hard it was at the start to develop good, simple ones that medical people would actually use! I wasn't surprised to learn that the Master Surgeons resisted what they saw as a challenge to their authority. But nurses, anesthesiologists and other medical personnel welcomed the checklists, and the evidence mounted that they are a powerful tool for improving medical care, at virtually no extra cost. I think their use is widespread now. I hope so!

Dr. Gawande concludes his book by recounting a surgery that went wrong despite the checklists. He is an expert on adrenal glands, and had scheduled surgery on a man with a rare tumor in one of his adrenals. The gland sits directly on the vena cava, the large vein that carries all of a person's blood back into their heart. Sadly, Dr. Gawande nicked this large vein, and the patient began losing catastrophic quantities of blood. Fortunately the hospital blood bank was well-stocked, because the patient ultimately needed to be transfused with three times the total quantity of blood he had prior to the operation! He did survive, with some damage from the heavy blood loss.

Highly recommended book. 4.5 stars, rounded up.

[Kevin Stumpf · Rating 1 out of 5]

I am not a pilot nor a surgeon. This book was useless for my life and career.

[Alfred Haplo · Rating 5 out of 5]

UPDATE Jul 11, 2019: It's terribly funny to see another book about "checklists", that almost seems to complement Gawande's with an equally Non-Succinct Title Beyond the Checklist: What Else Health Care Can Learn from Aviation Teamwork and Safety. Captain "Sully" Sullenberger appears in both books.

******************
Original Review:

”These are…ridiculously primitive insights. ...But, really, does it take all that to figure out what house movers, wedding planners, and tax accountants figured out ages ago?”

- Dr. Atul Gawande
(Annals of Medicine, essay in New Yorker, 2007).

In 2009’s Checklist Manifesto: How To Get Things Right, Gawande explains further.

(Not a spoiler. Just... more.)
In every industry of complexity, voluminous knowledge abounds and overwhelms any individual’s capacity to perform with optimal outcome. No one person can do it all. Not even a team can do it all, all the time. Multiply any one surgical scenario hundreds of thousands of times across different settings, resources and personalities - boom, failure imminent. Certainly not always, but in any events where patient safety is at stake, the odds for success from training, specialization and advanced technology ought to be correlated exponentially higher than what it currently is.

Gawande cites some numbers. According to the 9th edition of the World Health Organization’s (WHO) international classification of diseases, there are 13,000 different diseases, syndromes, and injury types. Clinicians have access to 6,000 drugs, 4,000 medical and surgical procedures with each a different requirement, risk and consideration. The average ICU patient required 178 individual actions per day, from administering a drug to suctioning the lungs, with every single action exposed to risk. How do 178 tasks get done consistently for every patient with a rotating medical staff without missing a beat? As Gawande puts it, “it is a lot to get right”.

Here’s more. Based on 2004 WHO data, one person out of 25 undergoes surgery every year with 10 to 100 times more risk than childbirth. Globally, surgeons perform over 230 million major operations annually but over 7 million people are left disabled and 1 million dead - a staggering amount of harm rivaled by malaria, tuberculosis and other known public health concerns. 5 million Americans are admitted to the ICU annually, with an average stay of 4 days and survival rate of 86%. Research consistently showed that 50% of deaths and major complications from surgery is avoidable.

“That means we need a different strategy for overcoming failure, one that builds on experience and takes advantage of the knowledge people have but somehow also makes up for our inevitable human inadequacies. And there is such a strategy - though it will seem almost ridiculous in its simplicity, maybe even crazy to those of us who have spent years carefully developing ever more advanced skills and technologies.”

Enters the checklist.

As a trivial exercise, check the following physiological data points at your next hospital appointment:

__ Body temperature (reading: __)
__ Pulse (reading: __)
__ Blood pressure (reading: __)
__ Respiratory rate (reading: __)

(Hint: Zero would be… immediately very problematic).

At every visit, these basic vital signs are recorded. Any one skipped could cost someone their life. As first line of defense, all it takes to raise initial red flags for the safeguarding of our health, is this rudimentary routine check. And at every subsequent step of the treatment plan, whether we realize it or not, there are medical checklists upon medical checklists, and checklists of checklists… or whatever terminology variation we prefer to coat it as. The word “checklist” sometimes meets mental resistance across the medical field for being too “dumbed down”, too “reductionist”, too… too insulting that a specialist, sub-specialist, ultra-specialist! Should ever need to check little boxes for what they already know like the back of their gloved surgical hands. Yet, knowing is not always doing.

At its most fundamental level, the checklist does two things: (a) Protects against faulty memory and distraction. Raise our hands, everyone who’s had an off day at work? Or, raise our hand, everyone who’s brought our A-game but everybody else is having an off day? On those days, the eveready checklist catches human fallibility. (b) Enforces mundane, but necessary minimum steps. In 2001, a critical care specialist at Johns Hopkins, Peter Provonost, implemented a doctor checklist of five no-brainer steps to target central line infections:

(1) wash hands with soap
(2) clean patient’s skin with chlorhexidine antiseptic
(3) put sterile drapes over entire patient
(4) wear mask, hat, sterile gown, gloves
(5) place sterile dressing over insertion site

The resulting observation? At least one step was missed for over a third of all patients needing a central venous catheter threaded directly into their vena cava, where an infection would be life-threatening. In the ensuring year, this “ridiculously simple” checklist produced a dramatic reduction of central line infections from 11% to ZERO%, and then only 2 cases over the next 15 months after. In more concrete numerical terms - 43 infections avoided, 8 people did not die, $2 million in costs saved (also nil emotional toll and $0 malpractice lawsuits). When Michigan state implemented Provonost’s checklist in ICUs statewide, an astounding 1500 lives and $170+ million were saved. THE CHECKLIST, its Status Elevated, is Certified Bonafide.

More checklists were tested in the JH ICU. @Checking for pain/4 hours - check. Result: patients in untreated pain? 41% to 3%. @Checking mechanical ventilators - check. Result: patients not receiving recommended care? 70% to 4%. @Checking on pneumonia - check. Result: patients who lived? 21, or 25% of total. @Importance of baseline performance checklists and check, check, check-ing them off - check. Result: Gain in checklist devotees? MANY%.

Are you checked out yet with checklist fatigue? Gawande has only just begun.

Sexy, the checklist isn’t. But neither is being sick, or dead, or in public healthcare verbiage, a missed opportunity. In early 2007, WHO invited Gawande, along with numerous international medical personnel, to convene for the monumental task of addressing surgical safety in developed nations - with economic wealth, specialties and advanced technology - to third world countries - in many instances, entire hospitals are staffed by only a few very overworked medical staff with limited resources and expertise. Lots of ideas were brainstormed to address a vast variety of problems. Lots of ideas were tried but failed to gain traction.

But a thought had begun to emerge - has anyone tried the humble checklist? One that could be deployed easily, cheaply, effectively, consistently and just as importantly, measured and duplicated easily, cheaply, effectively, consistently (Gawande repeatedly calls it ”transmissible” as if it’s a disease as only a doctor would!). He had noticed that all the problems have a common “leverage” attribute - a simple intervention leads to dramatically successful results.

Skepticism abound but enthusiasm grew as participants after participants shared stories of their own successful use of checklists, which may include anything from medical action (e.g. crucial antibiotics within narrow 60 min window) to pow-wows for communicating pitfalls and contingencies right before commencing surgery (e.g. confirming left kidney, not right. Speech impaired, attention to non-articulated distress) to very simply, introduction of each surgical team member by name (e.g. to foster trust).

After many revisions later, the WHO surgical checklist was born. Rolled out in 8 impoverished and affluent cities internationally, the checklist produced staggeringly positive results in its pilot year - major surgical complications fell 36%, deaths 47%. Fast forward to present time, implementation of it is now mandatory in 7 countries and over two dozen U.S. states, with an estimated 1,200 hospitals opting in as users. Gawande danced a mental jig on his desk, and thought, “this thing is real” (try to imagine a reserved Gawande in his standard attire of Brooks Brothers jacket and brown Oxford loafers letting loose his inner kid…). In absolute data, the surgical checklist is the real deal.

But the real star of Checklist Manifesto: How To Get Things Right isn’t the checklist, but Gawande the writer. After all, a checklist is a checklist and a best-selling book changes nothing of its quotidian nature. Very few non-fiction authors I have read get giddy about banal topics the way Gawande does in his slightly astonished, intellectually nerdy way. As if he has discovered the wonder of sliced bread and after interrogating its shape, its thickness, its texture, pronounced it perfect for sandwiches. Then he layers on these small, interesting, colorful personal anecdotes and soon, have us chomping away at tidbits peripheral to the bread. This is my 3rd book of his, and counting *.

If we say, great storytelling, Gawande, but show me the data. Worry not, he’s done the research neatly referenced by chapters at the back of book. It isn’t just surgery and public health that he writes earnestly, insightfully and meticulously about, it’s also the many non-medical industries - construction, supply chain management, investments, aviation - highlighted for utilizing their versions of the sacred yet ubiquitous checklist. Even if we are not frequent users of the checklist, any checklists, we can bet that many checklists have been applied to our lives directly or indirectly. If the idea of personally using a checklist seems hackneyed and restrictive to creative freedom, you’re probably right. Don’t use it. Gawande isn’t asking us to, he’s merely telling why he and other professional communities, use it to get their things right.



"Checklist Manifesto for the Checklist Aficionado" is my takeaway impression of Checklist Manifesto: How To Get Things Right. Using the checklist already has my buy-in since… oh, forever; an incurable habit from teenage days. Somewhat mis-titled, this book isn’t really a “How-To” but a "How I”. There is no sample. There is no stories of failures. There is no setback without a comeback. There is no guide on crafting a checklist, but a few pointers. There is no promise that the checklist is the be-all and end-all, only that it is a very effective tool. One that house movers, wedding planners, tax accountants, many others and eventually even Gawande, have figured out.


[* 4 stars: Being Mortal: Medicine and What Matters in the End , 4 stars:
Complications: A Surgeon's Notes on an Imperfect Science . And Gawande's Bio]

[Becky · Rating 5 out of 5]

More lively and fast-moving than you'd think a book about checklists could be.

Gawande speculates about why many people resist using checklists even though research has proven them effective. One reason interested me especially - that they distribute authority within a team. Thus nurses tend to like them more than surgeons, because a checklist provides a nurse with a more powerful voice, a surgeon with less.

I see this book as part of a movement in human endeavor away from organizational structures based on top-down authority, and toward structures in which a team holds authority holistically, in which authority rests upon processes and policies descended from, and measured against, explicit goals. Many people find this type of authority hard to understand. I've even heard people claim it's not "real" authority at all, and must ultimately result in either chaos or stultification. But I think that people face an interesting challenge the 21st century of developing technologies and systems that enhance this type of distributed authority, to make it ever more effective and efficient.

Gawande makes an eloquent case that members of more professions could reduce their error rates through the use of simple checklists. He includes a few pointers for developing good checklists; I would have preferred if he'd included even more.

[Jim · Rating 5 out of 5]

What I liked about this was how personal and specific it was. It spoke of a life that was saved in an operation he performed when a checklist alerted them there was not enough emergency blood in the OR. He pointed to anecdotes and statistics regarding his work with the WHO in creating and implementing a series of checklists. He speaks to master creators of airline checklist about what makes a good checklist and a bad one.Exceptional.


http://gawande.com/the-checklist-mani...

Gladwell's review of the book

A link which mentions the problems of cheap solution ie: checklists

http://freakonomics.blogs.nytimes.com...

[Andrew · Rating 4 out of 5]

The Checklist Manifesto: How To Get Things Right, by Atul Gawande, is an interesting book on the power of checklists in complex scenarios. Gawande is a doctor and famous author, and examines checklists mostly from a medical perspective. However, the application of checklists to various tasks transcends disciplines, and Gawande notes this. In various jobs throughout disciplines, oftentimes tasks can become muddled with interruptions and distractions. Even veteran doctors can forget simple things like washing ones hands, even though most people would expect them not too. In the medical world, one might be running through tasks for pre-surgery, when they are interrupted by a more pressing medical concern. What if someone is flat lining right in front of you? Will you remember every small detail and mundane but important task? Unlikely. We are not robots, and forgetfulness is a natural phenomena.

So in comes the checklist. Gawande runs through the implementation of checklists in various fields (mostly medical). When doctors in Austria began implementing checklists in an avalanche prone area, to combat a surge in patients who had suffocated, they saw rates of fatalities fall dramatically. When hospitals in the US implemented checklists to combat IV lines infected with bacteria, staff infection rates fell to astronomically low levels. Gawande notes that when doctors and nurses were observed in their tasks, without running through any sort of physical checklist, mistakes were made a majority of the time!

It is interesting how useful a simple checklist is, but it really should not be surprising. These simple tools help make complex tasks, like flying a B-52 flying fortress, or how to deal with an occurring risk that is a rarity, into step-by step processes where cognitive memory is not required. They are extremely useful tools because they take the human element out of tasks. Instead of a pilot having to remember to take a small pin out of a hole during take off every time, the process is relegated to a list with simple instructions.

There are issues with checklists, however. As Gawande notes, veteran employees, or skilled doctors or whathaveyou, may be reluctant to change like this. Does it not feel insulting when someone hands you a checklist for a task you have been doing for a decade? However, the numbers are clear.
Simple checklists can save lives, reduce pilot errors, smooth projects, and make tasks clear and concise. The checklist needs to be short, 100% accurate, and tested. It also needs to be accepted by employees, and given to the proper person to manage.

I really enjoyed this book. The insights on the medical world were very interesting to start, with the intricacies of the operating room laid bare, and the simple mistakes that individuals can make noted with honest clarity. I personally love checklists, as they make simple processes easy, and take the onus off of my memory (as it is terrible). Gawande has written a readable and interesting book on checklists, and I can easily recommend this book to those looking for a kick in memory or productivity in their personal or professional life.