The Checklist Manifesto: How to Get Things Right

by Atul Gawande

Getting the steps right is proving brutally hard, even if you know them.

Failures of ignorance we can forgive. If the knowledge of the best thing to do in a given situation does not exist, we are happy to have people simply make their best effort. But if the knowledge exists and is not applied correctly, it is difficult not to be infuriated.

It is not clear how we could produce substantially more expertise than we already have. Yet our failures remain frequent. They persist despite remarkable individual ability.

The knowledge exists. But however supremely specialized and trained we may have become, steps are still missed. Mistakes are still made.

Checklists seem to provide protection against such failures. They remind us of the minimum necessary steps and make them explicit.

And the question of when to follow one’s judgment and when to follow protocol is central to doing the job well—or to doing anything else that is hard.

First, how could they be sure that they had the right knowledge in hand? Second, how could they be sure that they were applying this knowledge correctly?

“The biggest cause of serious error in this business is a failure of communication,”

“A lot of you are going to have to make decisions above your level. Make the best decision that you can with the information that’s available to you at the time, and, above all, do the right thing.”

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.

the recipe—the most basic checklist of all.

These misses are simple failures—perfect for a classic checklist.

But the evidence suggests we need them to see their job not just as performing their isolated set of tasks well but also as helping the group get the best possible results.

There have been psychology studies in various fields backing up what should have been self-evident—people who don’t know one another’s names don’t work together nearly as well as those who do.

There are good checklists and bad, Boorman explained. 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 are, above all, practical.

But Boorman was adamant about one further point: no matter how careful we might be, no matter how much thought we might put in, a checklist has to be tested in the real world, which is inevitably more complicated than expected. First drafts always fall apart, he said, and one needs to study how, make changes, and keep testing until the checklist works consistently.

It is common to misconceive how checklists function in complex lines of work. They are not comprehensive how-to guides, whether for building a skyscraper or getting a plane out of trouble. They are quick and simple tools aimed to buttress the skills of expert professionals.

Sometimes, though, failures are investigated. We learn better ways of doing things.

The pilot and copilot knew what to do, though. They got out their checklist and followed the lessons it offered. Because they did, the engine recovered, and 247 people were saved. It went so smoothly, the passengers didn’t even notice.

However straightforward the checklist might appear, if you are used to getting along without one, incorporating it into the routine is not always a smooth process.

what is the big deal if we do so without joy in our souls? We’re doing it. That’s what matters, right? Not necessarily. Just ticking boxes is not the ultimate goal here. Embracing a culture of teamwork and discipline is.

in a period of enormous volatility the checklist gave his team at least one additional and unexpected edge over others: efficiency.

But finding a good idea is apparently not all that hard. Finding an entrepreneur who can execute a good idea is a different matter entirely.

experience does count for something. But those who added checklists to their experience proved substantially more successful.

It somehow feels beneath us to use a checklist, an embarrassment. It runs counter to deeply held beliefs about how the truly great among us—those we aspire to be—handle situations of high stakes and complexity. The truly great are daring. They improvise. They do not have protocols and checklists. Maybe our idea of heroism needs updating.

First is an expectation of selflessness: that we who accept responsibility for others—whether we are doctors, lawyers, teachers, public authorities, soldiers, or pilots—will place the needs and concerns of those who depend on us above our own. Second is an expectation of skill: that we will aim for excellence in our knowledge and expertise. Third is an expectation of trustworthiness: that we will be responsible in our personal behavior toward our charges.

Discipline is hard—harder than trustworthiness and skill and perhaps even than selflessness. We are by nature flawed and inconstant creatures. We can’t even keep from snacking between meals. We are not built for discipline. We are built for novelty and excitement, not for careful attention to detail. Discipline is something we have to work at.

When we look closely, we recognize the same balls being dropped over and over, even by those of great ability and determination. We know the patterns. We see the costs. It’s time to try something else. Try a checklist.