The Checklist Manifesto: How to Get Things Right

by Atul Gawande

the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us.

Faulty memory and distraction are a particular danger in what engineers call all-or-none processes: whether running to the store to buy ingredients for a cake, preparing an airplane for takeoff, or evaluating a sick person in the hospital, if you miss just one key thing, you might as well not have made the effort at all.

Two professors who study the science of complexity—Brenda Zimmerman of York University and Sholom Glouberman of the University of Toronto—have proposed a distinction among three different kinds of problems in the world: the simple, the complicated, and the complex.

Simple: bake a cake from mix complicated: send a rfocket to tge moon complex: raise a child

“forcing functions”: relatively straightforward solutions that force the necessary behavior—solutions like checklists.

They could, he suggested, suspend an immense four-hundred-ton concrete block from huge springs in the building’s crown on the fifty-ninth floor, so that when wind pitched the building one way, the block would swing the other way and steady it.

“The biggest cause of serious error in this business is a failure of communication,” O’Sullivan told me.

The philosophy is that you push the power of decision making out to the periphery and away from the center. You give people the room to adapt, based on their experience and expertise. All you ask is that they talk to one another and take responsibility. That is what works.

Surgery has, essentially, four big killers wherever it is done in the world: infection, bleeding, unsafe anesthesia, and what can only be called the unexpected.

You must decide whether you want a DO-CONFIRM checklist or a READ-DO checklist.

keep it to between five and nine items,

The wording should be simple and exact,

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,

we rarely investigate our failures. Not in medicine, not in teaching, not in the legal profession, not in the financial world, not in virtually any other kind of work where the mistakes do not turn up on cable news.

Sometimes, though, failures are investigated. We learn better ways of doing things. And then what happens?

Because the results does not translate to easy ctionable itemms, nothing changes

The reason is more often that the necessary knowledge has not been translated into a simple, usable, and systematic form.