The Checklist Manifesto Quotes

“Senior Wal-Mart officials concentrated on setting goals, measuring progress, and maintaining communication lines with employees at the front lines and with official agencies when they could. In other words, to handle this complex situation, they did not issue instructions. Conditions were too unpredictable and constantly changing. They worked on making sure people talked. Wal-Mart’s emergency operations team even included a member of the Red Cross. (The federal government declined Wal-Mart’s invitation to participate.) The team also opened a twenty-four-hour call center for employees, which started with eight operators but rapidly expanded to eighty to cope with the load. Along the way, the team discovered that, given common goals to do what they could to help and to coordinate with one another, Wal-Mart’s employees were able to fashion some extraordinary solutions. They set up three temporary mobile pharmacies in the city and adopted a plan to provide medications for free at all of their stores for evacuees with emergency needs—even without a prescription. They set up free check cashing for payroll and other checks in disaster-area stores. They opened temporary clinics to provide emergency personnel with inoculations against flood-borne illnesses. And most prominently, within just two days of Katrina’s landfall, the company’s logistics teams managed to contrive ways to get tractor trailers with food, water, and emergency equipment past roadblocks and into the dying city. They were able to supply water and food to refugees and even to the National Guard a day before the government appeared on the scene. By the end Wal-Mart had sent in a total of 2,498 trailer loads of emergency supplies and donated $3.5 million in merchandise to area shelters and command centers. “If the American government had responded like Wal-Mart has responded, we wouldn’t be in this crisis,” Jefferson Parish’s top official, Aaron Broussard, said in a network television interview at the time.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“Of all organizations, it was oddly enough Wal-Mart that best recognized the complex nature of the circumstances, according to a case study from Harvard’s Kennedy School of Government. Briefed on what was developing, the giant discount retailer’s chief executive officer, Lee Scott, issued a simple edict. “This company will respond to the level of this disaster,” he was remembered to have said in a meeting with his upper management. “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.” As one of the officers at the meeting later recalled, “That was it.” The edict was passed down to store managers and set the tone for how people were expected to react. On the most immediate level, Wal-Mart had 126 stores closed due to damage and power outages. Twenty thousand employees and their family members were displaced. The initial focus was on helping them. And within forty-eight hours, more than half of the damaged stores were up and running again. But according to one executive on the scene, as word of the disaster’s impact on the city’s population began filtering in from Wal-Mart employees on the ground, the priority shifted from reopening stores to “Oh, my God, what can we do to help these people?” Acting on their own authority, Wal-Mart’s store managers began distributing diapers, water, baby formula, and ice to residents. Where FEMA still hadn’t figured out how to requisition supplies, the managers fashioned crude paper-slip credit systems for first responders, providing them with food, sleeping bags, toiletries, and also, where available, rescue equipment like hatchets, ropes, and boots. The assistant manager of a Wal-Mart store engulfed by a thirty-foot storm surge ran a bulldozer through the store, loaded it with any items she could salvage, and gave them all away in the parking lot. When a local hospital told her it was running short of drugs, she went back in and broke into the store’s pharmacy—and was lauded by upper management for it.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“This is the reality of intensive care: at any point, we are as apt to harm as we are to heal. Line infections are so common that they are considered a routine complication. ICUs put five million lines into patients each year, and national statistics show that after ten days 4 percent of those lines become infected. Line infections occur in eighty thousand people a year in the United States and are fatal between 5 and 28 percent of the time, depending on how sick one is at the start. Those who survive line infections spend on average a week longer in intensive care. And this is just one of many risks. After ten days with a urinary catheter, 4 percent of American ICU patients develop a bladder infection. After ten days on a ventilator, 6 percent develop bacterial pneumonia, resulting in death 40 to 45 percent of the time. All in all, about half of ICU patients end up experiencing a serious complication, and once that occurs the chances of survival drop sharply.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“Fifteen years ago, Israeli scientists published a study in which engineers observed patient care in ICUs for twenty-four-hour stretches. They found that the average patient required 178 individual actions per day, ranging from administering a drug to suctioning the lungs, and every one of them posed risks. Remarkably, the nurses and doctors were observed to make an error in just 1 percent of these actions—but that still amounted to an average of two errors a day with every patient. Intensive care succeeds only when we hold the odds of doing harm low enough for the odds of doing good to prevail. This is hard. There are dangers simply in lying unconscious in bed for a few days. Muscles atrophy. Bones lose mass. Pressure ulcers form. Veins begin to clot. You have to stretch and exercise patients’ flaccid limbs daily to avoid contractures; you have to give subcutaneous injections of blood thinners at least twice a day, turn patients in bed every few hours, bathe them and change their sheets without knocking out a tube or a line, brush their teeth twice a day to avoid pneumonia from bacterial buildup in their mouths. Add a ventilator, dialysis, and the care of open wounds, and the difficulties only accumulate.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“the reason for the delay is not usually laziness or unwillingness. The reason is more often that the necessary knowledge has not been translated into a simple, usable, and systematic form.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“Good checklists, on the other hand, are precise. They are efficient, to the point, and easy to use even in the most difficult situations.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“In the end, a checklist is only an aid. If it doesn't aid, it's not right. But if it does, we must be ready to embrace the possibility.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“science has filled in enough knowledge to make ineptitude as much our struggle as ignorance.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“Yet given how much surgery is now done—Americans today undergo an average of seven operations in their lifetime, with surgeons performing more than fifty million operations annually—the amount of harm remains substantial. We continue to have upwards of 150,000 deaths following surgery every year”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“Medicine has become the art of managing extreme complexity—and a test of whether such complexity can, in fact, be humanly mastered.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“We couldn’t understand what had happened. He seemed to have developed an infection, but our X-rays and CT scans failed to turn up a source. Even after we put him on four antibiotics, he continued to spike fevers. During one fever, his heart went into fibrillation. A Code Blue was called. A dozen nurses and doctors raced to his bedside, slapped electric paddles onto his chest, and shocked him. His heart responded and went back into rhythm. It took two more days for us to figure out what had gone wrong. We considered the possibility that one of his lines had become infected, so we put in new lines and sent the old ones to the lab for culturing. Forty-eight hours later, the results returned. All the lines were infected. The infection had probably started in one line, which perhaps was contaminated during insertion, and spread through DeFilippo’s bloodstream to the others. Then they all began spilling bacteria into him, producing the fevers and steep decline.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“The second type of failure the philosophers call ineptitude—because in these instances the knowledge exists, yet we fail to apply it correctly.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“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. 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. It is a checklist.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“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.”
― Atul Gawande, The Checklist Manifesto: How To Get Things Right

“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. One needs a person who can take an idea from proposal to reality, work the long hours, build a team, handle the pressures and setbacks, manage technical and people problems alike, and stick with the effort for years on end without getting distracted or going insane. Such people are rare and extremely hard to spot.”
― Atul Gawande, The Checklist Manifesto: How To Get Things Right

“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, 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. Good checklists are, above all, practical.”
― Atul Gawande, The Checklist Manifesto: How To Get Things Right

“Многообразие и сложность строительной индустрии на всех этапах значительно превосходили возможности одного человека”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“Если бы все решали инженеры, то все здания были бы прямоугольными коробками”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“معمولاً همه از نحوه عملکرد چک‌لیست در شرایط پیچیده کاری، تصور غلطی دارند. آنها راهنماهای جامع نیستند، چه برای ساخت یک آسمان‌خراش یا حل مشکل یک هواپیما. آنها ابزاری سریع و ساده هستند که هدفشان پشتیبانی از مهارت‌های متخصصین حرفه‌ای است. و با توجه به سریع و کاربردی بودنشن، جان هزاران هزاران نفر را نجات می‌دهند.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“On any given day in the United States alone, some ninety thousand people are admitted to intensive care. Over a year, an estimated five million Americans will be, and over a normal lifetime nearly all of us will come to know the glassed bay of an ICU from the inside. Wide swaths of medicine now depend on the life support systems that ICUs provide: care for premature infants; for victims of trauma, strokes, and heart attacks; for patients who have had surgery on their brains, hearts, lungs, or major blood vessels. Critical care has become an increasingly large portion of what hospitals do. Fifty years ago, ICUs barely existed. Now, to take a recent random day in my hospital, 155 of our almost 700 patients are in intensive care. The average stay of an ICU patient is four days, and the survival rate is 86 percent. Going into an ICU, being put on a mechanical ventilator, having tubes and wires run into and out of you, is not a sentence of death. But the days will be the most precarious of your life.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“By the century’s end, all doctors had to have a college degree, a four-year medical degree, and an additional three to seven years of residency training in an individual field of practice—pediatrics, surgery, neurology, or the like. In recent years, though, even this level of preparation has not been enough for the new complexity of medicine. After their residencies, most young doctors today are going on to do fellowships, adding one to three further years of training in, say, laparoscopic surgery, or pediatric metabolic disorders, or breast radiology, or critical care.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“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.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“jump-start the heart,”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“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.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“An inherent tension exists between brevity and effectiveness. Cut too much and you won’t have enough checks to improve care. Leave too much in and the list becomes too long to use.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“First drafts always fall apart, he said, and one needs to study how, make changes, and keep testing until the checklist works consistently”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“The wording should be simple and exact, Boorman went on, and use the familiar language of the profession. Even the look of the checklist matters. Ideally, it should fit on one page. It should be free of clutter and unnecessary colors. It should use both uppercase and lowercase text for ease of reading. (He went so far as to recommend using a sans serif type like Helvetica.)”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“So you want to keep the list short by focusing on what he called “the killer items”—the steps that are most dangerous to skip and sometimes overlooked nonetheless.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“The checklist cannot be lengthy. A rule of thumb some use is to keep it to between five and nine items, which is the limit of working memory. Boorman didn’t think one had to be religious on this point. “It”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“You must decide whether you want a DO-CONFIRM checklist or a READ-DO checklist. With a DO-CONFIRM checklist, he said, team members perform their jobs from memory and experience, often separately. But then they stop. They pause to run the checklist and confirm that everything that was supposed to be done was done. With a READ-DO checklist, on the other hand, people carry out the tasks as they check them off—it’s more like a recipe.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right