The Checklist Manifesto Quotes

“Neuroscientists have found that the prospect of making money stimulates the same primitive reward circuits in the brain that cocaine does.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

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

“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. For the first three, science and experience have given us some straightforward and valuable preventive measures we think we consistently follow but don’t. These misses are simple failures—perfect for a classic checklist.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“under conditions of complexity, not only are checklists a help, they are required for success. There must always be room for judgment, but judgment aided—and even enhanced—by procedure.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“In a fire, the metal can plasticize—lose its stiffness and bend like spaghetti. This was why the World Trade Center buildings collapsed,”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“A young doctor is not so young nowadays; you typically don’t start in independent practice until your midthirties. We”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

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

“Teamwork may just be hard in certain lines of work. Under conditions of extreme complexity, we inevitably rely on a division of tasks and expertise—in the operating room, for example, there is the surgeon, the surgical assistant, the scrub nurse, the circulating nurse, the anesthesiologist, and so on. They can each be technical masters at what they do. That’s what we train them to be, and that alone can take years. 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. This requires finding a way to ensure that the group lets nothing fall between the cracks and also adapts as a team to whatever problems might arise.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“the real lesson is that under conditions of true complexity—where the knowledge required exceeds that of any individual and unpredictability reigns—efforts to dictate every step from the center will fail. People need room to act and adapt. Yet”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“It was also a checklist, but it didn’t specify construction tasks; it specified communication tasks. For the way the project managers dealt with the unexpected and the uncertain was by making sure the experts spoke to one another—on X date regarding Y process. The experts could make their individual judgments, but they had to do so as part of a team that took one another’s concerns into account, discussed unplanned developments, and agreed on the way forward. While no one could anticipate all the problems, they could foresee where and when they might occur. The checklist therefore detailed who had to talk to whom, by which date, and about what aspect of construction—who had to share (or “submit”) particular kinds of information before the next steps could proceed.”
― 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.”
― 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. The”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“Training in most fields is longer and more intense than ever. People spend years of sixty-, seventy-, eighty-hour weeks building their base of knowledge and experience before going out into practice on their own—whether they are doctors or professors or lawyers or engineers. They have sought to perfect themselves. 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. *”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“Just ticking boxes is not the ultimate goal here. Embracing a culture of teamwork and discipline is.”
― 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.”
― 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. So for any new checklist created from scratch, you have to pick the type that makes the most sense for the situation. The”
― 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.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“Checklists seem to provide 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: How to Get Things Right

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

“We are not omniscient or all-powerful. Even enhanced by technology, our physical and mental powers are limited.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“We know the patterns. We see the costs. It’s time to try something else. Try a checklist.”
― 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”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“In the face of the unknown—the always nagging uncertainty about whether, under complex circumstances, things will really be okay—”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

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

“It is not enough for a surgeon to have the textbook knowledge of how to treat trauma victims—to understand the science of penetrating wounds, the damage they cause, the different approaches to diagnosis and treatment, the importance of acting quickly. One must also grasp the clinical reality, with its nuances of timing and sequence. One needs practice to achieve mastery, a body of experience before one achieves real success. And if what we are missing when we fail is individual skill, then what is needed is simply more training and practice.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“But now the problem we face is ineptitude, or maybe it’s “eptitude”—making sure we apply the knowledge we have consistently and correctly. Just making the right treatment choice among the many options for a heart attack patient can be difficult, even for expert clinicians.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“It’s an opaque term, intensive care. Specialists in the field prefer to call what they do critical care, but that still doesn’t exactly clarify matters.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right

“But it’s not only the breadth and quantity of knowledge that has made medicine complicated. It is also the execution—the practical matter of what knowledge requires clinicians to do.”
― Atul Gawande, The Checklist Manifesto: How to Get Things Right