Book Summary | The Checklist Manifesto by Atul Gawande

Book Title: The Checklist Manifesto : How to get things right 
Author: Atul Gawande 

Today we live in a complex world with many systems and process interacting with each other. We knowingly or unknowingly use checklist as an integral part of our daily activities, from birth at hospital to graveyard. Check list is one of the widely used and basic Quality Control Tool. The author has shared examples of application of checklists in wide industry from airline, construction, investments, hospitality, hotels and into health care. This book will not help anyone to develop a checklist, but provides great insights on checklist and disciplined process for following will help to achieve or gets things right. 

Today we use checklist for many activities, just to ensure that we have completed the activity. Fifteen years ago, Israeli scientists published a report about patient care in ICU. It was observed that in a day, on an average 178 individual actions are required ranging from administering a drug to suctioning the lung. Every activity posed risks. On an average 2 errors per patient per day was recorded. With many diseases can health care accept 2 errors per day ?  Can this be reduced? Can checklist become useful …?

Before the world war II, Boeing developed a plane that could carry five times as many bombs as the army requested. It could fly faster than previous bomber using four engines.  During the trial it crashed. The crash of the airplane made Boeing into bankruptcy. An investigation revealed that nothing mechanical had gone wrong. The crash had been due to pilot error due to pilot has to attend to the four engines, each with its own oil fuel mix, the retractable landing gear, the wing flaps, electric trim tabs and regulated hydraulic controls. It was too much airplane for one man to fly. 
The US army purchased few Boeing and tried to  overcome this, they came up with an ingeniously simple approach; they created a pilot’s checklist. Using a checklist for take-off to safe landing. With checklist in hand the pilots went to fly the model 299 without any accident. Because flying the behemoth, the army gained decisive air advantage in the world war, enabling its devastating bombing camping across Germany. Checklist seem to provide protection against such failures. They remind us of the minimum necessary steps and make them explicit.

In 2001, critical care specialist Peter Pronovost decided to give a doctors checklist in Johns Hopkins Hospital.  Following the checklist resulted in line infection rate to zero from eleven percent within ten days.

There are good checklists and bad Checklists.

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 professional using them could miss. Good checklists are, above all, practical.” 

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 best example of application of checklist is crash landing of the airplane in the icy Hudson riven 2009. They followed the protocols for such situations.

Ticking the boxes is not the ultimate goal of the checklist. Embracing a culture of team work and discipline is. What is needed, however, isn't just that people working together be nice to each other. It is discipline. 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.