| | |  | Lean Six Sigma | Home » » » » The Checklist Manifesto: How to Get Things Right | | | | | | | Description: | | The New York Times bestselling author of Better and Complications reveals the surprising power of the ordinary checklist We live in a world of great and increasing complexity, where even the most expert professionals struggle to master the tasks they face. Longer training, ever more advanced technologiesneither seems to prevent grievous errors. But in a hopeful turn, acclaimed surgeon and writer Atul Gawande finds a remedy in the humblest and simplest of techniques: the checklist. First introduced decades ago by the U.S. Air Force, checklists have enabled pilots to fly aircraft of mind-boggling sophistication. Now innovative checklists are being adopted in hospitals around the world, helping doctors and nurses respond to everything from flu epidemics to avalanches. Even in the immensely complex world of surgery, a simple ninety-second variant has cut the rate of fatalities by more than a third. In riveting stories, Gawande takes us from Austria, where an emergency checklist saved a drowning victim who had spent half an hour underwater, to Michigan, where a cleanliness checklist in intensive care units virtually eliminated a type of deadly hospital infection. He explains how checklists actually work to prompt striking and immediate improvements. And he follows the checklist revolution into fields well beyond medicine, from disaster response to investment banking, skyscraper construction, and businesses of all kinds. An intellectual adventure in which lives are lost and saved and one simple idea makes a tremendous difference, The Checklist Manifesto is essential reading for anyone working to get things right. Atul Gawande is the author of Better and Complications. He is also a MacArthur Fellow, a general surgeon at the Brigham and Women’s Hospital in Boston, a staff writer for The New Yorker, and an assistant professor at Harvard Medical School and the Harvard School of Public Health. He lives with his wife and three children in Newton, Massachusetts. Taxed with great and increasing complexity, even the most expert professionals struggle to master the tasks they face. Longer training, ever more advanced technologiesneither seems to prevent grievous errors. But in a hopeful turn, acclaimed surgeon and writer Atul Gawande finds a remedy to this disquieting problem in the humblest and simplest of techniques: the checklist.
First introduced decades ago by the U.S. Air Force, checklists have enabled pilots to fly aircraft of mind-boggling sophistication. Now innovative checklists are being adopted in hospitals around the world, helping doctors and nurses respond to everything from flu epidemics to avalanches. Even in the immensely complex world of surgery, a simple ninety-second variant has cut the rate of fatalities by more than a third.
Gawande provides real testimonials in the form of riveting stories. In Austria, an emergency checklist saved a drowning victim who had spent half an hour underwater. In Michigan, a cleanliness checklist in intensive care units virtually eliminated a type of deadly hospital infection. He explains how checklists actually work to prompt striking and immediate improvements to procedure and increase positive results, even under the most precarious circumstances. And he follows the checklist revolution into fields well beyond medicine, from disaster response to investment banking, skyscraper construction, and businesses of all kinds.
Gawande shows how one simple idea can make a tremendous difference. The Checklist Manifesto is essential reading for anyone working to get things right. Few medical writers working today can transmit the gore-drenched terror of an operation that suddenly goes wronga terror that has a special resonance when it is Dr. Gawande himself who makes the initial horrifying mistake. And few can make it as clear as he can what exactly is at stake in the effort to minimize calamities.”The New York Times Few medical writers working today can transmit the gore-drenched terror of an operation that suddenly goes wronga terror that has a special resonance when it is Dr. Gawande himself who makes the initial horrifying mistake. And few can make it as clear as he can what exactly is at stake in the effort to minimize calamities.”The New York Times "Even skeptical readers will find the evidence staggering . . . Thoughtfully written and soundly defended, this book calls for medical professionals to improve patient care by adopting a basic, common-sense approach."The Washington Post "A persuasive champion of his cause."The Economist "Gawande deftly weaves in examples of checklist successes in diverse fields like aviation and skyscraper construction . . . Fascinating reading."The New York Times Book Review "This is a brilliant book about an idea so simple it sounds dumb until you hear the case for it. Atul Gawande presents an argument so strong that I challenge anyone to go away from this book unconvinced."The Seattle Times Fascinating . . . presents a convincing case that adopting more checklists will surely help.”Bloomberg News "Gawande argues convincingly and eloquently."San Francisco Chronicle "I read The Checklist Manifesto in one sitting yesterday, which is an amazing tribute to the book that Gawande has crafted. Not only is the book loaded with fascinating stories, but it honestly changed the way I think about the world. It is the best book I’ve read in ages."Steven Levitt, author of Freakonomics A vivid, punchy exposition of an intriguing idea: that by-the-book routine trumps individual prowess.” Publishers Weekly | | | Features: | |
• ISBN13: 9780805091748
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| | | Product Details: | | | Author:
| Atul Gawande | | Hardcover:
| 224 pages | | Publisher:
| Metropolitan Books | | Publication Date:
| December 22, 2009 | | Language:
| English | | ISBN:
| 0805091742 | | Product Length:
| 8.4 inches | | Product Width:
| 5.75 inches | | Product Height:
| 0.9 inches | | Product Weight:
| 0.76 pounds | | Package Length:
| 8.3 inches | | Package Width:
| 5.8 inches | | Package Height:
| 0.9 inches | | Package Weight:
| 0.8 pounds | | Average Customer Rating:
|  based on 127 reviews |
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 Short, Simple, and EffectiveJul 29, 2010
As a surgeon, Atul Gawande has been thinking hard for years about how to make the surgery room safer. The surgery room can be an incredibly complex place because the individuals -- surgeon, nurse, anesthesiologist -- involved are highly specialized individuals who must exercise extreme discretion and precision in their work. The stress and the complexity involved means that now and then a nurse forgots to wash her hands, with disastrous and deadly consequences. It's also common that when strangers suddenly meet in a room to either save or destroy lives people forget to ask each other's names, let alone communicate during surgery. Atul Gawande's solution is simple and effective: a check-list.
This idea is about how to practically implement the universally promoted mantras of teamwork and discipline , communication and process. Atul Gawande looks at the different fields of medicine, aviation, and finance, and argues that all three are high-pressure environments where highly intelligent and usually extremely disciplined individuals temporarily let go of their sanity. To hold everything in place and to cool the most feverish heads Atul Gawande suggests a check-list. Indeed, people have always thought that Warren Buffett, that most legendary of investors, himself keeps a mental check-list (although he would make more money if he kept a real one, because even geniuses slip now and then).
Atul Gawande is not suggesting that the checklist is a panacea -- what it is is a physical and concrete reminder for individuals, who would otherwise be overwhelmed by either pressure or ego, to maintain and to follow process, and to communicate with teammates, no matter how mundane and redundant the tasks seem.
Dr. Gawande is not a great writer, and he's aware of his limitations so he keeps his book short, simple, and plain. We can also see that when writing and editing his book he also kept a checklist. Do I make my main point, and back it up with evidence and proof? Do I hold the audience's interest, and explain things in the clearest and simplest manner?
 Checklists to cope with complexityJul 26, 2010
Atul Gawande has succinctly described the usage of checklists in different scenarios and how they help cope with the complexities in different areas involved in our day to day lives. Starting with Aviation which has pioneered the concept of a checklist as far back as the early twentieth century to help fly the then complex fighter aircraft B17 which was nicknamed the "flying fortress". A disaster, resulting from a pilot error due to a missed procedural step, on the first flight, led to the origination of a checklist. Since then all pilots, starting from the lowest 2 seater aircraft to the lofty space shuttle, are trained to use checklists to start an engine, taxi, take off, cruise, land, shut off the engine, and deal with any emergency encountered.
Chefs at famous restaurants routinely use recipes, which are a form of a checklist, to get the dish consistently right each time. It does not mean that a checklist is a static piece engraved in stone. It can be updated to reflect improvements. Gawande describes the crash of a British Airways Boeing 777 flight in January 2008. Flying over the North pole from Beijing into London, both of its engines lost power and crashed just a couple of miles short of the runway. The cause was speculated to be formation of ice crystals in the fuel lines. A recommendation was made to reduce the power for a few seconds in such cases, instead of increasing it, to reduce fuel and ice crystals in the fuel lines. This gives a chance for the heat exchanger to kick in and melt the ice crystals. The improved check list saved the day later that year for a Delta Airlines polar flight from Shanghai to Atlanta. Ice crystals formed in the Boeing 777 fuel lines while flying over Montana. The pilots reduced the power for a while and then increased it to recover the engines.
Checklists are used in cases where a lot of specialists are involved in executing numerous steps correctly to create an end product. An example is the construction industry. Master builders had built the famous buildings in the past like the Notre Dame and the US Capitol. Contemporary skyscrapers are so complex and involve so many specialities that the master builder has become an extinct specie. Better co-ordination and tracking thru checklists are the hallmarks of the construction industry which has become pretty efficient.
I was surprised to read Gawande mention that health care professionals do not use a checklist to deal with thousands of different procedures. Since I come from an Information Technology background, where checklists are commonly used, though not as often as in Aviation, I was ground in the checklist tradition arising out of my passion for flying small planes. By the same token, it is not surprising given that thehealth care field scores very low in the usage of Information Technology. Much of the records are paper based which contribute to low productivity, human errors, and high costs.
The crux of the book is the documentation by Gawande of an important case study undertaken for WHO to introduce the usage of a checklist in surgeries across 8 different hospitals in different parts of the world. In all the cases, there was significant improvement in the quality of the surgical procedures, drastic reduction in human errors and the resulting fatalities. The most common problem before the introduction of the checklist was the infection of lines in Intensive Care Units. Infections also resulted from doctors not washing their hands periodically, although this has been emphasized more than 150 years ago by Dr. Ignaz Semmelweis. Gawande wrote extensively about this problem in his earlier book "Better". This case study led to the acceptance of checklists by the hospitals.
This book concludes with the idea that checklists are making inroads into hospitals and are significantly bettering the outcomes of thousands of medical procedures performed every day.
The Checklist Manifesto: How to Get Things RightJul 21, 2010
The book is easy to read and keeps you interested and occupied. It elaborates on a very simple concept of using "check lists" to get things right for repetitive complex or not so complex tasks. I was used to using a mental list of things to check, but this books makes you aware of the process and so you could use it at places where you would have not thought of using it before. Very interesting writing.
Typically brilliant, gripping writing. Articulates forcefully the stunning efficacy of checklist. Drags a bit in the middle.Jul 18, 2010
Articulates forcefully the stunning efficacy of checklist as a means of reducing preventable errors, everywhere. Drags a bit in the middle though, but succeeds overall. Highly recommended.
The book talks about the increasing complexity that is becoming the norm in most professions. Where complex operations are involved, from surgeries to flying an airplane to building a 1000 feet skyscraper, the knowledge needed to perform these tasks successfully exists. But it is the sheer complexity and the number of tasks that have to be performed that leads to failures.
Failures because among all the hundreds of tasks that have to be performed by the dozens of people, one single task gets overlooked. The key lies in the ability to divvy up the tasks between the specialists, and then be able to monitor and track these individual tasks as they relate to the whole. Project plans are the norm in building projects. They are less often followed in the medical profession. For two reasons. The first is that medicine is a complex as well as a complicated profession. Not only are the steps required to accomplish a procedure many and difficult in themselves, but they can vary from patient to patient. The second is that in medicine, when you err, a patient may fall ill, or not recover in time, or at worst, die. In the case of airplanes, hundreds of passengers will most certainly die if complex procedures are not done right. In buildings, if the construction has not followed all applicable rules and guidelines, thousands could die.
There are quite a few stereotypical myths that are demolished. Specifically, three of them. The first is of the surgeon as the solo artist who sweeps into an operating theater and with a wave of his magical hands puts things right. Not quite true. The second is of the master-builder who knows everything about constructing a building, from the plumbing to the wiring to the ventilation to the architectural blueprint... The third is that of airline pilots who know not only how to fly an airplane but also what to do when something goes wrong, or when one of several lights on the cockpit console starts blinking.
The start of the book itself is riveting. The writing grabs you and you can't stop turning the pages. The introduction being off with a fellow doctor describing a case about a stab wound victim with a wound that was deeper than anything they expected.
.... There are a thousand ways that things can go wrong when you've got a patient with a stab wound. But everyone involved got almost every step right - the head-to-toe examination, the careful tracking of the patient's blood pressure and pulse and rate of breathing, the monitoring of his consciousness, the fluids run in by IV, the call to the blood bank to have blood ready, the placement of a urinary catheter to make sure his urine was running clear, everything. Except no one remembered to ask the patient or the emergency medical technicians what the weapon was.
.... "Your mind doesn't think of a bayonet in San Francisco," John could only say.
Turns out the man had been at a costume party, and the person who stabbed him after an altercation had been dressed as a soldier - with a bayonet.
.... The ninth edition of the World Health Organization's international classification of diseases has grown to distinguish more than thirteen thousand different diseases, syndromes, and types of injury - more than thirteen thousand different ways, in other words, that the body can fail. And, for nearly all of them, science has given us things we can do to help. If we cannot cure the disease, then we can usually reduce the harm and misery it causes. But for each condition the steps are different and they are almost never simple. Clinicians now have at their disposal some six thousand drugs and four thousand medical and surgical procedures, each with different requirements, risks, and considerations. It is a lot to get right. [page 19]
To take a specific example, when we think about an ICU (Intensive Care Unit) at a hospital, we somehow conjure up this vision of a person lying in a bed, with needles and tubes running from him/her to a set of monitors, and all. But above all, the vision we have is one of quietude and solitude. It's just as if the very act of keeping the person in the ICU and running these tubes into him is all that is needed to stabilize and cure the person. We have movies to thank for this vision. But what about reality? Is it really that serene?
.... 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.
...
.... 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 daily thinners at least twice a day, turn patients in bed every few hours, bathe them and change their sheets without knocking over 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. [page 24]
The solution lies in having checklists.
.... In the Keystons Initiative's first eighteen months, the hospitals saved $an estimated 175 million in costs and more than fifteen hundred lives. The successes have been sustained for several years now - all because of a stupid little checklist. [page 44]
One criticism that I would level is that while checklists can certainly help improve coordination and reduce avoidable errors, what is not covered at all is the fact that cultural mores can at times hinder and hamper error correcting behavior. For example, it has been well documented that in a tragic airline crash, the co-pilot did not warn the pilot strongly enough that the plane's altitude was higher than it should be - it was simply not done for a junior pilot to be seen correcting his senior pilot. The warning uttered by the junior pilot was more by way of a gentle and deferential question. A checklist would not have helped here. The same goes for a hospital setting too. In some cultures it may be ok for a nurse to correct a surgeon in an operation theater, but in several others this will simply not happen.
The book does drag somewhat during the middle. But then picks up again. This is the author's first full-length book. His earlier two books, Complications: A Surgeon's Notes on an Imperfect Science, and Better: A Surgeon's Notes on Performance were essays on a related topic that were compiled into a book. Writing a full length book on a single topic is more challenging. Dr Gawande succeeds, mostly.
Never go any where without your list!Jul 18, 2010
Once a week my wife reminds me not to go shopping without a list. The agreed list overcomes the problem of arriving home without an important ingredient, and secondly, it limits the potential problem of my "undisciplined" purchases. (So, what is wrong with stocking up for the next cyclone, or world shortage of some essential item?)
Gawande takes list making to a higher level and graphically reminds the readers of the need for checklists in aviation and engineering. He takes time to show how he worked with the World Health Organisation to develop surgery checklists.
H'mmm, if engineers and pilots use checklists, why don't we do it too? Are there some jobs that are so menial and simple that the do-ers don't need a checklist?
Human fallibility is such that we will always need checklists. May the checklists go forth and proliferate.
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