“The Checklist Manifesto” Review

| April 30, 2012 | 0 Comments

The Checklist Manifesto

It is no secret that our lives depend on the successful execution of complex processes. Whether we are managing them at home or work, we are all involved with a large number of tasks at all times. Sophisticated projects surround us, ranging from urban development to investment banking to plans for responses to natural disasters (the list goes on and on). Atul Gawande, a Harvard surgeon and New York Times journalist, has developed a system to help surgeons (i.e. very educated and experienced professionals) reduce their error rate on the job. “The Checklist Manifesto” presents a strong argument in favor of applying his proven system across other industries to save lives and eliminate unnecessary costs.

Despite Atul Gawande’s impressive curriculum vitae (Rhodes scholar at Stanford, went on to study at Oxford and Harvard), “The Checklist Manifesto” is written for the casual reader and does not require medical expertise to understand. He keeps the book very interesting by frequently interspersing dramatic stories (mostly drawn from medicine) which support his thought process.

Why We Need Checklists

Drawing from his surgical experience, Gawande cites multiple examples of complex situations with various outcomes. The book starts with a story about a drunk Halloween party-goer being rushed to the hospital with a stab wound and describes the ensuing medical nightmare which resulted from an oversight by the medical staff. Equally powerful stories are frequently used throughout the book to illustrate the main two reasons why we need checklists:

  1. Experts are up against the fallibility of human memory/attention, and
  2. Humans can lull themselves into skipping certain steps of a process even when they remember them.

Gawande draws upon a diverse background of personal experiences and research to give specific examples of professional oversight. In addition to medicine, his anecdotes come from aviation, construction, and investment banking. He shows that all professionals are capable of minor oversights which can cause massive problems. Even worse, Gawande shows that even the most intelligent professionals are capable of rationalizing their conscious choice to “skip” steps in a process because they’re often unnecessary. These people might say, “This has never been a problem.” Until one day it is.

Checklists in Practice

After making a convincing case regarding our fallibility and need for checklists, Gawande cites a 2001 study from John Hopkins Hospital whereby checklists were implemented in the intensive care unit (ICU). Over a year, the checklist protocol prevented 43 infections, 8 deaths, and saved $2 million in costs.

Three chapters in “The Checklist Manifesto” are dedicated to describing Gawande’s own journey to develop a solution toward increased safety during surgeries around the world. He spends a chapter analyzing the finer points of checklists used by the aviation industry and exactly how they inspired his surgical checklist strategy. This chapter is most useful for someone developing their own checklist because it describes the limitations of checklists and how they need to be designed for practical usage.

Gawande closes the book by revealing the incredibly positive results of his global checklist project. Despite the project’s success, there were still doctors resisting the checklist. Gawande’s wisdom shines through when he designed a post-project poll which revealed that most skeptics understood the value of the checklist.


The ultimate point of this book is that humans make costly and repeatable mistakes which could potentially be remedied by a solution as simple as a checklist. Surgeons, who require years of intense education and experience to practice independently, have witnessed astounding improvements as a result of checklists. The rest of the population is just as likely to miss a step, especially during a complex process or under stress. For this reason, you should read “The Checklist Manifesto” to understand how a simple checklist could reduce your stress while increasing success.


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