The Checklist Manifesto — Summary

This book shows how we can deal with the complexity in our lives

Human knowledge has become highly complex

Thanks to the accumulative progress of human knowledge, we have increasingly detailed information about nearly every problem. Take for example medicine, over 13.000 diseases, injuries and syndromes are defined according to the World Health Organization.

For many of those problems, there are a number of possible treatments. It is easy to see how this mountain of knowledge can become unmanageable even for a highly professional doctor or medical team.

That leaves us with a problem, how can we manage the vast amount of knowledge and apply it efficiently?

Checklists can help execute organized knowledge

In the 1970s, the philosophers Samuel Gorovitz and Alasdair MacIntyre published a short essay on the nature of human fallibility. The question they sought to answer was why we fail at what we set out to do in the world.

One reason, they observed, is “necessary fallibility” — some things we want to do are simply beyond our capacity.

Even enhanced by technology, our physical and mental powers are limited. Much of the world and universe is outside our understanding and control.

In the realms which we do have control over, however, there are two reasons why we may fail nonetheless, ignorance and ineptitude.

  • Ignorance means when we err because science has given us only a partial understanding and incomplete understanding of the world and how it works.
  • Ineptitude means that the knowledge exists, yet we fail to apply it correctly.

There is one simple strategy which helps avoid ineptitude, a checklist. You may scoff at checklists and turn them down as only useful for to-do lists, however when checklists contain all essential items and are concise. They are very powerful tools.

Checklists have to be clear and concise.

Once important aspect of checklists is “killer items.” They are items which if not completed, could lead to disaster.

Example: One case of a “killer item” could be a reminder to identify a patient’s allergies before surgery.

Although checklists should contain all essential items, they shouldn’t be thorough guides. They should be readable around one minute after that people can become distracted and skip vital steps. The veteran pilot Daniel Boorman says that around five to nine items are ideal.

Checklists should be clear and user friendly.

Example: A nurse had checked off the steps for a procedure before it had even started, this created confusion because the checklist was meant to be checked as they went through the procedure.

DO-CONFIRM and READ-DO checklists

Checklists can be divided into do-confirm and read-do lists. The difference is that in do-confirm lists, team members perform their jobs from memory and experience, often separately. Then they stop and confirm with their checklists that everything that was supposed to be done was done.

With an 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.

Team communication is greatly enhanced by checklists

Often it is of vital importance that teams communicate efficiently. For example the captain of a plane has to communicate with air control to check if the airport is clear to land, the co-pilot would not know when or if to take control, the flight crew wouldn’t know when to conduct safety checks, and so on.

Communication can be enhanced greatly by a checklists which includes steps that are aimed at improving the flow of information.

Checklists have already saved many lives

One study carried out by critical care specialist Peter Pronovost found that by introducing a checklist, 1500 lives and $175 million were saved over 18 months. The reason being, that they helped reduce the number of infected catheters inserted into the veins of intensive care patients.

Inspired by Pronovost, the WHO developed a checklist to be tested in eight hospitals around the world. The program was called Surgery Saves Lives program, and the results were astounding, deaths from surgeries were reduced by 47 percent.

Checklists are effective in many areas

Not only complex environments which demand high precision like medicine benefit from checklists.

Example: Jody Adams, a chef at Rialto Restaurant in Boston, uses checklists as recipes and to make sure special requirements of individual customers are met. This simple strategy has made Jody win awards and propelled the restaurant to the “best-restaurant-lists.”

Financiers use checklists to check whether to invest in a company or not. They enable them to build a quick method to evaluate investments.

Use checklists to avoid errors and make use of complex knowledge in an effective way.

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Also published on Medium.