Friday, April 9, 2010

The Checklist Manifesto

I just finished "The Checklist Manifesto" by Atul Gawande which made a quick appearance on the New York Times Bestseller list. The title also says "how to get things right" so I thought it might be a book on how to make a better list for getting things done. While it didn't do that, the book did have some fascinating facts about the role checklists can play in our lives and how they make large, almost impossible tasks, more do-able. What Dr. Gawande seems to be really writing about is his hope to get hospitals into the mode of doing more checklists that will catch many of the small, but extremely important tasks that need to be done routinely during surgeries. It is a little unnerving to read about some of the things which can be forgotten during surgery prep that have the potential to be life-threatening. I was surprised to learn that many of the doctors and nurses working on you have never met one another. One of the checklist items Dr. Gawande feels makes a big difference in the surgery outcome, is the surgery team knowing each other's names and their responsibilities so they work together better as a team.

Dr. Gawande looks at the airline checklists as a model to be followed. He writes about the introduction of the Boeing B-17 model 299 and the crash of the first test run due to "pilot error" . The plane was so complex to fly that even the best trained pilots missed steps. Test pilots got together to consider what to do and they came up with the pilot's checklist. The list was simple, brief, and to the point - short enough to fit on an index card, with step-by-step checks for takeoff, flight landing and taxiing.

Another checklist that Dr. Gawande mentions are the checklists that have to be used for building construction. He notes that large complex buildings could not be constructed without every component of the construction trade having their list of responsibilities and sharing daily or weekly with the contractor so they all fit together to finish the building in cooperative steps.

I certainly hope Dr. Gawande gets those checklists into all the hospitals as common practice, I think we will all be safer.

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