December 11, 2009
Jack Covert Selects: Jack Covert Selects - The Checklist Manifesto
The Checklist Manifesto: How to Get Things Right by Atul Gawande, Metropolitan Books, 224 Pages, $24.50, Hardcover, January 2010, ISBN 9780805091748 Atul Gawande is the Malcolm Gladwell of medical and ethical writing, with one big difference: Gawande is not just a cultural observer who tells great stories; instead he is a practicing surgeon and professor at Harvard Medical School and, as a true insider who happens to be a very talented writer for The New Yorker, his work is precise and detailed while also elegant and arresting. The Checklist Manifesto is the author’s third book and he continues along the same theme of his previous works by revealing flaws in medical care and pondering larger ethical dilemmas that can contribute to the loss of life. In my favorite of Gawande’s previous books, Better, the author tackles the complicated issues and thought that derives from a very simple concept—getting better, for both the patient and the medical practitioner. In The Checklist Manifesto, Gawande’s focus is the lowly checklist. With the incredible amount of complex data and information medical professionals are currently inundated with, they need help breaking down and remembering the small things. Gawande opens Chapter 1 with a story about a young girl who fell through the ice and was underwater for 30 minutes. A small, local Austrian hospital saved her life because they were experienced in dealing with avalanche victims and had created a checklist they followed during just such situations. Later, in another story that moves beyond the medical profession, Gawande harkens back to 1935 when Boeing demoed their latest aircraft for the government. It crashed, and the investigation showed that the Boeing plane was “too much airplane for one man to fly.” The pilot who died had forgotten a simple procedure before takeoff. Boeing, who almost went bankrupt because of the crash, was saved by a group of test pilots who got together and created a checklist that pilots would follow. That Boeing aircraft would be retested, passed, and become the Boeing B-17 which would go on to fly 1.8 million miles without another accident. The author concludes that:
[C]hecklists seem able to defend anyone, even the experienced, against failure in many more tasks than we realized. They provide a kind of cognitive net. They catch mental flaws inherent in all of us—flaws of memory and attention and thoroughness. And because they do, they raise wide, unexpected possibilities.Ultimately, checklists are about consistency, about preparing in times of calm a strategy to handle emergencies. As with his previous books, in The Checklist Manifesto, Atul Gawande asks of professionals one key thing: to be humble enough to admit one’s own humanity and take simple steps to prevent simple errors that are all too often very costly. And perhaps what is most admirable about Gawande is that he does not leave himself out of this request, admitting to his own mistakes and allowing us a glimpse at his own fallibility and that very humility that is needed to improve ourselves.