The Checklist Manifesto: How To Get Things Right

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The Checklist Manifesto: How To Get Things RightAtul Gawande

On stooping to conquer

The squeamish among you — okay, us — don’t dig unnecessarily detailed descriptions of surgery. For you — we — a business book by a surgeon, analogising business practice from surgical procedures by means of the grisly misdeeds that happen when you carelessly cut people open, might seem a tough one.

Happily, Atul Gawande soon moves out of the ICU. In the meantime, he makes some surprising and valuable observations. I was going to call them “counter-intuitive” but, strangely, they do seem intuitively right. So, “surprising”.

What is most surprising is that there is no paradigm-shifting reveal here: no “long tail”, “tipping point”, “black swan”, “universal acid”, or “wealthy network” which has fundamentally altered the rules of engagement in the collective enterprises we’re talking about. The groundbreaking technique to which Gawande appeals for his insight is the humble checklist.

But what of The (Mis)Behaviour of Markets or The Black Swan? These are eloquent entreaties to the futility of trying to anticipate unplanned contingencies. If you can’t even expect them then trying to codify for them seems to commit to a cardinal error: homogeneous risk management by rote is what brought about the global financial crisis, after all.

But far from chaining us to some kind of deterministic mast, Gawande’s prescription set us free. It is a triage. In any complex procedure, even ones requiring infinite skill and judgement, large parts of it are, nonetheless simple, and rule-bound — indeed, that is almost the definition of complexity. So, before you perform that emergency tracheotomy, first wash your hands and sterilise that scalpel. It is an asymmetric risk. Sterilising the scalpel may not guarantee success, but not sterilising it hugely magnifies the odds of failure.

These steps are rote — in the language of complexity theory, “simple”. They require no judgment or intuition. But the meatware isn’t good at running algorithms without help: we make excellent experts, but hopeless machines. We’re good at improvising and exercising judgment and discretion: just the things machines aren’t good at.

But failure to do the easy stuff can undermine the most exquisite expertise. An aide memoire to help you through the drudgery reduces that risk. A well-formed checklist can, unglamorously, ensure that exquisite judgement and skill is being exercised: putting in group meetings in a repeat process where all concerned have an opportunity to raise questions and hash things out.

Not any old to-do list, of course: a checklist is something quite different. There is an art to composing an effective checklist — making it short enough to be feasible, profound enough to ensure no steps are “skipped”, but thorough enough to catch a significant portion of “operational error”.

Those involved in professional occupations which will find much surprising learning in Gawande’s short book. I dare say the challenge will be convincing supercilious fellow practitioners — can you imagine any of those, readers? — to stoop to such an elementary means of improving their expert performance.

But those who are prepared to stoop may conquer.

See also