My new appreciation for checklists and Atul Gawande

I just finished reading The Checklist Manifesto by Atul Gawande (a practicing surgeon), one of my favorite non fiction authors. Honestly, I was not expecting to get much from the book. It’s about checklists, and making lists is just part of the project management discipline. I figured he’d have a couple of stories I’d like and that’s about it.

It was nice to be wrong.

Dr. Gawande exposed a bias I’ve held for almost 2 decades about the use of scripts, fool-proof automation, and checklists. My experience with Mrs. Fields cookies (technically, my father’s experience, my pereception) was that checklists were mostly to be used to help hire less skilled people to do the jobs of craftsmen. Capture the knowedge, automate the steps, hire less skilled people. (Certainly a frequent theme in the 80s.)

But, Dr. Gawande has flipped me to a new position:

Checklists also assist highly skilled professionals to perform their jobs better in 2 ways. (Think airline pilots.) First, by ensuring that routine items are not missed (freeing up mental bandwidth for the hard stuff and reducing error rates) and second,  by institutionalizing team communication to handle the unexpected.

Surgeons miss the mundane all of the time, and sometimes we get hurt. Checklists, in his research, demonstrably cut down on errors.

I  liked the idea of a communications line item on a checklist. The WHO safe surgery checklist has a very simple communications line item: everyone stop, introuce yourselves, what roles you will play, and go over expectations of the surgery. For ad hoc teams, it did not merely facilitate information, the meeting created a better operating team.

The technique works in all industries of course, but for surgeons, it’s save many lives.

I don’t know about you, but next hospital I’m admitted to, I’m asking if they use the WHO checklist…


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