Book Review (of sorts): The Checklist Manifesto

The Checklist Manifesto: How to get things right
By Atul Gawande

This book is a fast and easy read as Gawande writes well and engagingly. The subject of checklists and the efficacy of them is intriguing because I am highly interested in efficiencies, value, and high performance. This is the Great Trifecta, to be able to do something with minimal effort and cost, but with high reward or return. Gawande makes the case that checklists, being fundamentally low cost, are highly efficacious. The returns in various fields that he reports on all seem substantial.

The drawbacks? People don’t like to do things that seem regimented and that require discipline, which is how checklists have to be used. As Gawande writes,

“Discipline is hard – harder than trustworthiness and skill and perhaps even than selflessness. We are by nature flawed and inconstant creatures. We can’t even keep from snacking between meals. We are not built for discipline. We are built for novelty and excitement, not for careful attention to detail. Discipline is something we have to work at.”

Checklists are not just checklists. They require human adherence to them in a way that requires discipline and acceptance that we are fallible even in our most mundane, simple tasks. Gawande doesn’t really get into this so much, but beyond our dislike for disciplined, regimented action, we also don’t want to accept that many of our expectations exceed our abilities to do what needs to be done to reach those expectations. In other words, we want things to work out perfectly - or at least, very well - but to get to those expectations, we have to realize how fallible we are, how limited we actually are. Despite all the choices the modern age presents us, despite the surfeit of sophistication in the world around us, despite the technology we have, we humans are highly fallible, and our worse mistake is believe we are anything but.

I suppose age brings a certain realization that this is so, but I think as a society, we don’t like to think that all of our technology, all of our social progress, and all of our apparent intelligence does NOT bring us easier lives, but in fact, presents us with a greater need for discipline in order to match the outcomes of our actions with our expectations. Using checklists, in a way, underscores for us how fallible we are.

I gleaned a few interesting points from Gawande’s research. From the aviation industry, he discovers that checklist creation is a process. There are some important elements:

1. They have to be short enough, usually one page, only, ideally 5-9 items.
2. They should have pause points where people take the time to assess some condition.
3. They are either DO-CONFIRM or READ-DO.
4. They should focus on “killer” items only, the steps in a process that are the most critical.
5. Simple and exact wording.
6. Easy to read, using lowercase and uppercase, using sans serif type, like Helvetica.
7. It has to get tested until it works consistently.

The last point underscores the way checklists are created at a fundamental level. They are created because of mistakes. Either people have died, or things have gone very, very badly in order that checklists needed to be made in the first place. This gives us a place to start if we wish to make our own checklists – where are the mistakes recurring? What keeps happening badly that requires we take a step back and see the flaw in the process?

It would be nice to have a checklist for life, but that one would either be longer than than day, or be fairly short. I think it might look something like this:

1. Think.
2. Do.
3. Repeat.