Review of The Checklist Manifesto

The Checklist Manifesto: How to Get Things RightThe Checklist Manifesto: How to Get Things Right by Atul Gawande
My rating: 5 of 5 stars

A little over a year ago I heard about this book at a medical conference I attended where we were discussing the benefits of CPOE (Computerized Patient Order Entry) for hospital patients. Based on the recommendations of others at the conference I went ahead and bought the book and finally got to it a few weeks ago. I highly recommend you read this book.

About the Author:
Atul Gawande is a surgeon who both maintains a private practice and consults for the World Health Organization (WHO) regarding worldwide health issues. He has written several other books, and based on this one, I’ll definitely be getting his others to read in the near future.

Basic Premise:
Gawande was presented with a statistical problem (epidemic) by the WHO – the rate of surgery and surgical complications is exploding in the world. That issue raises the question of what can be done to improve outcomes, not just in economically advanced countries but also in third world sites where surgery is still being performed at accelerating rates. While expensive solutions may be an option for developed nations, that isn’t likely to be an option for those developing countries.

Dr. Gawande opens with a look into several medical cases as examples of the complexity of the medical decision-making process. These are, by the way, fascinating cases. He shows some failures and incredible successes. What makes the difference in these outcomes? He then takes the reader on a journey in which he looks for answers in different industries that could apply to the medical problem he is confronting. He looks at the construction industry, where incredibly complicated buildings are constructed in clockwork fashion taking into account thousands of natural variables. Those guys end up being able to do that with an incredibly small failure rate. Of course, when a building fails, it is likely to lead to many deaths. The same is true for medical cases. He discovers the value of a checklist in the construction world, but decides the type of checklist they use isn’t really practical in medicine because while construction occurs over months to years, medical decisions must be made in seconds.

He then moves on to the airline industry, which is fascinating. This is a much more accurate fit with the medical problem and he finds again that checklists are in place in that industry leading to their very low rate of failure. Again he covers several interesting cases and how the implementation of checklists saved lives. Then he looks at the financial trading industry and how checklists have potential impact for that industry, but they fail to benefit from it due to the culture of the industry.

Finally, he gives some personal anecdotes as he implements a checklist in his own O.R. With success the outcome, of course.

Despite the setting of the book in the context of a medical issue, this book probably should be required reading for anyone who makes important decisions. The whole theme of the book, really, is that implementing checklists which ensure critical elements of any “process” aren’t missed can and probably will result in improved outcomes. It’s true in the construction and airline industry. There is evidence that it works even for institutional traders, if they’d use it, and the same is true for surgeons. How likely is it that your particular industry could do better with a checklist? I would suggest very likely. The Checklist Manifesto really raises a lot of questions about where can I benefit from developing checklists for my work as a hospitalist. There may even be room for a second book discussing how an organization should go about developing a checklist, although he does describe the process his team used. Consider the same for your own situation.

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