Tuesday, June 8, 2010

The Checklist Manifesto: Atul Gawande

I first read about Dr Atul Gawande as one of this prominent Thinkers of this decade, as selected by the TIME Magazine. So on coming across a book by him at Crossword, Nagpur, it was hard to resist picking it up.

Leafing through a few pages, the matter seemed interesting, so took it home.

Later that evening, as wife prepared dinner, I began to read; and got so much hooked to it, that only put it down after finishing it around 2 AM... and the next day was a Monday.

Nevertheless, it was worth the time.

In this book, Atul Gawande, a surgeon with specialization in endocrine oncology, talks about checklists. He doesn't tell you how to create one, but why one is needed in the first place. The subject matter may seem mundane, but what makes the book exciting is the way in which the author describes how he arrived at the concept of using checklists in a critical field like surgery.

He begins by sharing with us some hair-raising stories of surgeries, in which the patients had a touch and go with death. He describes how The rising complexity and sophistication has made even the best minds sometimes miss out on critical factors. Surgery has become, in his own words, 'too much of an airplane for a single person to fly'.

In a quest to find a solution for a better success rate in surgeries, he meets people from diverse fields to know the secret of their efficiency: a builder, a master chef, a team of Wal-Mart staff that provided on-time relief to victims of Katrina hurricane, a key technical guy at Boeing.... and he discovers that each one of these uses something as basic as a checklist to ensure that things fall in place when they matter the most.

He learns of Keystone Initiative, a programmer started by Peter Provonost to get doctors and all those involved in health care serious about reducing avoidable errors.

Gawande then sets out to try and test his theory, using support of the World Health Organization (WHO). He and his research team involve hospitals from all over the world, New York, London, Delhi, Nairobi... in which the operating teams are required to adhere to a simple checklist during each surgery.

The results, he says, exceeded his own expectations.

It's a thrilling narrative, one that at once fills your mind with awe about complexity of the human body, and admiration for the people who have mastered at least a significant part of it. Gawande spares no one, including himself when he talks about the mistakes and errors that people make, mostly out of carelessness borne out of routine.

If you think checklists are a bore, then this book should make you re-think your position.

And if you are already a checklist enthusiast (like me!), then this book would give you a sense of having got it right in the first place!

[This article has two companion blog posts. Mind Matters  talks about my personal take on checklists, whereas ByteSpace takes a look at checklists from a technical writer's perspective.]

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