The Checklist Manifesto

After reading this book you will never get into something without doing your checklist first. Atul Gawande is challenging what we think of the reliability of experts with the question: what do we do when expertise is not enough?


He demonstrates how good the impact of the checklist is through carefully chosen stories. It's about surgeons, airline pilots, engineers, investors and the degree of complexity they face to do their job.


Here is my curated version of the book:



The problem of extreme complexity


« Here, then, is the fundamental puzzle of modern medical care: you have a desperately sick patient and in order to have a chance of saving him you have to get the knowledge right and then you have to make sure that the 178 daily tasks that follow are done correctly—despite some monitor's alarm going off for God knows what reason, despite the patient in the next bed crashing, despite a nurse poking his head around the curtain to ask whether someone could help “get this lady's chest open”.

There is complexity upon complexity. And even specialization has begun to seem inadequate. So what do you do?”


“There are degrees of complexity, though, and medicine and other fields like it have grown so far beyond the usual kind that avoiding daily mistakes is proving impossible even for our most superspecialized.”



The checklist


“ Substantial parts of what software designers, financial managers, fire-fighters, police officers, lawyers, and most certainly clinicians do are now too complex for them to carry out reliably from memory alone.”


The end of the master builder


“Four generations after the first aviation checklists went into use, a lesson is emerging: checklists seem able to defend anyone, even the experienced, against failure in many more tasks than we realized. They provide a kind of cognitive net. They catch mental flaws inherent in all of us—flaws of memory and attention and thoroughness.”


There is three different kinds of problems in the world: the simple, the complicated and the complex.


“Simple problems are ones like baking a cake from a mix. There is a recipe. Following the recipe brings a high likelihood of success.”


“Complicated problems are ones like sending a rocket to the moon. They can sometimes be broken down into a series of problems. But there is no straightforward recipe. Success frequently requires multiple people, often multiple teams, and specialized expertise.”


“ Complex problems are ones like raising a child. Once you learn how to send a rocket to the moon, you can repeat the process with other rockets and perfect it. But not so with raising a child. Every child is unique. Although raising one child may provide experience, it does not guarantee success with the next child.”



The checklist factory


“Good checklists are precise. They are efficient, to the point, and easy to use even in the most difficult situations. They do not try to spell out everything—a checklist cannot fly a plane. Instead, they provide reminders of only the most critical and important steps—the ones that even the highly skilled professionals using them could miss. Good checklists are, above all, practical.”


“Pilots nonetheless turn to their checklists for two reasons. First, they are trained to do so. They learn for the beginning of flight school that their memory and judgment are unreliable and that lives depend on their recognizing that fact. Second, the checklists have proved their worth—they work. Aviation checklists are by no means perfect. Some have been found confusing or unclear of flawed. Nonetheless, they have earned pilots' faith.”



The test


“In London, during a knee replacement by an orthopedic surgeon who was one of the toughest critics, the checklist brought the team to recognize, before incision and the point of no return, that the knee prosthesis on hand was the wrong size for the patient—and that the right size was not available in the hospital. The surgeon became an instant checklist proponent.”


“More than 250 staff members—surgeons, anesthesiologists, nurses, and others—filled out an anonymous survey after three months of using the checklist. […] Then we asked the staff one more question. “If you were having an operation, would you want the checklist to be used?”

A full 93 percent said yes.”



The hero in the age of checklists


“ 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.”



Since then I started thinking in terms of checklists for every task I'm working on. Checklists are big deal. How did the checklist impacted your daily work?