Atul Gawande is a man of many things, an oncologist surgeon, prolific book writer (Checklist Manifesto is one the four books), journalist and recently a CEO of a new age company called Haven formed by Amazon, Berkshire Hathaway and J P Morgan Chase. Haven aims to improve healthcare and reduce costs for employees of these three companies.

Why Checklists?

Today technology has grown by great extents and with internet accessibility, availability has also skyrocketed. Each field has become very complicated and it has become very difficult for any one individual to become master in one area.

The answer to this has been extreme specialization in every area including medicine, construction, building systems and many more. These specializations have created these experts in their limited areas which leads to development of many cracks where problem can fall and get unnoticed and become nobody’s problem. Teamwork and coordination has become the most important things in a world that is seeing specialists more often in most of the areas.

Checklists are nothing but basic step by step process of stupid things that smart, lazy and biased human minds skip all the times. It’s the struggle between the fast System 1 and slow and methodical System 2 ( Danny Kahneman & Ames Tversky theory on behavioral economics). Gawande in his book is himself on this path of discovering checklists.

Checklists won’t help to do things it will help one to not overlook an existing knowledge, enable effective communication between the team, enable anyone in the team member to ask questions.  

Are Checklist Successful?

Gawande takes two examples where checklist have worked wonders and used day in and day out. Airline industry has been developing and following Checklists for a while now. In 1930 itself Pilots realized that it is not possible to improvise on flying all the time and they implemented checklist for various things. Another industry which is considered in the book is construction industry where gone are those days of Master Builders who was the one man show, these days any major construction needs about 16 different subcontractors to get the job done and everything is planned using sort of checklists with few to take care of emergency issues.

Now we know how safe Airline Industry is and how many skyscrapers don’t fall while building, so these industries are making use of Checklist in a great way.

How Checklist should be made?

Checklist should always be precise. They should be efficient, to the point and easy to use even in most difficult situations.They do not try to spell out everything instead they provide reminders of most critical and important steps , the ones that even highly skilled professional can miss. Good checklist are above all practical.

Checklist can be Read-Do (like a recipe) or Do-Confirm (the person does things from memory and then stop) types. Depending on the situation we need choose one. Also by thumb rule checklist should be between five and nine points but it can be relaxed if there is time at hand. Checklist should always be tested and revised time to time.

Are there real examples?

Checklists are useful where a team is responsible to achieve a task and most ly each team member brings in a separate expertise. Also places where hierarchy plays a role and decision making has different weights like in a operation theater doctor commands more power than a nurse or anesthesiologist or an experienced engineer than an intern or Second Pilot versus the main pilot.

Gawande takes an example of the US Airways Flight 1549 where the plane came upon the Canadian Geese and there was a rare dual bird strike that led to both the engines to shut off. Sullenberger or Sully who was the main pilot took control from the co-pilot Skyles who was relatively new to A320. Sully decided to land in Hudson as there was no power with the engines. Skyles started executing the checklists to restart the engines and was able to run it for both the engines. Sully was figuring out the gliding with the help of planes fly-by-wire system. They landed on the water and Sully went out of the cockpit to monitor the passengers and damage to aircraft whereas Skyles was in the cockpit executing the evacuation checklist. The crew adhered to vital procedures when it mattered most. There was a big luck factor but following a defined procedure helped them to save bunch of lives.

Checklist Manifesto is able to convince the use of Checklist in various fields like aerospace, construction, medicine and investments. Its use is simple but will not work out in scenarios where its a top down approach. Moreover the team needs to realize the importance of the checklist and how it can help them do their work.