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  • The Checklist Manifesto See large image

    The Checklist Manifesto (Hardback) By (author) Atul Gawande

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    Short Description for The Checklist ManifestoExplores the significance of the lowly checklist, and how it has revolutionised medical practice and saved lives. This book looks at how taking this idea to the complicated world of surgery produced a 90-second checklist that reduced surgical deaths and complications in eight hospitals around the world by more than one-third.
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  • Checklist Manifesto5

    Hugh Dillon Half the deaths following surgery in the United States are preventable and Atul Gawande would like to do something about it. The Checklist Manifesto is Gawande's third book. He has been building up to it. His first, Complications, explored the issue of fallibility and failure in medicine. Better, his second, developed ideas about the elements of high professional performance: diligence, ethical conduct and ingenuity. In those books he thematically collected several essays. The "manifesto" is a single essay on the problem of extreme complexity and what we can do to reduce human error when dealing with it.
    Atul Gawande is a doctor and a writer. He is a general surgeon at a major Boston teaching hospital, a professor at the Harvard Medical School, director of the World Health Organization's Global Challenge for Safer Surgical Care and a staff writer on the New Yorker magazine. Writing is not a hobby for him. For Gawande, writing is a way of becoming "a positive deviant", someone who helps make a difference. He certainly does because his angelic writing complements his medical work seamlessly.
    Gawande's WHO project, designed to improve surgical outcomes globally, but especially in poor countries, focussed on developing and implementing a basic surgical checklist. A 19-point surgical safety checklist for non-cardiac operations was written and put into practice in eight hospitals around the world. Some were in rich countries (the US, Canada, NZ) and others in the Philippines, Jordan, India and Tanzania. The overall result was that surgical deaths were halved and the rate of post-operative complications was reduced by about one-third.
    What happened? Gawande argues that much of modern life, including surgery, building construction, aviation and many other human activities, has become so complex that expertise and experience is insufficient to protect us from ourselves. By following a checklist, the surgical teams reduced the numbers of errors that almost inevitably arise in complex activities and, critically, improved their teamwork because the checklists smoothed communications between members of the team.
    In developing his ideas about checklists, Gawande explores the methodologies of building skyscrapers and flying jet aircraft in emergencies as well as of surgical teams. He is a superb reporter, blending anecdotes and deep research in vivid and stylish prose. Despite the formal complexity of his subject matter, because of the lucidity of his writing and his intellectual power and enthusiasm, the reader is quickly engaged in the excitement of the quest.
    Most of the ideas about checklists in complex environments originated in the aviation industry. Gawande begins with the test flight crash of a Boeing bomber in 1935: it was "too much airplane for one man to fly." From the ashes of that disaster the Boeing test pilots developed flight checklists on cards to help them operate the aircraft safely.
    Why do checklists work? The human brain can manage a maximum of between five and nine issues at the same time. Complex environments, however, may throw up more challenges, especially unanticipated problems, as distractions. A checklist provides support when the brain goes into cognitive overload. But it has other advantages. It ensures that tasks are done in the correct sequence. And if a team is using a checklist, it becomes a medium of communication for them: "Um, doctor, we need to check the antibiotics before you start the incision..."
    So powerful an advocate is Gawande for his big idea that it is easy to overlook the sophisticated shadings of his argument. With becoming modesty he recognises that checklists have their limits. He makes the point that checklists must be carefully constructed and road-tested to be useful. They are not a replacement for expertise or experience in, for example, flying a plane. Checklists lose much of their usefulness if they become overly complex. They are positively counter-productive if used merely as another level of bureaucracy thwarting people from meeting unexpected or unusual challenges arising in complex situations: "the computer says, 'No'". A good checklist is an aid not a shackle.
    Gawande's primary interest is in saving lives by improving surgical performance but this important book teaches lessons that ought be gratefully embraced by professionals in any complex field. by Hugh Dillon

  • A story of checklists4

    Kweetat Chew This is a book that details why checklists are increasingly needed in this complex world where the master-builder, the lone guru no longer or seldom exists in isolation to create today's architectural wonders, the medical cures or procedures(or medical diagnoses ala Dr. House), in daily "taken-for-granted" medical, aviation, architectural and even rock concert tasks. I would have given the book 5-stars had there been a chapter on how to create checklists, but this book is not so much a DIY or self-improvement book, as much as it is a reality expose on why the lowly checklist has come to take a prominent place in tasks demanding safety and quality. It describes also the author's own experience in creating, deploying and testing the safe surgery checklist with the help of WHO. Some examples of Medical and Flight checklists can indeed be found in "www.Gawande.com". Checklists are in fact part and parcel of what many in industry call Standard Operating Procedures (SOPs), where the latter is much more process-oriented, the former, is a final tick-off before deployment or actual action. It would have been good to have some form of explanation or debate about whether checklists by and large can substitute for SOPs as SOPs are so ubiquitous these days and blindly used, that perhaps a simple checklist could in fact be a substitute for it. by Kweetat Chew

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