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The Checklist Manifesto: How to Get Things Right
by Atul Gwande


Book Summary

Atul Gwande is one of the world’s most prominent surgical oncologists and also a deeply insightful writer on the complexities of being human. In this book, Gwande highlights the dichotomy between information accessibility and failures, using examples from multiple fields, including surgery and aviation, to illustrate that education, access to information, and experience do not always ensure success. Gwande worked with the World Health Organization to develop and pilot a pre-surgical checklist to minimize the chances of procedural errors, and through this experience and research into the checklist methods of other occupations, shows how we can all be more successful and reduce the chance of errors in our work.

Key Insights

  • Humility is essential in creating and following a successful checklist. Gawande emphasizes that individuals of all stations, educations, and experiences are still prone to making simple errors in their work. Understanding and accepting the possibility of errors is essential to creating a methodology that corrects them. Simple procedures like checklists, even though they may seem frivolous, can help ensure accuracy, safety, and success for professionals at any level.  

  • Teamwork ensures successful checklist protocol, regardless of seniority. The two major fields Gawande provides as examples, medicine and aviation, have clearly defined hierarchies and roles of authority. However, the existence of authority does not always ensure success. Gawande shares examples in which quick thinking or commentary from both surgical nurses and flight attendants helped avert disaster to emphasize that participation and engagement from all team members, regardless of station, is critical to ensuring success. 

  • Iteration is a necessary part of composition. During his experience creating a checklist for the World Health Organization, Gawande found himself revising his checklist multiple times with new additions and specifications based on his cases. While the goal of using a checklist is to capture a process in a simplified and organized list, Gawande shows that processes are often fluid and variable, which means the checklists that accompany them should retain room for change.  


Workflow Applications

  • If you see something, say something: Although our team is small (and mighty!), we do have defined workflows and hierarchy within our company. However, each individual on the team has the authority to point out an error, suggest a new approach, or call for a pause to check understanding or direction. Respecting each other’s abilities to contributions regardless of authority is a strength, and we actively encourage team members to speak up through our processes. 

  • Template Revisions: While no two engagements are the same, we have recently been working on templatizing common themes or approaches from our deliverables as a checklist of sorts to assist in production on future projects. Production can be a hard nut to crack, especially as every project is often brand-new material in a large and complex industry. Creating templates for more commonly produced themes will help our team work faster and stay targeted throughout production while leaving more time to work through the complex, nuanced areas of industry per project. 

  • Stay humble: Humility appears to be a key learning from many of our book club selections, and for good reason. We are always open to improving our processes and workflows to ensure we produce the best possible results, and that requires humility in many ways, including taking note of a process that could be improved, reviewing a data set that may not tell the story in the right way, or reaching out to a teammate for help when we feel stuck or don’t understand something. 

Discussion Questions

  • What examples from the book stood out as particularly successful or failures? Explain what you see in those examples. 

  • How does Gawande’s checklist method inform each of our individual workflows? What about our workflows as a team? 

  • What are some of the benefits of using checklists in your professional life?

  • What, if any, are the faults and drawbacks of creating and using checklists for a process?

Memorable Quotes From The Book

  • "The checklist cannot be lengthy. A rule of thumb some use is to keep it to between five and nine items, which is the limit of working memory.”

  • "We don’t like checklists. They can be painstaking. They are not fun.”

  • "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.”

  • "The volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us.”

Additional Resources