The Checklist Manifesto

In a series of intriguing stories taken from diverse fields, ranging from aviation to construction, Gawande is able to make the compelling argument that, although we might be training longer and becoming more specialized, human fallibility remains unavoidable. A checklist can not only increase our likelihood of success, but it can also help us raise our baseline performance standards. 

The Three Types of Problems 

Gawande offers three different types of problems that can be managed using a checklist. The classification of these problems were made by two professors, Brenda Zimmerman of York University and Sholom Glouberman of the University of Toronto, who study the science of complexity. The three types are: 

1. Simple 

2. Complicated 

3. Complex 

Simple problems are those like baking a cake, where simply following the recipe brings a high likelihood of success. 

Complicated problems are ones like sending a rocket to the moon. These types of problems can often be broken down into simpler ones, but there is no straightforward recipe and success will almost certainly require multiple people, teams, and specialized expertise. 

Complex problems can be compared to that of raising a child where experience is valuable, but not sufficient, as no two children are alike. Successfully raising one does not guarantee successfully raising another. 

Gawande emphasizes that a key step in creating a checklist to improve success is first identifying which problems actually require a checklist. 

Do Checklists Work for Complex Problems? 

Gawande wonders if checklists can be useful for complex problems too and finds his answer after speaking to the structural engineer for the new hospital wing, Joe Salvia. Salvia walked Gawande through the construction process, where simple problems are known to morph into complicated and even complex problems. Gawande was surprised to discover that the construction field uses not only the “construction schedule”, which specified construction tasks and the order in which they should be done, but also other communication checklists. These allowed experts from one specialized field to communicate with experts in other fields in order to deal with the unexpected and to also solve problems that impacted multiple areas. This helped Gwande realize the important role that a checklist can have in facilitating crucial communication in order to solve complex problems in high-risk situations. 

The Two Types of Checklists 

According to Gawande there are two types of checklists: Do-Confirm and Read-Do. Do-Confirm checklists allow people to carry out their tasks from memory and experience, but then take a moment to stop, run through the checklist and confirm that everything that needed to be done was in fact done. Read-Do checklists allow people to carry out their tasks as they check them off. Gawandes compares it to a recipe, as it is intended to be done step by step.  

Creating an Effective Checklist 

Gawande reached out to veteran pilot Daniel Boorman to learn the key to creating an effective checklist. According to Boorman, if you're starting a checklist from scratch, you first need to decide if it will be a Do-Confirm or Read-Do checklist. The next tip is to keep it short, the general rule of thumb is to keep it between five and nine items, the limit of the human working memory. Boorman goes on to explain how after about sixty to ninety seconds a checklist will turn from a helpful aid to a distraction, that's when people start shortcutting and crucial steps get missed. To avoid this Boorman says to keep focused on what he refers to as “the killer items”, the steps that are the most dangerous to skip yet still occasionally overlooked. The next key characteristic of an effective checklist is; simple and exact wording. It also helps to use the familiar language of the profession. The overall look of the checklist is important too. According to Boorman, it should all fit on one page, be clutter-free, and not use any unnecessary colors. It should use both upper and lower case text for easy reading and he even suggests using a sans serif font like Helvetica. Lastly, Boorman emphasized that regardless of how much thought we might put into our checklists, they must be tested in the real world, which is not as easy as it might seem.

Why Checklists Work & How They Help Us Get Things Done Right

Checklists explicitly spell out the essential steps in a task. This creates a verification process to safeguard against human fallibility and enforce discipline to maintain performance standards. 

Major Takeaways: 

1. Checklists are a crucial tool that can protect against failure 

2. Checklists can establish a higher standard of baseline performance 

3. A checklist is to be used as an aid 

4. An effective checklist is short, uses simple and exact wording, and must be tested in the real world.