The Checklist Manifesto: How to Get Things Right

by Atul Gawande

$24.50, 193 pages. Hardcover.

When I was browsing the non-fiction section at The Book Nook, the cover of this book (pictured here) caught my eye. A simple red check-mark on a bright, even blindingly white background. Who could write almost two-hundred pages about checklists? And perhaps even more intriguing, why would someone write almost two-hundred pages about checklists?

Atul Gawande has a very good reason. Several, it turns out. His work has long-reaching implications for any professional (not just doctors) who want to achieve long-term, sustainable success in their profession. It is especially prurient for those who want to make sweeping, lasting, and positive changes in bureaucratic or autocratic organizations (those who make constant, avoidable mistakes).

Despite the decidedly communist-leaning word “manifesto” making it into the title, and the similar associations of the color red in the check-mark on the cover, the book has nothing to do with Karl Marx or the extreme political left. In fact, I believe a more apt title would be simply, The Checklist. Gawande examines the premise that in the complex world of medicine (as in the complex professions of teaching, law, aviation, and construction- – just to name a few) there are increasingly frightening and preventable mistakes being made, but the simple, almost inane use of monitored and well-developed checklists can decrease the inevitability of these mistakes.

In aviation, Gawande explains, checklists have been routine since the second world war. The aeronautics giant Boeing has been mandating and revising air-flight checklists for the last seventy years, and there are at least two U.S. government agencies devoted to making sure these lists remain practical and up to date. So, Gawande wonders, can the discipline and efficiency the checklists bring to aviation also be applied in other professions? Even medicine?

To answer his question(s), he investigates a large hospital building being constructed within his own Boston medical complex. He works alongside the WHO (World Health Organization) to develop a method for improving safe surgical practice across its nearly two hundred member nations. He investigates the history of the aviation checklist, and visits a Boeing test-flight facility where aviation check-lists are still being written, updated, and tested. He even talks to three financiers who have used checklists in their investment firms, and looks at psychological findings about how venture capitalists who use check-list-style organization are statistically more successful than ones who don’t.

Everywhere he turns, the check-list system of organization offers discipline, efficiency, and ultimately a more complete rate of success than the autonomous, “master” professional working alone in a theoretical state of artistry and genius. After all, when was the last time you remember a sky-scraper failing from construction-error? Maybe, Gawande posits, that’s because the communication and discipline being fostered by check-list style organization have left the construction industry in a more sturdy and successful place than other professions.

For anyone who has ever dreamed of changing “the system,” for anyone who wants to improve their personal efficiency, and for anyone who wants to understand why a simple slip of paper with between five and nine items on it is saving lives around the world every hour of every day, this book is a must read. Sophisticated, different, and thought-provoking, with an easy-to-follow and humble style which helps the reader sympathize with the author as he narrates the often harrowing tragedies and day-to-day mistakes that his simple crusade seeks to end.

Overall Score: 8.5/10

Tom Donovan, The Book Nook, 6/1/10