The Checklist Manifesto: How to Get Things Right

Joe Salvia is a structural engineer from Boston whom Gawande interviews in Chapter 3. Salvia has a brief appearance in the book, but Gawande learns about the nature of construction from him, as well as distinctions between book learning and real-world experience. Salvia’s first job out of college was working on a roof at a shopping plaza in Texas. He states the experience taught him fundamental lessons, specifically to expect the unexpected. He likens a building to a human body, relating the concept to Gawande’s profession and noting the complexities shared between their fields. Salvia also informs Gawande of the “master builder” concept, an outdated command structure in which one expert directs an entire project. He echoes Gawande in saying the complexity of his trade has increased because of technology, creating a greater need for collaboration compared to the master builder’s way of doing things.

Stephen Luby is a public health official whom Gawande interviews in Chapter 5. Luby studied infectious diseases in the United States before working with the WHO to research infectious diseases in Karachi, Pakistan, specifically in a highly impoverished area. Working with limited resources in the face of extreme public health issues, Luby pushed health-based corporation Proctor & Gamble to donate a new type of soap. After the soap was distributed, there was a decrease in diseases such as diarrhea and pneumonia, especially among children. Luby theorized that the hand-washing instructions, a type of checklist, included with the soap donations was the true driving force behind the reduction of disease. The checklist was brief, but ultimately habituated the populace. It is Luby’s account of this success that allowed Gawande to form a connection between checklists and behavioral modifications.

Dan Boorman is the man in charge of developing flight manuals for aerospace manufacturer Boeing. Gawande learns a great deal about the art of the checklist from Boorman, who not only studies the mistakes made in flight crashes and creates responsive checklists, but tests the effectiveness of his checklists. Boorman is a disciplined observer and makes a fitting teacher for Gawande. He differentiates between good and bad checklists, and affords Gawande the opportunity to use a checklist in a flight simulator—to test it in an unexpected scenario. He insists the checklist’s function is to foster communication between team members in order to mitigate complacency that can lead to catastrophe.