40 pages • 1 hour read
Atul GawandeThe Checklist Manifesto: How to Get Things Right
Nonfiction | Book | Adult | Published in 2009A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Themes
The Effectiveness of Teamwork
Throughout The Checklist Manifesto: How to Get Things Right, Atul Gawande maintains that the true purpose of a checklist is to foster communication between team members. In a surgical setting, the traditional top-down command structure inhibits effective communication, which Gawande sees as a primary culprit for easily avoidable mistakes. Speaking as a hypothetical surgeon, a “master physician,” Gawande says, “This is my patient. This is my operating room. And the way I carry out an operation is my business and my responsibility. So who do these people think they are, telling me what to do?” (159). In Gawande’s experience (albeit exaggerated), ego and vanity permeate the medical field, all of which stem from the traditional power dynamics of the operating room. He sees ego as a detriment to his profession, and something the checklist helps reduce because it decentralizes authority, spreading it to other personnel.
As Gawande conducts research on the use of checklists across different industries (aviation, construction, etc.), he discovers how these lists encourage a more democratic approach to problem-solving. He states “in a world in which success now requires large enterprises, teams of clinicians, high-risk technologies, and knowledge that outstrips any one person’s abilities, individual autonomy hardly seems the ideal we should aim for” (183). This is an argument against traditional power structures, as all members of a given team should play a part in group endeavors, rather than a single leader or point person. It also illustrates the ever-increasing complexity of modern professions brought about by technology and other factors. This complexity, in Gawande’s opinion, calls for teamwork and communication unincumbered by a strict chain of command (which is illustrated by the construction industry’s use of submittal schedules).
To reinforce the importance of teamwork, Gawande discusses the “miracle on the Hudson,” a famous airline incident in which a plane struck a flock of geese after taking off, leading to both engines failing. While the media tried to present the story as a one-man act of heroism, the man in question, Chesley “Sully” Sullenberger, was but one person operating as part of a team. While Sully’s part in the safe landing of the plane was laudable, both he and Gawande recognize the importance of the plane’s crew: “They understood how to function in a complex and dire situation. They recognized that it required teamwork and preparation and that it required them long before the situation became complex and dire” (182). Because the crew followed protocol and showed discipline as a team, the plane was saved from disaster.
The Applicability of Checklists
Gawande spends much of the book describing his research on how checklists work in professions outside medicine, from aviation to construction. He sees variations in checklist structure and purpose, as well as how checklists work in real-world scenarios. One of his insights is what checklists are not: “They are not comprehensive how-to guides, whether for building a skyscraper or getting a plane out of trouble” (128). Gawande theorizes that one reason why people have this misconception is because they see the checklist as a mundane thing that makes light of a person’s expertise and responsibilities. He then defines what a checklist truly is: “They are quick and simple tools aimed to buttress the skills of expert professionals. And by remaining swift and usable and resolutely modest, they are saving thousands upon thousands of lives” (128). Checklists provide additional support against mistakes of ineptitude and are not intended to replace an individual’s expertise and instinct. In theory, they can be applied to any profession, as long as they remain clear and precise in their instructions.
Overall, “Checklists seem able to defend anyone, even the experienced, against failure in many more tasks than we realized. […] They catch mental flaws inherent in all of us—flaws of memory and attention and thoroughness” (48). All humans make mistakes, even experts. The checklist as a tool is not meant to challenge or replace human skills, but ensure that mistakes, which are inevitable, are caught or prevented altogether. In Chapter 8, Gawande interviews three money managers and inquires how they use checklists to prevent making impulsive investments. One of these managers, whom Gawande refers to as “Cook,” states “[…] the checklist helps him be as smart as possible every step of the way, ensuring that he’s got the critical information he needs when he needs it, that he’s systematic about decision making, that he’s talked to everyone he should” (167). Again, the checklist is framed as supplemental, and neither Cook nor the other managers rely on it to do work for them. Rather, it is a guard against impulsivity, which can lead to mistakes—which in the world of finance, can be especially costly. As both Gawande and Cook mention in regards to their own professions, the checklist is not necessarily a one-person tool; it can be used to foster and improve communication between people of the same profession, those on the same team for a group endeavor or otherwise.
The Power of Discipline
Being a professional himself, Gawande states “Discipline is hard—harder than trustworthiness and skill and perhaps even than selflessness. We are by nature flawed and inconstant creatures” (183). He does not pretend that people should instinctively have and exercise discipline. Instead, he underscores that discipline is something that people must work on and apply to their own unique set of skills. Gawande acknowledges that discipline does not come naturally, but reiterates that this is no excuse when it comes to his own profession as a surgeon—someone who provides relief and saves lives. One of Gawande’s more compelling arguments in favor of the use of checklists comes up toward the end of the book. He maintains that adhering to checklists helps people develop discipline, as these lists encourage following specific steps and establish a pattern with enough repetition: “[Checklists] remind us of the minimum necessary steps and make them explicit. They not only offer the possibility of verification but also instill a kind of discipline of higher performance” (36). When working within a team, doing one’s part and doing it well is especially important. While not all endeavors are all-or-none processes (in which skipping even one step can be disastrous), training oneself in discipline is just as valuable as helping one’s team.
Gawande uses real-life examples to illustrate the power of discipline. While visiting Rialto, a fine-dining establishment in Boston, he observes how the kitchen staff operates. At a restaurant such as this, a complex environment that requires constant communication among staff, adaptability to the unexpected is an important discipline. Gawande credits adherence to protocol as having the most impact on Rialto’s success: “[…] it’s discipline—uncelebrated and untelevised—that keeps the kitchen clicking. And sure enough, checklists were at the center of that discipline” (82). He also observes the power of discipline as demonstrated by those involved with the “miracle on the Hudson’’ incident. Again, he believes adherence to protocol is what saved both crew and passengers from disaster: “Before the pilots started the plane’s engines at the gate […] they adhered to a strict discipline—the kind most other professions avoid” (175). Discipline, in this case, literally saved lives. Even after the passengers were rescued, the staff continued to adhere to protocol, following all procedures until the end of their ordeal. Pilot Chesley “Sully” Sullenberger himself walked through the plane to ensure that all persons were removed in case someone was left behind. This is the kind of discipline that makes a difference in performance—even saving lives.
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