The Checklist Manifesto Summary and Application

In his book, The Checklist Manifesto, Atul Gawande wants to eliminate mistakes through the power of a checklist. Gawande points out that people make a lot of mistakes, usually because of ignorance or ineptitude. People may not know what to do or they may fail to apply the knowledge they do have correctly (8). Further compounding the problem is “extreme complexity.” There is so much knowledge and the problems are so vast and complicated that solving them is nearly impossible for any one individual alone. Furthermore, people are just not able to predict the problems they will encounter. The typical answer to complexity has been specialization—more and advanced training of individuals. But even specialization has been unable to cope with the complexities of the modern world (31). It is here that Gawande proposes a simple solution: the checklist. 

The checklist can help solve the problems of ignorance, ineptitude, and complexity in various ways. Checklists can overcome the problem of human memory and fallibility (36). Checklists can also keep people from skipping steps and provide “the minimum necessary steps and make them explicit” (36). Checklists keep the team focused on the essentials that need to take place in order to get the job done and solve the problem. They also “offload” strain on the human mind by “routine-izing” (my word) the basics. By pushing most of the procedures onto a checklist and out of the human mind, people can then use their cognitive capacities for deeper thought. Deep thought is extremely important in today’s world because the biggest problems require the deepest thought. 

Checklists can solve certain kinds of problems and therefore it’s important to know what these problems are. There are three kinds of problems: simple, complicated, and complex (49). Simple problems are one which follow a series of clear steps, like baking a cake. Complicated problems can be broken down in a series of steps, but always require intense collaboration, usually with multiple teams and specialization. Yet once the process is mastered to solve the complicated problems, it can often be repeated.  Complex problems, on the other hand, are unique and shift. Their outcomes remain highly uncertain (49). It is like raising children: each one is unique and each child needs to be parented in a different way. What worked earlier in a child’s life probably won’t work later on. 

Checklists can obviously solve simple problems. They guard against “elementary errors” such as not adding in milk to a recipe (50). They can also help with complicated problems, once the process is documented and disseminating to the relevant team members. But can checklists solve complex problems? Gawande argues that, yes, they can. Checklists can handle complex problems by providing some structure to the basic procedures that need to be get done, and new checklists can be written for each project (62). But more importantly, checklists can solve complex problem by focusing on communication (65). The way that unexpected and uncertain outcomes and problems can be solved is through “make sure the experts [speak] to one another” (65). If the right people are able to get together and talk over the issues, serious problems could be avoided (66). 

Getting people to talk to one another to solve problems is crucial. Gawande advocates for pushing the “power of decision making out to the periphery and away from the center” (73). In other words, you don’t want to centralize all the decisions. You want “empowered execution” to use a term from Team of Teams. Those on the ground can help make the decisions. As a leader, “all you ask is that they talk to one another and take responsibility” (73). The two kinds of checklists—the procedural and the communication—are powerful antidotes to complexity: “They supply a set of checks to ensure the stupid but critical stuff is not overlooked, and they supply another set of checks to ensure people talk and coordinate” (79). Gawande even goes so far to say that in complex situations checklists are “required” for success (79). 

Gawande desired to test the power of the checklist by implementing one to reduce surgical site infections around the whole world. But how would he get the whole world to adopt a standardized checklist with so many variables changing from context-to-context? First, Gawande wanted to make sure that there were reminders for people to use the checklist (99). Second, he wanted to have people stop and talk (102). If there is silence, there is usually dysfunction. Third, checklists must be usable (133). They need to be refined and workable. They must be easy to read, not too much information and too little. They also need to be tweaked regularly and kept updated. 

While technology has certainly helped automate checklists and provide some immunity to error, there are certain things technology cannot do. Technology cannot deal with the unpredictable (184). In fact, technology has added a layer of complexity onto the world because it takes much effort and thought to use the technology! To combat this complexity given by technology, people often resort to “systems thinking” (184). Unfortunately, few people pay attention to making the systems “fit together well” (184). Optimizing parts of the system in isolation from the rest is not necessarily the path to success (185). We must study how to integrate systems together. One of the ways to fix this is by thoroughly investigating our failures (185). People do not like to see their failures and learn from their mistakes, but it is essential that they do so. 

Application for LBC:

  • Develop checklists for EVERYTHING. 
  • COMMUNICATION CHECKLISTS are vital!!! Develop those. 
  • Set REMINDERS to update stuff. 
  • Remember to integrate the systems of the body of Christ. No SILOS. 
  • Learn from failure. Review, review, review. 

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  1. Pingback: A World Without Email | – Raising Lazarus

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