Checklist Manifesto

A brilliant, important article in the 2007 Dec 10 New Yorker magazine, basis of a book: "The Checklist" by Atul Gawande. It tells stories, from medicine and aviation, about how ultra-lightweight tools like checklists can make a huge difference in managing complex processes and avoiding unforced errors. After a crash during testing of a new, complex aircraft:

... they came up with an ingeniously simple approach: they created a pilot's checklist, with step-by-step checks for takeoff, flight, landing, and taxiing. Its mere existence indicated how far aeronautics had advanced. In the early years of flight, getting an aircraft into the air might have been nerve-racking, but it was hardly complex. Using a checklist for takeoff would no more have occurred to a pilot than to a driver backing a car out of the garage. But this new plane was too complicated to be left to the memory of any pilot, however expert.

With the checklist in hand, the pilots went on to fly the Model 299 a total of 1.8 million miles without one accident. The Army ultimately ordered almost thirteen thousand of the aircraft, which it dubbed the B-17. And, because flying the behemoth was now possible, the Army gained a decisive air advantage in the Second World War which enabled its devastating bombing campaign across Nazi Germany.

... and later in the article, re checklists in medicine:

In December, 2006, the Keystone Initiative published its findings in a landmark article in The New England Journal of Medicine. Within the first three months of the project, the infection rate in Michigan's I.C.U.s decreased by sixty-six per cent. The typical I.C.U.—including the ones at Sinai-Grace Hospital—cut its quarterly infection rate to zero. Michigan's infection rates fell so low that its average I.C.U. outperformed ninety per cent of I.C.U.s nationwide. In the Keystone Initiative's first eighteen months, the hospitals saved an estimated hundred and seventy-five million dollars in costs and more than fifteen hundred lives. The successes have been sustained for almost four years—all because of a stupid little checklist.

... and MD/PhD Peter Provnost, who helped jumpstart the use of checklists in medicine, as described by a colleague:

"I've never seen anybody inspire as he does. ... Partly, he has this contagious, excitable nature. He has a smile that's tough to match. But he also has a way of making people feel heard. People will come to him with the dumbest ideas, and he'll endorse them anyway. 'Oh, I like that, I like that, I like that!' he'll say. I've watched him, and I still have no idea how deliberate this is. Maybe he really does like every idea. But wait, and you realize: he only acts on the ones he truly believes in."

^z - 2018-04-05