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The Checklist Manifesto
How to Get Things Right
Atul Gawande
read on June 2, 2018

I think, but am no longer certain, that I came upon a reference to this book while reading Tim Geithner's memoir on the financial crisis, as a system of managing complexity.

This is an interesting, short read. This is a bit of a tangent but I'm fascinated with things that are just ideas (versus a physical / tech / engineering advancement) that can be a productive enhancement. Recently I've been thinking about blockchains and encryption and those are literally just ideas written down and made manifest through software, but that have an incredible economic impact on the world. Checklists are a bit similar - you wouldn't think that using a checklist can make such a profound increase in results, across so many industries, but here we are.

Some notes:

  • Thesis of the book is: when facing difficult, but well-defined and well-understood problems, centralizing power via highly directive checklists are the best way to go. However, when facing non-routine, novel, highly complex problems, you need to decentralize power entirely, allowing all team members to opine and contribute toward final solution.
  • Example of the latter as Wal-Mart's response to Katrina, where Wal-Mart mobilized effectivly and provided better a better humanitarian response in the US South than FEMA in the immediate aftermath of the storm. 
    • ... [the Wal-Mart CEO] issued a simple edict. "This company will respond to the level of this disaster. A lot of you [local store managers] are going to have to make decisions above your level. Make the best decision that you can with the information that's available to you at the time, and, above all, do the right thing." ... Acting on their own authority, Wal-Mart's store managers began distributing diapers, water, baby formula, and ice to residents. Where FEMA still hadn't figured out how to requisition supplies, the managers fashioned crude paper-slip credit systems for first responders, providing them with food, sleeping bags, toiletries, and also, where available, rescue equipment. The assistant manager of a Wal-Mart store engulfed by a thirty-foot storm surge ran a bulldozer through the store, loaded it with any items she could salvage, and gave them all away in the parking lot. When a local hospital told her it was running short of drugs, she went back in and broke into the store's pharmacy - and was lauded by upper management for it.
  • After Guwande makes a safe-surgery checklist for the WHO, he sees that using it reduces surgery complication rates by 36 percent, and deaths by 47 percent. This is at the best hospitals in the world. All from just running through a list of 20 or so things every time, making sure that the full team knows that the routine stuff is done, and allowing a moment of decentralized power, where teams meet on a first name basis and are empowered to bring up any concerns they have, regardless of role power. Insane.

Author Bio:

Atul Gawande has been a staff writer for The New Yorker since 1998. He is the author of three best-selling books: “Complications,” a finalist for the National Book Award; “Better,” selected by Amazon.com as one of the ten best books of 2007; and “The Checklist Manifesto.” His latest book is “Being Mortal: Medicine and What Matters in the End.” He has won the Lewis Thomas Prize for Writing about Science, a MacArthur fellowship, and two National Magazine Awards. He is also a surgeon at Brigham and Women’s Hospital, in Boston, and a professor in the department of health policy and management at Harvard School of Public Health and in the department of surgery at Harvard Medical School. He is the executive director of Ariadne Labs, a joint center for health-systems innovation, and the chairman of Lifebox, a nonprofit organization making surgery safer globally.