"Discipline is hard - harder than trustworthiness and skill and perhaps even selflessness. We are by nature flawed and inconstant creatures. We can't even keep from snacking in between meals. We are not built for discipline. We are built for novelty and excitement, not for careful attention to detail. Discipline is something we have to work at."
- The Checklist Manifesto, page 183
"Under conditions of complexity, not only are checklists a help, they are required for success. There must always be room for judgment, but judgment aided - and even enhanced - by procedure."- The Checklist Manifesto, page 79
Gawande suggests that people tend to fail for two main reasons. The first is ignorance – having only a partial understanding of the task in front of us. The second is ineptitude – instances where we have the knowledge but we fail to apply it correctly.
But it’s not ignorance that leads to mistakes in today’s world. We have access to more and more information and our knowledge base is growing every day in every field. It’s the complexity of our world that is increasing, making it more difficult to deploy our knowledge predictably and routinely. Medicine is becoming more sophisticated – same with raising skyscrapers and responding to natural disasters.
As the complexity of the challenges, problems, and tasks we face increases, we can’t just rely on memory or our “routine” to help us perform at the highest level. Gawande points out that, “[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.”
"The fear people have about the idea of adherence to a protocol is rigidity. They imagine mindless automatons, heads down in a checklist, incapable of looking out their windshield and coping with the real world in front of them. But what you find, when a checklist is well made, is exactly the opposite. The checklist gets the dumb stuff out of the way."- The Checklist Manifesto, page 177
Intelligent, educated, and experienced people resist having tasks or procedures that seem routine reduced to a checklist. Want to avoid this in your organization? Build good checklists. Bad checklists are long, impractical, and vague. Often they are designed by people with no real hands-on experience of the situation or the nature of the task. And they are often tossed aside.
Gawande offers some tips for building good checklists:
But no matter how good they are, remember, “By themselves, checklists cannot make anyone follow them.”
"We have an opportunity before us, not just in medicine, but in virtually any endeavor. Even the most expert among us can gain from searching out the patterns of mistakes and failures and putting a few checks in place. But will we do it? Are we ready to grab onto the idea?"- The Checklist Manifesto, page 159
Whether in medicine, customer service, or auto repair – predictable, repeatable results are the cornerstone of the most successful businesses. One of the simplest ways of achieving high performance is eliminating unnecessary mistakes, especially when pride is the largest obstacle.
Part of the beauty of checklists is their versatility. You can use them as a way to ensure proper execution or as a tool when things don’t go as planned. The airline industry is a perfect example. Pilots go through a number of pre-flight checklists to make sure everything is in order and no steps were overlooked. And for an issues mid-flight, they again refer to a checklist to take corrective action.
Here are three suggestions on how you can implement checklists more effectively:
1. Identify areas of opportunity: What areas of your business could benefit from a checklist? How could you begin to reduce the number of mindless mistakes that lead to unhappy customers, failed execution, or even something far worse?
2. Check your ego: Throughout the entire book, ego more than anything seems to be the largest obstacle to implementing checklists. Remember, they are not intended to undermine your intelligence or ability. They are a tool to combat the increasingly complex nature of our lives.
3. Curate: Not everything requires a checklist, nor are they effective for every situation. The key is using them only in the most essential places and to be diligent about making them practical and precise.
The Checklist Manifesto is a short, fast read. But don’t be fooled, its implications are great. As we continue to have greater access to information and the ability to acquire knowledge in various fields and industries, it will be those who can deploy it the most reliably who will succeed.
A surgeon and a writer, Atul Gawande is a staff member of Brigham and Women’s Hospital, the Dana Farber Cancer Institute, and “The New Yorker” magazine. He received his B.A.S. from Stanford University, M.A. (in politics, philosophy, and economics) from Oxford University, M.D. from Harvard Medical School, and M.P.H. from the Harvard School of Public Health. He served as a senior health policy advisor in the Clinton presidential campaign and White House from 1992 to 1993. Since 1998, he has been a staff writer for “The New Yorker” magazine. In 2003, he completed his surgical residency at Brigham and Women’s Hospital, Boston, and joined the faculty as a general and endocrine surgeon.
